Keeping An Eye On Age-Related Macular Degeneration

Marilyn Gozdon can tell you from personal experience why it’s crucial to know your risks for age-related macular degeneration (AMD). Marilyn lost most of the vision in her left eye to “wet” AMD five years ago, before new medications revolutionized treatment of this form of the disease. Today Marilyn is fiercely committed to working with her Eye MD (ophthalmologist) to maintain the 20/40 vision she still enjoys in her “good” right eye.

AMD is a main cause of vision loss in the United States. Advanced AMD destroys the detailed, central vision we need to recognize faces, read, drive, and enjoy daily life. March is AMD Awareness Month, and the American Academy of Ophthalmology together with the American Society of Retina Specialists, the Macula Society, and The Retina Society, encourage Americans to know their risks for AMD.

“When we catch AMD early, patients can make lifestyle changes that may slow disease progress, or we can start treatment, if needed,” says Mark S. Hughes, MD, a retinal specialist with Ophthalmic Consultants of Boston and a clinical correspondent for the Academy. “Even someone with 20/20 vision can suffer rapid vision loss from undetected AMD. People need to know their risks so that they can save their sight.”

As part of the EyeSmart campaign, the Academy and EyeCare America, a public service program of the Foundation of the American Academy of Ophthalmology, recommend that adults with no signs or risk factors for AMD or other eye diseases get a baseline eye disease screening at age 40-when early signs of age-related diseases and vision loss often become apparent. People of any age who have symptoms or risks, such as family history, should see their ophthalmologist to determine how often to have checkups. Risks for AMD include: being 60 or older, having a family history of AMD, being overweight, having hypertension or high cholesterol, and being a smoker. Smokers’ risk of AMD is twice that of nonsmokers.

By the time Marilyn became Dr. Hughes’ patient it was too late to save the vision in her left eye. She is well aware that without the injections she receives about once a month to control abnormal blood vessels in her right eye’s retina, she could become legally blind. A few months ago “I fell asleep watching TV, and when I woke up I noticed a red spot in my field of vision,” Marilyn says. “I called Dr. Hughes right away, and he treated me the next day. After a few treatments my eye stopped leaking and has been fine since. I can drive and go about my daily life. Reading is harder than it used to be, but I can do it.”

“Marilyn monitors her symptoms and lets me know immediately if she notices her vision changing,” says Dr. Hughes. “This kind of vigilance and partnership is essential to good AMD care. In contrast, some people-even a highly educated person like my university professor patient-notice their eyes getting worse but delay coming in. Perhaps they’re afraid of what AMD may be doing to their eyes-but the truth is the sooner we intervene, the better our chances.” Once part of the visual field is lost to AMD, it may be difficult or impossible to restore it.

Dr. Hughes advises all AMD patients to control their weight and hypertension and quit smoking. He says lifestyle choices that are good for heart health generally will also benefit AMD patients. UV light exposure has been linked to AMD in some studies, so UV-blocking glasses and hats may be important, especially for people with light-colored eyes. A specific high-potency supplement, the Age-Related Disease Study (AREDS) formula, may slow progression in people with intermediate or early-advanced AMD. (Smokers need to use a formula without beta carotene.) Those with the early stage of the disease should take a daily multivitamin. Eating fruits and deeply colored vegetables such as red peppers, kale, and spinach-sources of antioxidants-provides many health benefits, and one is likely to be a reduced risk of AMD.

“Research is moving forward rapidly and the next few years will probably bring dramatic diagnosis and treatment breakthroughs,” says Dr. Hughes. “Genetic and immune system discoveries may allow us to predict which treatments will be most effective for a given patient. Stay tuned!”

About AMD

The disease takes two forms, termed “dry” and “wet.” In the early “dry” stage, yellowish deposits called drusen develop under the retina, the light-sensitive tissue at the back of the eye, but most people would not notice their vision changing. Patients with more and larger drusen, and more pigment changes in the central retina, or macula, are considered to have intermediate AMD and are at higher risk for both advanced “dry” and “wet” AMD. Most people with intermediate AMD will not progress to the advanced stage, but they should be carefully followed by an Eye MD so that treatment can be given right away, if needed.

