Bausch & Lomb Gives Gift Of Sight To 100 People In 100 Minutes

In just 100 minutes on Wednesday, April 9, the lives of 100 low-income people in cities and towns across the United States will be changed forever, as their failing eyesight goes from murky to new-found clarity at all distances with crystalens® cataract-lens implants, free of charge.

Not only can this unique program – Changing 100 Lives in 100 Minutes – dramatically improve patients’ eyesight, but many patients may never need eyeglasses again.

Bausch & Lomb, which manufactures the innovative crystalens intraocular lens (IOL) for cataracts, will donate 100 pairs of these lenses not generally covered by private insurance or Medicare. From coast to coast, 100 participating ophthalmologists will perform crystalens IOL implantation surgeries simultaneously over the course of an hour and 40 minutes at no additional charge.

This national effort will begin promptly next Wednesday at 7:30 a.m. (Eastern Daylight Time) with the implantation of the 100,000th crystalens IOL. The crystalens IOL is the only intraocular lens that uses eye muscles to focus in much the same way as the eye’s natural lens, and is designed to provide clear vision at all distances – near, intermediate and far.

The 100,000th crystalens IOL surgery will be performed by Dr. James P. Gills, founder of St. Luke’s Cataract & Laser Institute in Tarpon Springs, Fla.

The crystalens IOL design is based on the human eye and uses the eye muscle to focus on objects at all distances. It is the only lens to use the eye’s natural focusing ability and is the first and only such lens to be approved by the U.S. Food and Drug Administration. Few crystalens IOL patients have experienced problems with night vision, halos or glare.

“We couldn’t think of a better way to show our appreciation for the success of the cyrstalens IOL than to share the gift of sight with people who struggle with cataracts,” said Andy Corley, president, U.S. Surgical, Bausch & Lomb. “We hope that our contribution, and the contributions of dedicated surgeons across the country, makes a difference in the lives of people in need.”

For more details about the crystalens IOL Changing 100 Lives in 100 Minutes program, visit crystalens.

Bausch & Lomb is the eye health company dedicated to perfecting vision and enhancing life for consumers around the world. Its core businesses include contact lenses and lens care products, and ophthalmic surgical and pharmaceutical products. The Bausch & Lomb name is one of the best known and most respected healthcare brands in the world. Founded in 1853, the Company is headquartered in Rochester, N.Y., and employs approximately 13,000 people worldwide. Its products are available in more than 100 countries.

bausch

Steroid Treatment Shows No Long-Term Benefit For Diabetes-Related Eye Disease

The steroid triamcinolone does not appear to offer a long-term benefit in the treatment of diabetic macular edema (swelling of the retina due to excess fluid build-up), and patients who take the drug are likely to require cataract surgery, according to a report in the same issue. Authors writing on behalf of the Diabetic Retinopathy Clinical Research Network report the three-year outcomes of a clinical trial in which 306 eyes of patients with diabetic macular edema were randomly assigned to receive either photocoagulation (laser treatments to stop fluid leakage), 1 milligram of intravitreal (administered through the eye) triamcinolone or 4 milligrams of intravitreal triamcinolone.

“Our three-year results, analyzed from a subset of the randomized subjects, are consistent with the previously published results after two years of follow-up,” the authors write. “There was no long-term benefit of intravitreal triamcinolone relative to focal/grid photocoagulation [laser treatment] for patients with diabetes macular edema receiving treatment as performed in this clinical trial. Rather, visual acuity outcomes slightly favored the laser group over either of the two triamcinolone groups. It appears that most eyes receiving this 4-milligram triamcinolone preparation will require cataract surgery, though only a few will develop glaucoma that will require surgery.”

Arch Ophthalmol. 2009;127[3]:245-451.

Archives of Ophthalmology

Symposium To Focus On Ophthalmic Drug Delivery, UK

A drug delivery symposium titled Ophthalmic drug delivery: what is currently available and
where are we going? will take place at the Royal Pharmaceutical Society of Great Britain’s
(RPSGB) headquarters in London on Monday 30 June.

