Month: May 2014

A combination of in-office therapy and at-home treatment is the best solution for a common childhood eye problem, optometrists at Nova Southeastern University (NSU) have found.

The team, led by Stacey Coulter, O.D., worked with researchers across the country to determine which treatment works best for a condition known as convergence insufficiency.

Convergence insufficiency, which is common among children, is a condition in which patients cannot accurately point their eyes together, so they see double or have eye strain. Other symptoms of convergence insufficiency include loss of place, loss of concentration, reading slowly, headaches, and blurry vision. It affects some patients’ ability to learn.

“This study has sparked a lot of interest because people are concerned about conditions that can impact learning,” Coulter says.

Traditionally, the majority of eye care professionals treated children diagnosed with convergence insufficiency using some form of home-based therapy. This study concludes that office-based treatment by a trained therapist along with at-home reinforcement is more effective.

The research, reported in the Oct.13 issue of Archives of Ophthalmology, was funded by the National Eye Institute, part of the National Institutes of Health.

The 12-week Convergence Insufficiency Treatment Trial (CITT) study found that approximately 75 percent of those who received in-office therapy by a trained therapist plus at-home treatment reported fewer and less severe symptoms related to reading and other near work.

The CITT, which included 221 children age 9 to 17, is the first to compare three forms of vision therapy and a placebo therapy option. The first therapy was the current treatment standard known as home-based pencil push-up therapy, an exercise in which patients visually followed a small letter on a pencil as they moved the pencil closer to the bridge of their nose. The goal was to keep the letter clear and single, and to stop if it appeared double. The second group used home-based pencil push-ups with additional computer vision therapy. The third attended weekly hour-long sessions of office-based vision therapy with a trained therapist and performed at-home reinforcement exercises. The last group was given placebo vision activities designed to simulate office-based therapy.

After 12 weeks of treatment, nearly 75 percent of children who were given the office-based vision therapy along with at-home reinforcement achieved normal vision or had significantly fewer symptoms of convergence insufficiency. Only 43 percent of patients who completed home-based therapy alone showed similar results, as did 33 percent of patients who used home-based pencil push-ups plus computer therapy and 35 percent of patients given a placebo office-based therapy.

The study involved NSU and eight other universities, eye institutes, and medical centers. NSU received a $387,764 grant from the National Eye Institute for the project. Coulter completed this project with seven other NSU College of Optometry faculty members —- Annette Bade, O.D., Jackie Rodena, O.D., Mary Bartuccio, O.D., Yin Tea, O.D., Deborah Amster, O.D, Greg Fecho, O.D., and Tanya Mahaphon, O.D.

A 12-month follow-up study is being conducted to examine the long-term effects of these convergence insufficiency treatments. Further information about the reported trial, NCT 00338611, can be found at clinicaltrials.

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Tocagen Inc. announced the company is enrolling patients with recurrent high grade glioma, such as those with glioblastoma multiforme (GBM, Grade 4), in its first-in-human clinical trial of Toca 511.

The multicenter, open-label study is evaluating the safety and tolerability of single ascending doses of Toca 511 administered intratumorally followed by cycles of the prodrug 5-fluorocytosine (5-FC) in patients who have failed prior surgery and chemoradiation. Patients will receive a single dose of Toca 511, a gene transfer viral vector that delivers a cytosine deaminase (CD) gene to tumor cells. After the vector is allowed to spread through the tumor for approximately 4 weeks, patients receive a six-day course of oral 5-FC. In the tumor cells expressing the CD gene, 5-FC is converted by the CD enzyme into the anti-cancer drug 5-fluorouracil (5-FU). Subsequently, patients receive additional cycles of oral 5-FC monthly for up to six months.

“There are limited treatment options available for patients with glioblastoma. It is therefore a priority to explore potential new therapies to treat this form of cancer,” said Timothy Cloughesy, M.D., Director of the Neuro-Oncology Program at the University California, Los Angeles Jonsson Cancer Center and a principal investigator for the Toca 511 study. “Toca 511 is a novel approach that offers new hope to combating this deadly disease.”