Advanced AMD can occur in the “dry” or the “wet” form. No medical or surgical treatment is available for advanced “dry” AMD, which causes blind areas in the central macula, although patients can use low-vision technologies like improved lighting and magnification to maintain their quality of life. In the “wet” form, abnormal new blood vessels develop under the retina that bleed or leak fluid and form scars, resulting in central vision loss. Only about 10 percent of the 10 to 15 million Americans with AMD have the “wet” form, but until two years ago it was responsible for most severe vision loss. New, highly effective treatments such as the injectable medications ranibizumab and bevacizumab are dramatically reducing damage from “wet” AMD: vision stabilized in up to 90 percent of patients and actually improved in more than 30 percent of patients in two of the large multicenter clinical trials to evaluate ranibizumab.

For more information about AMD and other eye diseases, visit geteyesmart.

EyeCare America is a public service program of the Foundation of the American Academy of Ophthalmology. Its award-winning AMD EyeCare Program promotes annual eye exams for people 65 and older, raises awareness of AMD, provides the latest information on treatments and low vision resources, and facilitates access to care at no out-of-pocket cost for those who qualify.

The no-cost eye exams are for individuals who have not been diagnosed with AMD and:

– are age 65 and older;
– are US citizens or legal residents;
– have not seen an ophthalmologist in three or more years; and
– do not belong to an HMO or the VA.

For information on no-cost care for oneself, family or friends, phone the toll-free helpline at 1-866-324-EYES (3937) anytime. For more on EyeCare America visit eyecareamerica.

More information on the American Society of Retinal Specialists can be found on asrs; on the Macular Society: maculasociety; and on The Retina Society: retinasociety.

Broadcast Eds: AMD B-roll footage is available from the Academy. Please contact the Academy’s media relations department for download information.

About the American Academy of Ophthalmology

The American Academy of Ophthalmology 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.

American Academy of Ophthalmology

New Protection For Workers From Artificial Light, UK

New regulations further protecting workers from the dangers of hazardous sources of artificial light come into force today.

The Control of Artificial Optical Radiation at Work Regulations meets a European Union Directive to ensure that standards are set and harmonised across Europe to protect workers from harm arising from exposure to hazardous sources of artificial light.

Some sources of artificial light, particularly UV radiation and light from lasers can harm the eyes and skin of workers and must be properly managed.

Workers in Great Britain are generally well protected from dangerous sources of light and the majority of businesses know how to manage the risks effectively. Therefore the regulations will mean few practical changes for most businesses, including those who are already managing the risks.

To help those businesses who are not already managing the risks understand what’s required and what they need to do, HSE is producing guidance to ensure workers can remain appropriately protected.

Common sources of light in the workplace such as office lights, photocopiers and computers are not affected by the regulations.


– Information on the new regulations and what’s required can be found here.

– Further information on the EU directive can be found here.

Diabetes UK

Two Surgeries For Nearsightedness Equally Effective

A new review of recent studies suggests two popular laser-assisted surgeries to correct nearsightedness are equally effective at restoring 20/20 vision six months to a year after the surgery.

However, LASIK patients tend to recover their vision faster than PRK patients, which may be part of the reason their number has grown rapidly since the late 1990s, said Dr. Alex Schortt and Dr. Bruce Allan of the Moorfields Eye Hospital in London.

LASIK patients also report less pain after surgery than PRK patients, although they tend to be more uncomfortable during the actual surgery, the researchers found.

Schortt says patients might prefer these “side effects” associated with LASIK, but “none of the individual studies included in this review demonstrated a significant [vision] advantage for either treatment,” he said.

“There are cases for both procedures where LASIK would be best for one patient and PRK would be best for another patient,” said Melissa Bailey, Ph.D., an optometrist at the Ohio State University College of Optometry. “It really depends on individual patient factors,” such the thickness of tissues in the eye and severity of the nearsightedness, she said.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Typically, the nearsighted eye is longer than usual from back to front. This shape causes the eye to focus on light from distant objects in front of instead of directly on the retina, the part of the eye that transforms light into the nervous system signals that make up vision. The misfocus blurs the appearance of far-off objects such as highway signs or faces seen at a distance in a crowd.

LASIK (laser-assisted in-situ keratomileusis) and PRK (photorefractive keratectomy) both use a laser to reshape the eye’s cornea, which helps to focus incoming light, in people with nearsightedness. With PRK, the cornea is reshaped by using the laser to gently shave off microscopic layers of the cornea. In LASIK procedures, surgeons cut a flap in the cornea to remove excess tissue below and then replace the flap like a hinged door.