Organised by the RPSGB and the Academy of Pharmaceutical Sciences the symposium will
discuss the current and future drug and device combinations on the market to treat diseases of
the eye, and will address issues such as topical and retinal delivery options. There will also be
a discussion on current regulatory trends and points for the industry to consider while
developing drugs and combination products for delivery to the eye.

The event is aimed at managers and scientists from pharmaceutical or device companies, as
well as engineers in pharmaceutical sciences and colleagues from the regulatory, clinical and
medical fields. Academics studying diseases of the eye will also find the meeting beneficial.

Jayne Lawrence, Chief Scientific Advisor at RPSGB, said: “This event will bring together
leading scientists in the field of ophthalmic drug delivery. It will discuss many important issues
and I encourage anyone with an interest in the subject to attend.”

Royal Pharmaceutical Society of Great Britain

Saving Eyesight: Developing A Test To Detect Glaucoma At Its Earliest Stages

Scientists are reporting progress toward a test that could revolutionize the diagnosis of glaucoma – the second leading cause of vision loss and blindness worldwide – by detecting the disease years earlier than usually happens at present. They reported the findings at the 239th National Meeting of the American Chemical Society (ACS).

“We are confident that we’re moving toward a breakthrough that will allow us to detect glaucoma at its earliest stage,” said Chenxu Yu, Ph.D., who headed the study. “We hope it will benefit millions of glaucoma patients and individuals at risk for this devastating eye disease worldwide.”

Glaucoma is a group of eye disorders that can damage the optic nerve, which carries visual information from the eye to the brain. It usually occurs when fluid pressure inside the eye slowly increases over time. The fluid presses on the optic nerve and damages it. Glaucoma affects about 70 million people worldwide, including about 2 million in the United States. It damages vision by stealth, with no obvious warning symptoms that would send patients to a doctor. There is no cure, and glaucoma causes irreversible loss of vision.

Doctors now use two main techniques to detect the disease. One test is tonometry, which measures eye pressure by gently touching a special instrument to the outer surface of the eye. The other is ophthalmoscopy, in which an eye specialist uses an instrument called an ophthalmoscope to look directly through the pupil of the eye at the optic nerve. The nerve’s color and appearance can indicate the presence of damage from glaucoma.

“All too often, these tests detect glaucoma after the disease has been silently causing damage to the optic nerve,” Yu explained. “Years may pass between the first biological change associated with glaucoma inside the eye and diagnosis. We need ways of diagnosing glaucoma earlier, before permanent damage has occurred, so that patients can begin taking medication to control it.”

In their ACS report, Yu and colleagues described development and early testing of a potential new early diagnostic method. It gives a mainstay tool in chemistry labs – Raman spectroscopy – a potential new life in medicine. The technique as used in chemistry and other laboratories involves focusing a beam of infrared laser light – invisible to the human eye – into a test sample to get information about the sample’s composition. Yu’s method uses Raman spectroscopy to shine laser light through the pupil of the eye. Optic nerve cells (retinal ganglion cells) inside the eye scatter the light, producing a rainbow-like “spectrum” or pattern revealing the chemical composition of the cells. Scientists can then use that snapshot to identify biochemical changes in retinal cells that announce the presence of glaucoma.

Efforts are underway to use Raman spectroscopy – named for an Indian scientist who won the Nobel Prize for developing it – elsewhere in medicine (i.e., cancer diagnosis). But Yu described this research as among the first attempts to apply the Raman technology to diagnosis of glaucoma.

Yu and his colleague, Dr. Sinisa Grozdanic, a glaucoma researcher and Director of Animal Research for the Iowa City Veterans Administration Center for Treatment and Prevention of Vision Loss (VA CPTVL), are pleased with results of animal retinal tissue testing from glaucomatous dogs, in which the technique detected glaucomatous changes with 90 percent accuracy, the scientists say.