In studies performed in animal models of GBM, nearly all animals treated with Toca 511 followed by 5-FC lived for the duration of the study (six months), compared to less than two months for control (untreated) animals. Toca 511 spread through the brain tumors and, following 5-FC treatment, marked tumor regression occurred while healthy brain tissue was unharmed.

“Unlike conventional cancer treatments in which toxic side effects limit how much drug can be given, Toca 511 has the potential to deliver cancer-killing drug to tumors without systemic side effects,” said Harry E. Gruber, M.D., chief executive officer of Tocagen. “We plan to present the clinical data from this study at a scientific conference focused on brain cancer.”

Source: Tocagen Inc

UK medical schools are failing to comply with the recommended curriculum for ophthalmology, set out by the International Council of Ophthalmologists (ICO), suggests a survey published online in the British Journal of Ophthalmology.

Amid concerns that the specialty was being squeezed out of undergraduate education, the council urged medical schools to make it a core subject and produced guidance to help them do this.

But a questionnaire sent to 32 UK medical schools, which prompted 18 to complete returns, shows that while all include ophthalmology in the curriculum, the amount of time devoted to the subject varies from two to 12 days. Only four of the schools taught all 13 of the recommended formal teaching topics.

No school taught all 10 recommended clinical skills, and only one school taught nine of them, the responses show.

While most of the respondents (83%) formally assessed students’ clinical skills at the end of the ophthalmic course, only seven (39%) required a pass in ophthalmology for the student to pass or complete the whole year.

The results are similar to an Australasian survey, say the authors, although there was more agreement among the Australasian medical schools on the content of the ophthalmology course.

Their findings prompt the authors to ask whether there is any point in devising “ideal” curricula if they are so widely ignored, and to wonder whether medical schools might not be wasting effort by developing their own curricula without any reference to those already produced.

They also question whether medical students are being taught the skills they need to deal with everyday eye problems that they are likely to encounter.

“This survey suggests that doctors in training receive varied ophthalmic training, most of which does not meet the recommended ICO standards, and some may receive insufficient training for their subsequent careers,” they conclude.

Source:

British Journal of Ophthalmology

Randy Johnston, MD, became the new president of the American Academy of Ophthalmology on January 1, 2010, taking over from departing President Michael W. Brennan, MD. Dr. Johnston is in private practice in Cheyenne, Wyo., as a vitreoretinal specialist and is a consultant to the Cheyenne VA Medical Center.

“This is a crucial time for ophthalmology, both in terms of opportunities and challenges,” said Dr. Johnston. “I am looking forward to working on the issues that are of critical importance to our members now.”

Dr. Johnston has held numerous leadership positions in the Academy. He has served on the Academy’s Board of Trustees since 2003. Most recently, he served on the Board as senior secretary for advocacy. He has been a member of the Academy’s Council and Committee on State Governmental Affairs and acted as chairman of the Academy’s OPHTHPAC Committee as well as coordinating Eye MD for the Academy’s Laser Surgery Initiative. He has also carried out 12 years on the Regional Roundup Organizing Committee.

“We are pleased to have Dr. Johnston’s leadership through this year,” said David W. Parke II, MD, executive vice president and CEO of the Academy. “He will bring a great mix of clinical, academic, and organizational expertise to this presidency post, with much dedication and enthusiasm to the Academy and the profession,”

Dr. Johnston received his medical doctorate in 1979 and completed his internship and residency in 1980 and 1983, respectively, from the University of Utah College of Medicine. He received his fellowship in diseases and surgery of the retina and vitreous at the University of Pennsylvania’s Scheie Eye Institute in 1984.

Source
American Academy of Ophthalmology

A paper published in this week’s British Medical Journal has established that poverty is significantly associated with blindness and visual impairment in Pakistan.

Led by staff at the Pakistan Institute of Community Ophthalmology in Peshawar with support from the International Centre for Eye Health in London, the Pakistan National Blindness and Visual Impairment Survey is the first of its kind to investigate the link between blindness and deprivation at both a micro and a macro level.