“”This is a very promising technique,” said Yu, an assistant professor at Iowa State University in Ames. “We are very excited about the results so far and look forward to additional studies.”

The scientists look forward to potential clinical trials in humans. If animal studies go well, and show good efficacy and safety of methodology, the technique could be ready to be used in eye doctor’s office within five years, they estimate. The test likely will take about 30 minutes, longer than existing glaucoma tests, but may benefit patients with more accurate diagnosis of disease, Yu said.

The research carries personal meaning for Yu. Doctors have diagnosed him as a being at high-risk for glaucoma. Yu’s collaborators in this study also include Qi Wang, a doctoral student at the university; Nicholas Hamouche, M.D., a glaucoma specialist, at McFarland Clinic in Ames, Iowa; and Drs. Matthew Harper and Helga Kecova who are research scientists at the Iowa City VACPTVL. The Iowa State University and Veterans Administration funded the study.

Source:
Michael Bernstein

American Chemical Society

Link Between Sleep Apnea And Hard-To-Diagnose Eye Disorders

A British study finds that the condition known as floppy eyelid syndrome (FES) is strongly associated with obstructive sleep apnea (OSA), implying that when doctors see FES in a patient, they should also look for OSA, and vice-versa. The study, published in April’s Ophthalmology, the journal of the American Academy of Ophthalmology, describes factors shared by OSA and FES and specific findings on how FES develops that will help doctors better diagnose and treat patients.

People with OSA face several health challenges – at worst, they are at risk of dying of oxygen deprivation when breathing slows or stops during sleep. OSA can contribute to or be aggravated by high blood pressure, diabetes, obesity and other systemic problems. Researchers led by Daniel G. Ezra, MD, MRCOphth, of Moorfields Eye Hospital, London, England, found the strong OSA-FES association in a case-controlled study of 102 patients tracked between 1995 and 2008; 102 matched controls were also tracked.

“About one-third (32 of 102) FES patients in our study also had OSA,” Dr. Ezra said. “The significant association of the two disorders was evident even when we considered and controlled for patients’ body-mass index (BMI, an indicator of whether obesity was a factor). FES is often considered a disease of overweight, middle-aged men, but our study did not find a patient cluster based on age, gender or BMI,” he added.

People with FES have rubbery-textured upper eyelids that may easily flip up during sleep, exposing the “whites of the eyes,” which can lead to dry, irritated eyes and/or discharge. The Moorfields research and other studies suggest that central nervous system arousal may be impaired in OAS suffers, so they do not wake up as people normally do when breathing slows or stops, or when the eyelid is subjected to extreme stress. People with OSA often preferentially sleep on one side, which could result in intense, repeated pressure on the eyelid on that side of the face. A combination of these factors may contribute to or cause FES. The Moorfield report notes that FES resolved in an OSA patient who was treated with a continuous positive airway pressure mask.

Also, the Moorfields study confirms earlier findings that FES is associated with keratoconus, in which the cornea thins out and becomes cone-shaped. Patients with FES often rub their eyes excessively, perhaps contributing to keratoconus. Eye M.D.s (ophthalmologists) should recognize that visual problems in patients with FES may be due to keratoconus – rather than dry eye disease or other surface irritation – and treat them accordingly, the researchers say.

In a separate study, Dr. Ezra and colleagues followed 78 FES patients who had had been treated surgically for FES at Moorfields Eye Hospital within a 13 year period that began in 1995. Of the surgical methods used, better outcomes resulted for the procedures known as medial and lateral canthal placation, and upper lid lateral tarsal strip. But outcomes for all procedures were less favorable than reported in earlier studies; the Moorfields study attributes this difference to their study’s longer follow-up period.

Source:
Mary Wade

American Academy of Ophthalmology

Discovery Of The Binocular Vision Gene

In work that could lead to new treatments for sensory disorders in which people experience the strange phenomena of seeing better with one eye covered, MIT researchers report that they have identified the gene responsible for binocular vision.

Unlike horses and eagles, whose eyes on the sides of their heads provide two different scenes, humans see a single, in-depth view. Now researchers from the Picower Institute for Learning and Memory at MIT have identified the gene responsible for melding images from two eyes into one useful picture in the brain.

The work, which appeared in the Public Library of Science (PloS) Biology and in the journal Cerebral Cortex, shows that a novel gene is necessary for binocular vision.

“There are other instances in the brain where two different inputs have to be properly aligned and matched — such as auditory and visual projections to the midbrain that enable us to orient to sound,” said lead author Mriganka Sur, Sherman Fairchild Professor of Neuroscience at the Picower Institute and head of the Department of Brain and Cognitive Sciences at MIT. “This is the first study to pinpoint a gene with this kind of job.”

Two points of view


Binocular vision allows us to perceive depth and carry out detailed visual processing. The images projected by each eye are aligned and matched up in brain regions called the visual thalamus and cortex.

The MIT researchers discovered that the genes Ten_m3 and Bcl6 have a key role in the early development of brain pathways for vision and touch. Ten_m3 appears to be critical for the brain to make sense of the two disparate images from each eye.

In mice that had the Ten_m3 gene knocked out, projections from their two eyes were mismatched in their brains. Because each eye’s projection suppresses the other, the mice were blind, even though their eyes worked normally.

Remarkably, the researchers found that when the output of one eye was blocked at a molecular level, the knockout mice could see again. With one eye’s conflicting input shut down, the other eye was able to function, though only with monocular vision.

“This is an amazing instance of ‘gain of function’ that proves immediately that the gene is directly responsible for creating matched projections from the two eyes,” Sur said.

Human disorders in which the Ten_m family of genes is affected are often accompanied by visual deficits. “There are reports of human visual conditions in which simply closing one eye allows a person to see much better,” Sur said. “We believe that genes such as Ten_m3 are at the heart of these disorders.”

Co-authors include Catherine A. Learney, former MIT postdoctoral associate now at the University of Sydney; Atomu Sawatari, Kelly A. Glendining, Sam Merlin, Paul Lattouf and Natasha Demel of the University of Sydney; MIT affiliates Gabriel Kreiman, Kuan H. Wang and Ning-Dong Kang; Reinhard Fassler and Xiaohong Zhou of the Max Planck Institute for Biochemistry in Germany; and Susumu Tonegawa, Picower Professor of Biology and Neuroscience at MIT.

This work was supported by the National Institutes of Health, the Simons Foundation and Australia’s National Health and Medical Research Council.

Source: Elizabeth Thomson

Massachusetts Institute of Technology

Integrated Eye Health Project For Central Australia

The Commonwealth Government will spend $184,000 over the next 12 months to develop an improved model to deliver eye care for people in Central Australia.

The funding will employ an eye health program manager as part of a broader government-community eye-health partnership in Central Australia, Minister for Health and Ageing, Tony Abbott, said today.

“The eye health program manager will work to better co-ordinate existing eye-health service delivery arrangements. One of the objectives will be to cut waiting lists for eye surgery in Central Australia. This will include additional sessions of eye surgery at the Alice Springs Hospital,” Mr Abbott said.

The partnership includes the Commonwealth Government, the Fred Hollows Foundation, the Northern Territory Department of Health and Community Services, the Central Australian Aboriginal Congress, Anyinginyi Health Aboriginal Corporation, and the Eye Foundation.

Central Australian Aboriginal Congress and Anyinginyi Health Aboriginal Corporation will work with the hospital to ensure Aboriginal patients throughout the region are appropriately cared for before and after the necessary surgical procedures.

Brian Doolan, CEO of the Fred Hollows Foundation, said the partnership had adopted “a no-nonsense approach, the way Professor Fred Hollows did things – practical solutions to health problems in Central Australia.

“All the parties have come to the table and are keen to identify and knock over obstacles. There are certainly more difficulties for people in places like Docker River to get access to good eye health services than there are for the residents of Double Bay in Sydney. Those difficulties are exactly what we have joined together to overcome.”