Ranked 134 out of 177 on the Human Development Index, Pakistan has the sixth largest population in the world and cataract is the commonest cause of blindness. Data from the survey indicates that there are approximately 900,000 people with operable cataract.

The prevalence of blindness is known to be three to four times higher in developing countries than in industrialised nations but, until now, only limited information on the link between poverty and visual impairment has been available.

The paper’s key findings are as follows:

– The prevalence of blindness is significantly higher in poorer households and in deprived areas in Pakistan. Lower access to eye care and poorer quality services are important contributory factors.

– Participants living in urban areas in Sindh province were found to be the most affluent and rural areas in Balochistan the poorest. All poor clusters were located in rural areas.

– The prevalence of total blindness in Balochistan is more than three times higher than in affluent areas.

– Spectacle coverage is low and most notably in poor households and among women. Cataract surgical coverage was also lower in poorer areas and among women.

– Cataract is the leading cause of visual impairment in poor and medium clusters; in affluent clusters the leading cause is uncorrected refractive error.

The paper recommends that:

– to reduce blindness in Pakistan, strategies targeting the least well-off and women in particular are required.

– as uncorrected refractive error is a common cause of visual impairment, and highly cost-effective interventions exist, the country’s refractive and optical services need to be expanded.

According to Dr Clare Gilbert, first author of the paper: “Poverty is both a cause and consequence of blindness. The findings in Pakistan illustrate how poorer people have lower access to eyecare services and how women in particular need to be the specific focus of eyecare programmes.”

Dr Haroon Awan, Pakistan representative for leading blindness charity Sightsavers International which co-funded the survey, commented: “This paper provides an unequivocal basis for greater investment in eye health as part of strengthening overall health systems as a strategy for reducing poverty, marginalization and social exclusion.”

Notes:

The Pakistan National Blindness and Visual Impairment Survey examined 16,507 adults over the age of 30 years, sampled from 221 clusters in 94 of Pakistan’s 106 districts between 2001 and 2004. 561 blind individuals were identified. The survey was co-funded by Sightsavers International, Christoffel Blinden Mission, Fred Hollows Foundation, and the Pakistan office of the World Health Organisation.

On behalf of the Pakistan National Eye Survey Study Group, the authors of the Poverty and Blindness in Pakistan paper are Miss CE Gilbert, Mr SP Shah, Dr MZ Jadoon, Mr R Bourne, Mr B Dineen, Dr MA Khan, Professor Johnson GJ and Professor MD Khan. Clare Gilbert from the International Centre for Eye Health and medical advisor to Sightsavers International is available for interview. Copies of the Poverty and Blindness in Pakistan paper are also available.

There are 37 million blind people in the world; 75% of all blindness can be prevented or cured.
Sightsavers International is a registered UK charity (number 207544) that works in more than 30 developing countries to prevent blindness, restore sight and advocate for inclusion for people who are blind and visually impaired.

Sightsavers International

Ophthalmologists at South Nassau Communities Hospital are using a new micro-incision ophthalmologic surgical system that allows ophthalmologists to perform cataract surgery through a single incision that is 2.2mm or smaller. Traditional, no-stitch cataract surgery requires an incision that is 33 percent larger.

In addition to this latest innovation in micro-incision eye surgery, South Nassau ophthalmologists are among the first in the region to use a cataract surgery system that has three different surgical options. This allows them to develop surgical approaches that are tailored to the needs of each patient.

“We are committed to using advanced surgical technology that improves patient outcomes, safety, and recovery time following surgery,” said Richard Nauheim, MD, Director of Ophthalmology. “The new technologies give us greater surgical control, which results in better patient outcomes and increased safety as compared to traditional cataract removal technologies.”

In addition to reducing post-operative pain and recovery time, the new system improves the effectiveness of cataract surgery and further minimizes post-operative risk for astigmatism (a condition that causes blurred vision due to the curvature of the cornea).