The program covers an area of 1.6 million square kilometers of Central Australia, making it geographically one of the largest integrated eye health programs in the world.

The Northern Territory Minister for Health, Chris Burns, praised the Fred Hollows Foundation for this new chapter in its long history of improving eye health in Aboriginal people.

“This project contributes to the very worthy work of Fred Hollows himself,” Dr Burns said. “It represents an important partnership between the government and the non-government sector to improve Aboriginal health. The Territory Government is proud to support this initiative with more than $86,000 in theatre consumables and office space, and the expertise of an ophthalmologist from Alice Springs Hospital.”

The eye conditions most common among people in Central Australia are refractive error, cataracts, trachoma and diabetic retinopathy. Seventy per cent of people awaiting eye surgery in Central Australia require surgery for cataracts.

www.health.au

Jefferson And Wills Eye Battling Rare Childhood Cancer Together

Retinoblastoma is a rare cancer that develops in the retina of the eye and mostly affects young children. According to the National Cancer Institute, about 300 children are diagnosed with the disease each year in the United States. In fact, the vast majority of cases of retinoblastoma occur among young children, with almost two-thirds of all retinoblastomas occurring before the age of two years and 95 percent occurring before the age of five years. Now, Jefferson Hospital for Neuroscience (JHN) and Wills Eye Institute are offering these young patients a new, targeted treatment option that can save their life and help save their sight and eyes.

Intra-arterial chemotherapy is a novel technique that delivers high doses of chemotherapy directly into the artery that leads to the affected eye. This therapy allows for a repeated delivery of the chemotherapeutic agents, with the aim of destroying the retinoblastoma cells, while minimizing side effects associated with more traditional intravenous (IV) chemotherapy.

For most retinoblastoma patients, chemotherapy is delivered either through an IV, where it travels throughout the body and successfully eradicates the cancer but can cause side effects like hair loss or more serious effects like deafness, kidney failure or leukemia. Unfortunately, surgical removal of the affected eye (enucleation) is often necessary for children with advanced retinoblastoma to ensure safe life prognosis.

But more recently, intra-arterial chemotherapy has been pioneered by the Philadelphia team at Jefferson Hospital for Neuroscience (JHN) and Wills Eye Institute. Carol Shields, M.D., an eye cancer specialist at Wills Eye Institute, has teamed up with Robert Rosenwasser, M.D., chair of the Department of Neurological Surgery at Jefferson Medical College of Thomas Jefferson University, to treat these patients with this new, targeted therapy. First the child is evaluated by Dr. Shields and the diagnosis of retinoblastoma is established and evaluation of blood flow to the eye is studied. Next, Dr. Rosenwasser inserts a long, thin tube known as a microcatheter into an artery in the child’s body and threads it up until it reaches the artery leading to the eye containing the retinoblastoma cancer. Chemotherapy agents are then injected into the tube and delivered directly into the eye. Later, reassessment with laser treatment to the cancer is performed by Dr. Shields.

“Intra-arterial chemotherapy is a promising new technique for treatment of selective cases of retinoblastoma and allows for a higher local dose of chemotherapy to the eye with minimal side effects to the body as compared to the more traditional intravenous method,” said Dr. Carol Shields. “This high dose of chemotherapy delivered to the eye accelerates regression of the tumor, without adversely affecting other healthy organs. While the long term outcome of these patients is still unknown, this new delivery system may reduce the need for the surgical removal of some patients’ eyes.”

The physicians of Wills Eye Institute serve as the Department of Ophthalmology at Jefferson Medical College of Thomas Jefferson University.

Source: Thomas Jefferson University

Eye Diseases Gave Great Painters Different Vision Of Their Work, Stanford Ophthalmologist Says

Michael Marmor, MD, wanted to know what it was like to see through the eyes of an artist. Literally.

After writing two books on the topic of artists and eye disease, the Stanford University School of Medicine ophthalmologist decided to go one step further and create images that would show how artists with eye disease actually saw their world and their canvases. Combining computer simulation with his own medical knowledge, Marmor has recreated images of some of the masterpieces of the French impressionistic painters Claude Monet and Edgar Degas who continued to work while they struggled with cataracts and retinal disease.

The results are striking.

In Marmor’s simulated versions of how the painters would most likely have seen their work, Degas’ later paintings of nude bathers become so blurry it’s difficult to see any of the artist’s brush strokes. Monet’s later paintings of the lily pond and the Japanese bridge at Giverny, when adjusted to reflect the typical symptoms of cataracts, appear dark and muddied. The artist’s signature vibrant colors are muted, replaced by browns and yellows.

“These simulations may lead one to question whether the artists intended these late works to look exactly as they do,” said Marmor who has long had interest in both the mechanics of vision and the vision of artists. “The fact is that these artists weren’t painting in this manner totally for artistic reasons.”

Degas and Monet were both founders of the Impressionist era, and their artistic styles were well formed before their eye disease affected their vision. But their paintings grew significantly more abstract in later life as, coincidentally, their eye problems increased.

“Contemporaries of both have noted that their late works were strangely coarse or garish and seemed out of character to the finer works that these artists had produced over the years,” Marmor wrote in a paper titled “Ophthalmology and Art: Simulation of Monet’s Cataracts and Degas’ Retinal Disease” that was published in the December issue of the Archives of Ophthalmology.

It’s well-known that such artists as Monet, Degas, Rembrandt, Mary Cassatt and Georgia O’Keefe all reached their heights of artistic vision while facing a decline in their ocular vision. Marmor chose to focus on Degas and Monet for these simulations because both artists suffered from eye disease that was well-documented in historical records, journals and medical histories. Degas had retinal eye disease that frustrated him for the last 50 years of his long career. Monet complained of cataracts interfering with his ability to see colors for 10 years before he finally underwent surgery to have them removed.

“We understand better from these simulations what Degas and Monet struggled with as vision failed,” Marmor said.

Over the past 32 years, the Harvard-educated physician has published 200-plus scientific articles on the science of eye disease while at the same time writing about famous artists and how eye disease may have affected their artwork. He authored one book, Degas Through His Own Eyes, and co-authored another, The Eye of the Artist, with James G. Ravin.

“As an ophthalmologist, I’m fascinated with the visual components of art,” said Marmor, whose Stanford home is decorated with pieces of modern art that emphasize optical illusions. His family donated works of art to the Cantor Arts Center at Stanford. “I’ve also spent years talking to patients about the symptoms of their eye diseases. This was a natural outgrowth of my science and art interests.”

One museum curator, Richard Kendall, called Marmor’s publications on Degas and Monet “of considerable value to the art historical community.”

“I consider him one of the most thoughtful commentators from the scientific community on questions of eyesight among French 19th-century artists,” said Kendall, who is curator-at-large at the Sterling and Francine Clark Art Institute in Williamstown, Mass.

To create the images of the artists’ paintings as seen through their own eyes, Marmor used Adobe Photoshop software. He adjusted the blur and filter settings to what he determined would be the different stages of Degas’ and Monet’s eye diseases, based on medical expertise and historical research.

Degas suffered failing vision from 1860 to 1910. As his eye disease progressed, his paintings grew increasingly rough. From treating hundreds of patients with retinal disease similar to what Degas suffered, Marmor said, he knows that the shading and contrast of images becomes less defined and blurriness increases as such illness progresses.

“Friends would ask Degas, ‘Why are you still painting?'” Marmor wrote in his December paper. “His works in the 1870s were drawn quite precisely with facial detail, careful shading and attention to the folding of ballet costumes and towels.” By the 1880s and 1890s, the shading lines and details of the face, hair and clothing of the same subjects became progressively less refined.

“After 1900,” Marmor said, “these effects were quite extreme and many pictures seem mere shadows of his customary style.”