Studies and papers published in peer-reviewed journals herald the benefits of micro-incision cataract surgery. A study on the outcome of 84 micro-incision surgical cases conducted by Viraj Vasavada, DO, MS; Vaishali Vasavada, DO, MS; Shetal M. Raj, DO, MS; and Abhay R. Vasavada, MS, FRCS, and published in the June 2007 issue of the Journal of Cataract & Refractive Surgery found that the approach achieved consistent and satisfactory postoperative outcomes. A paper published in the February 2007 issue of Current Opinion in Ophthalmology stated that “surgeons need to learn the new techniques and instrumentation as cataract surgery moves towards less invasive surgery, with smaller incisions, more precise refractive outcomes, and fewer complications.”

A cataract is a clouding of the eye’s lens, which is located behind the iris (the colored part of the eye) and the pupil (the round opening in the center of the iris). The lens is mostly made of water and protein, which combine to keep the lens clear, allowing light to pass through it. With aging, some of the protein may clump together, forming a cataract, clouding an area of the lens.

Cataracts are a leading cause of vision loss in adults age 55 and older. By age 65, about half of the human population has a cataract, and by age 75, almost everyone has a cataract. The National Eye Institute (NEI) reports that more than half of all United States residents 65 and older have a cataract. According to the NEI, cataracts are more common in women than in men, and Caucasians have cataracts more frequently than other races.

In the early stages of a cataract, people may notice only a slight cloudiness. As the cataract grows, it blocks more light and vision becomes cloudier. As vision worsens, cataract surgery is recommended. Cataract surgery is one of the most common surgeries performed in the United States , with more than 1.5 million surgeries performed each year.

Cataract surgery takes approximately 20 minutes and requires a tiny incision in the cornea that serves as a portal to insert an ultrasonic tip. Vibrating at thousands of times a second, the ultrasonic tip breaks up the cataract-clouded lens. The fragments of the lens are removed by suction through a small hole in the tip of the probe. After the lens is removed, an intraocular lens (also referred to as an IOL, which is an artificial lens made of plastic or acrylic and replaces the eye’s natural lens) is placed into the eye through the same incision and set into the same position as the natural lens, restoring the eye’s ability to focus.

South Nassau Communities Hospital is one of the region’s largest hospitals with 441 beds, more than 875 physicians and 2,600 employees. Located in Oceanside , NY , the hospital is an acute – care, not-for-profit teaching hospital that provides state-of-the-art care in cardiac, oncologic, orthopedic, bariatric, pain management, mental health and emergency services. In addition to its extensive outpatient specialty centers, South Nassau is a designated Stroke Center , boasts Long Island ‘s first Gamma Knife??? and is permitted to perform angioplasty in an emergency or as an elective procedure. It is also recognized as a Bariatric Surgery Center of Excellence by the American Society of Bariatric Surgery.

South Nassau Communities Hospital

The Illinois Eye Institute (IEI) has launched Chicago Vision Outreach, a pilot initiative that will improve eye care for patients in desperate need. The program will connect optometrists to underserved patients who suffer from vision and eye care problems often caused by chronic illnesses such as diabetes. This community-focused initiative, which will dramatically increase accessibility to eye care to many Chicago residents, is supported by a total of $350,000 in private grants.

“We identified thousands of underserved patients who desperately need eye care in Chicago,” said Leonard Messner, O.D., executive director of the Illinois Eye Institute. “This initiative brings eye care directly to people suffering most, and who are least likely to receive it.” Many of these patients have vision problems brought on by complicated eye diseases such as glaucoma or diabetic retinopathy. The Centers for Disease Control and Prevention indicates the prevalence of vision disorders among underserved adults was a staggering 26 percent in 2007.

IEI has a tradition of treating patients regardless of their ability to pay and has become a safety net eye care provider for uninsured or under-insured Chicagoans. With Federally Qualified Health Centers (FQHCs) fast becoming the medical homes for these populations, frontline vision and eye care services need to be included in the primary healthcare services offered at these sites. If optometric services are provided, patients benefit and experience a significant increase in access to critical vision and eye care services.

The pilot program has started at the Alivio Medical Center in the Pilsen neighborhood on Chicago’s South Side. It will expand in several weeks to another Federally Qualified Health Center (FQHC), Erie Family Health Center in Humboldt Park. Additional participants are expected to come on board as the program rolls out.

“Alivio has worked diligently for the past several years with the Illinois Eye Institute to access eye care for patients,” said Carmen Velasquez, executive director of Alivio Medical Center. “We, at Alivio, are very pleased with this wonderful collaboration.”

The cost of undiagnosed eye problems is stunning. A report from Prevent Blindness America estimates the total annual impact of eye diseases at $51.4 billion in 2007. The Economic Impact of Vision Problems arrives at the total by citing two studies. The first, by KD Frick, et al, estimates at $35.4 billion annually the financial burden of visual impairment and blindness to individual caregivers and other healthcare payers. The second, by David Rein, et al, estimates the burden of vision problems to the U.S. economy at $16 billion a year.

Early diagnosis and treatment of these illnesses is key to controlling national healthcare costs. Yet, currently, only 20 percent of FQHCs in the U.S. offer optometry services. The pilot is financed by seed grant funding from the Lloyd A. Fry Foundation, The Chicago Community Trust, Alcon Foundation and Blue Cross and Blue Shield of Illinois. The program fills a crucial need because only about five percent of eye care providers in Chicago accept patients who are uninsured or have Medicaid.

As the clinical training facility of the Illinois College of Optometry (ICO), the Illinois Eye Institute will use this initiative to train tomorrow’s doctors how to address the diverse challenges of a patient population that desperately needs preventive eye care. This program gives ICO students a new opportunity to work in the community and treat underserved patients. This philosophy exemplifies ICO leadership within the healthcare community, where medical and dental schools are moving toward deploying students in community health centers to reach underserved patients.

Source: Illinois Eye Institute

The year comes to a close – but not the innovative power and the ambition of Leica Microsystems to provide perfect solutions to the challenges of ophthalmic surgery. The new Leica offers users all the high-performance features of the 8-series surgical microscopes, thereby meeting highest opthalmic requirements.

High performance that is easy to operate

The new high-performance microscope combines premium optical components and easy, comfortable use. The F19 stand features precise mechanical breaks that ensure consistent motion and firm positioning of the entire microscope system at the same time.

Finest optics & lighting

The Leica M820 F19 with the original APO-OptiChromeTM optics offers the best view based on a dual zoom system, maximum resolution, outstanding plasticity, brilliant depth of focus, high contrast and natural, true colors. Additionally, the original direct halogen light provides a bright & homogenously illuminated image. The unique double beam stereo illumination provides the surgeon with a steady red reflex and a three-dimensional image.

Simply functional

Ingenious functions for smooth procedures in the OR: the “Two-in-One-Screen” acts as a control unit and video display in one. More than 30 individual settings can be entered simultaneously – the current operation can be shown with only one touch of a button. Clever operation of the “Step CycleTM'” saves time: individual users can save zoom, focus, and light values, which are accessed at the touch of a button. If the microscope is placed in the top vertical position after surgery, the “Auto Reset” function will reset all start settings to zero.

Ergonomics & flexibility from A to Z

The term “Leica ErgonOpticTM” stands for a wide array of binocular tubes that meet the various requirements of every surgeon and assistant. This remarkable system, including a footswitch with either 16 or 12 functions, creates best conditions for an ergonomic workspace without fatiguing. The adjustable Leica Zoom Video Adapter always provides the surgeon and his team with the right picture. High-resolution documentation systems such as the Leica D2D V3 video and photo system, the precise Leica slit lamp, and the integration of the Oculus SDI/BIOM 3c wide angle observation system, as well as several laser systems give the Leica M820 F19 flexibility and versatility for any application.