Monet wrote of his growing frustration with his deteriorating vision, describing how he was forced to memorize where the colors were placed on his palette. In 1914 he wrote in his correspondence that colors no longer had the same intensity. “Reds had begun to look muddy,” he wrote. “My painting was getting more and more darkened.” He was forced to rely on the labels on the tubes of paint in place of his own vision.

“Like retinal disease, cataracts also blur vision,” Marmor said, “but more importantly for a painter like Monet, whose style was based on the use of light and color, they can affect the ability to see colors.”

“Monet must have struggled mightily as he looked out into the murky yellow-brown garden and tried to decide what subtle impression to create on canvas,” Marmor wrote in the December paper. “Slowly progressive age-related cataracts manifest as yellowing and darkening of the lens. This has a major effect on color perception as well as visual acuity.”

After reluctantly submitting to cataract surgery in 1923, Monet returned to his original painting style, even throwing away much of the artwork he’d done during the 10-year period that he had cataracts.

“He just couldn’t see the colors,” Marmor said. “These simulations show how much his sense of color had been destroyed. Some people say, ‘Oh, it’s a stylistic change.’ Gosh, I don’t think so.”

Understanding the challenges these artists faced because of eye disease helps further illuminate the accomplishments they achieved despite their disabilities, Marmor said.

“There’s some reluctance among people in the art world to look outside the historical or psychological influences on the great artists,” Marmor said. “I’m open to debate about what these visual changes might mean stylistically or aesthetically. What is not open to debate is what the artists saw. If you ignore that, you’re ignoring facts.”

Stanford University Medical Center integrates research, medical education and patient care at its three institutions – Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children’s Hospital at Stanford. For more information, please visit the Web site of the medical center’s Office of Communication & Public Affairs at mednews.stanford.edu/.

Contact: Tracie White
Stanford University Medical Center

Research Highlights From The AAO-SOE Joint Meeting

The 2008 Joint Meeting of the American Academy of Ophthalmology (Academy) and European Society of Ophthalmology (SOE ), the largest and most comprehensive ophthalmic educational meeting in the world, is in session November 8 to 11 at the Georgia World Congress Center, Atlanta. Offerings include 277 continuing medical education courses, 179 “Breakfast with the Experts” roundtables, 95 skills transfer courses, and more than 100 hours of scientific presentations, at no charge.

The scientific program includes reports on a potential biomarker for age-related macular degeneration (AMD) that may also imply common biological signaling mechanisms for general aging and AMD, and on positive results in keratoconus patients treated with a promising technique, corneal collagen crosslinking.

Plasma Interleukin 6 as a Potential Biomarker of Age-related Macular Degeneration (AMD)

In its advanced stages, AMD destroys the detailed, central vision we need to read, drive, recognize faces, and enjoy daily life, and is a major cause of vision loss in the U.S. Ophthalmic researchers are making rapid progress in understanding how genetics, immune system factors, nutrition choices, and other variables interact to produce or prevent AMD. These discoveries will enable ophthalmologists (Eye M.D.s) to more precisely identify those who are likely to develop AMD, to select optimal, individualized treatments, and to monitor the disease.

Janice C. Law, MD, and her colleagues at the Vanderbilt Eye Institute, looked for plasma (blood) biochemical markers, or biomarkers, that would indicate systemic oxidative stress and an inflammatory response in 57 patients with AMD and in an age-matched control group. Oxidative stress occurs in the body when there is an imbalance between cells’ production of reactive oxygen (such as superoxide and hydrogen peroxide) and cells’ ability to detoxify byproducts of reactive oxygen, such as free radicals, which can damage protein, DNA and other cell components. In an inflammatory response, the body’s vascular and immune systems work in concert to remove disease-causing agents, damaged cells, or other irritants, and to initiate tissue healing. If immune system regulation goes awry, an overly strong inflammatory response–such as hay fever or atherosclerosis–can result.

In Dr. Law’s study an inflammation-promoting biochemical, interleukin 6 (IL-6), was found to be significantly higher in the AMD patients, and IL-6 levels also correlated with oxidative stress measurements in these patients. This suggests that IL-6 is a good candidate for further study as a potential AMD biomarker. It also indicates that common biological signaling mechanisms may be involved in both oxidative stress and inflammation and may contribute to AMD development as well as general aging.

Other recent research has established that AMD is closely associated with certain genetic variations that control aspects of the immune system, especially the inflammatory response. Numerous studies have also confirmed the role of oxidative stress in AMD development and progression. Dr. Law’s study focused on plasma-based biomarkers because blood sample screening is a relatively simple yet accurate diagnostic tool.

This preliminary cohort study did not attempt to determine whether IL-6 levels varied with AMD types–“wet” AMD, characterized by rapid growth of abnormal blood vessels and heightened risk of vision loss, or the more common “dry” type–or with disease severity.

Corneal Collagen Crosslinking: Treatment Results in Keratoconus Patients

Keratoconus is an eye disorder that causes corneal tissue to become abnormally thin and the central area to protrude in a cone shape, distorting vision. The cornea is the clear tissue that covers the front of the eye and is crucial to focusing light on the back of the eye. In the US, keratoconus occurs in 50 to200 per 100,000 people; reported rates vary with the criteria used for diagnosis. Unofficial reports indicate this disorder may be more prevalent in the Indian subcontinent, Arabia, and New Zealand. Although usually a progressive disease, recent data suggests that it stabilizes after time in most patients, and that treatment with rigid contact lenses is successful for many. Ten to 20 percent of keratoconus patients in the US eventually receive corneal transplants to restore their vision.

Co-investigators Mohan Rajan, MD, and Sujatha Mohan, MD, of the Rajan Eye Care Hospital, India, studied collagen crosslinking in 48 patients (60 eyes), aged 12 to 48 years, who had progressive keratoconus. The collagen crosslinking technique, developed in recent years, is under study for the treatment of several eye disorders. In keratoconus patients, drops containing riboflavin, a B-complex vitamin, are applied to the cornea which is then exposed to UVA light; this stimulates collagen fibers to connect to one another, or crosslink. Collagen is the primary protein constituent of the body’s connective tissues. The procedure helps restore appropriate curvature and structure to the cornea, and makes it possible for most patients who need them to wear rigid contact lenses again. Collagen crosslinking may prove a viable alternative to cornea transplant, and three FDA-approved trials are now underway in the US.

The Rajan-Mohan study involved 40 eyes (group A) in which infected tissue and any foreign matter were removed from the top tissue layer, and 20 eyes (group B) in which the tissue layer was left intact prior to treatment. Patients received follow-up exams at one, three, six and twelve months. Vision corrected with eyeglasses or contact lenses improved in 45 percent of patients by six months, but no change was noted in any patients’ vision when measured without eyeglasses or contact lenses. The corneal curve flattened appropriately in 51 of 60 eyes (85 percent), with more significant flattening in group A patients. Based on subjective reports, 46.6 percent of participants were better able to tolerate wearing contact lenses. No significant side effects were noted.

“In our study collagen crosslinking showed promising results,” said Dr. Mohan. “The positive corneal changes observed in these patients, together with improved vision and contact lens tolerance, indicates that it was a safe and effective procedure for these keratoconus patients.” Because it is less invasive than corneal transplant, the patient’s surgery-related risks are reduced. As a less expensive, technically simpler procedure, collagen crosslinking could be particularly useful in developing countries where corneal transplant and other procedures may be difficult to access.

About the American Academy of Ophthalmology

AAO is the world’s largest association of eye physicians and surgeons – Eye M.D.s – with more than 27,000 members worldwide. Eye health care is provided by the three “O’s” – opticians, optometrists and ophthalmologists. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases and injuries, and perform eye surgery. To find an Eye M.D. in your area, visit the Academy’s Web site at aao/

Source: Mary Wade

American Academy of Ophthalmology