Leica Microsystems is a leading global designer and producer of innovative high-tech precision optics systems for the analysis of microstructures. It is one of the market leaders in each of the fields Microscopy, Imaging Systems, Specimen Preparation, Medical Equipment and Semiconductor Equipment. The company manufactures a broad range of products for numerous applications, which require either microscopic visual presentation, measurement, analysis or electron-beam lithography. The company offers system solutions in the areas of Life Science including biotechnology and medicine, as well as the science of raw materials, industrial quality assurance and the semiconductor industry. The company is represented in over 100 countries with 10 manufacturing facilities in 6 countries, sales and service organizations in 19 countries and an international network of dealers. With its workforce of about 3,700 employees it made a turnover of 530m euros in 2004. The international management is headquartered in Wetzlar, Germany.

Leica Microsystems (Schweiz) AG

Business Unit SOM

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CH-9435 Heerbrugg
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Telephone +41 71 726 33 33
Fax +41 71 726 32 19
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Dr. Angela Nahl of La Jolla LASIK Institute recently became the first San Diego LASIK surgeon to perform refractive surgery on a patient using the new Ziemer Z-LASIK technology. The patient, who happens to be a physician, reported only minor discomfort and tested with 20/20 vision following the ten minute procedure.

During LASIK, the surgeon cuts a flap in the patient’s cornea, performs laser treatment and replaces the flap. Over the last eight years, the quality of results and speed of healing have been improved as lasers such as the IntraLase have replaced fine blades. The power and speed of the laser is enhanced With Z-LASIK, which enables quicker and more accurate cutting of the flap. This shortens the length of the procedure and the recovery time.

Dr. Nahl is a leading San Diego LASIK surgeon, having performed thousands of procedures. “I’ve been very impressed with the research on Z-LASIK, and believe my patients will be pleased with the results,” said Nahl.

While the technology behind the fast and bladeless LASIK is impressive, it is only effective when applied by a skillful, well-trained surgeon. “Even with the best technology, surgeons make choices every step of the way that affect patient outcomes,” explains Dr. Nahl. “This comes down to such small details as what formulation of artificial tears to use during the procedure itself. Because I’m aiming for a perfect result every time, I want to make sure every detail is working in my patients’ favor.”

For more information, visit here.

Source
La Jolla LASIK Institute

Each day nearly 2,000 American workers suffer from avoidable workplace eye injuries that require medical treatment. Despite the risk of eye injury, many workers bypass appropriate precautions to protect their eyes. Today The Vision Council, with the American Society of Safety Engineers (ASSE), announced the release of a new issue brief, Eye Safety At-a-Glance: Protecting Your Vision at Work, about the importance of protecting eyes while on the job.

In addition to the physical toll of workplace eye injuries, they also come at great cost to businesses. About $300 million annually in medical bills, compensation and downtime is the result of workplace eye injury. Lost productivity is another consequence, with approximately 27,000 reported days away from work among private industry employees ( 2008).

“Although workplace eye injuries are devastating, there is a positive story to about prevention when workers consistently use the right protective eyewear,” said Ed Greene, CEO of The Vision Council. “The Vision Council wants to ensure that business owners and workers are aware that proper eye protection can prevent eye injuries and vision loss.”

Eye hazards can be found in every industry. While 61 percent of eye injuries occur in manufacturing, construction or trade jobs, threats like chemical exposure can happen hospitals, laboratories and other workplace settings. Research also shows that nearly three out of five workers injured were wearing the wrong kind or no eye protection at all.

Employers are required to assess eye safety hazards in the workplace and take measures to ensure employee safety through compliance with government regulations for eyewear and eyewash stations. Employees should also be aware of eye injury potential and ways to protect themselves.

Safety eyewear protection includes:

— non-prescription and prescription safety glasses;

— goggles;

— face shields;

— welding helmets; and

— full-face respirators.

Eye hazards and vision safety have been a focus of ASSE. ASSE serves as secretariat for several American National Standard Institute projects and was formerly secretariat for the Z87 standard, focusing on vision safety, eye and face protection in the workplace and provides guidelines for eye protection design and construction.

Source: The Vision Council