In their review of six high-quality studies comparing LASIK and PRK, Schortt and Allan found no significant difference in the number of eyes regaining 20/20 “perfect” vision six to 12 months after each type of surgery, regardless of how severe the nearsightedness was before surgery. The studies involved a total of 417 eyes, 201 treated with PRK and 216 treated with LASIK, with some participants having surgery only on one eye, or some having each eye treated with the different procedures.

The researchers found some evidence that a greater proportion of eyes lose some of their visual acuity with PRK compared to LASIK six months after surgery.

Vision lost after PRK may be due in part to a corneal “haze” produced by inflammation caused by the procedure, the reviewers say.

“The risk of significant haze after PRK is an important difference between these procedures,” Schortt said, although he notes that none of the studies they reviewed included the use of an anti-scar drug called mitomycin C, which has been used successfully to cut back on postoperative eye haze.

Although Schortt and Allan said their conclusions are not new and are “consistent with current practice,” they believe that patients should still be aware of how the procedures compare. Allan, a practicing surgeon, uses both LASIK and PRK with his patients.

“I think patients and doctors prefer LASIK to PRK because it has a shorter and less painful recovery time,” Bailey said.

“These interventions are performed on healthy eyes and the vast majority of patients are under 60 years of age,” Schortt said, noting that patients can still choose more conservative options such as glasses and contact lens to treat nearsightedness.

It is important that patients are informed about and understand the effectiveness, limitations, safety, complications and relative merits of these procedures,” he said.

Becky Ham, Science Writer Health Behavior News Service

FOR MORE INFORMATION Health Behavior News Service: (202) 387-2829 or hbns/.

A.J. Shortt and B.D.S. Allan. Photorefractive keratectomy (PRK) versus laser-assisted in-situ keratomileusis (LASIK) for myopia. The Cochrane Database of Systematic Reviews 2006, Issue 2.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane/ for more information.

Contact: Bruce Allan
Center for the Advancement of Health

General Opitcal Council Launches New Website, UK

The General Optical Council (GOC) has launched its new website as part of its mission to promote good eye care and protect the public.

Extra functionality has been added which is designed to make the site informative and user-friendly for registrants and other users. The site also meets internationally recognised standards for website accessibility (WC3) and is AAA compliant.

Key new features include:

– A registrants’ area where optometrists and dispensing opticians can log in and update their personal details. Registrants can also update and add practice addresses to their profile.

– Audience homepages to alert users to content and news that is relevant to them.

– Search the site function.

– Dedicated hearings section with explanations of the hearings process, plus details on sanctions and outcomes from past hearings.

– Glossary explaining key terms.

– Updated and revised FAQs section, including option to filter by category.

– History section exploring the origins of statutory regulation within the optical professions.

– Search for a practice results can be limited by distance from postcode

Popular features from the current site, including legislation and Council papers are still available, but should be easier to find and use thanks to a new structure and standardised document download formats. A policies, procedures and protocols area contains core documents on issues such as complaints and declaring criminal offences.

Kate Fielding, Head of Communications commented: “Our website is a vital information resource for registrants and the public. We’ve listened to people’s ideas and overhauled the entire site. It is designed to be accessible for everyone regardless of cultural, physical or technical barriers. We want registrants and other users to have an online experience that is informative, coherent, and engaging, and which reflects the best in UK optics and regulation.”

The relaunch of the GOC’s website is the result of a 12-month user consultation programme, involving members of the public, partner organisations and registrants. Almost 300 people participated by providing comments and suggestions on the design, structure and content of the new site.

Design agency L&Co were commissioned by the Council to produce modern, clean and spacious concepts for the site. The GOC appointed Pixl8 Interactive to develop the site based on a content management system which supports the website’s new functionality and content.

1. The following groups can access the registrants’ area:

– full registrants
– student optometrists
– student dispensing opticians
– bodies corporate

To log in:

– Click on login icon in the top left corner from anywhere in the site.
– Enter username and password.
– Username: GOC number. Those who do not know their registration number should call the GOC registration team on 020 7580 3898 (option 1).
– Password: date of birth.

2. The new site incorporates an online Press kit for journalists and media professionals. The kit contains an image library, GOC facts and FAQs. Journalists can also request a spokesperson to comment on topical issues. The Press Kit can be accessed here.

3. In October 2006, a website questionnaire was sent to all full registrants, student optometrists and dispensing opticians, plus partner organisations, optical press and other key user groups. The questionnaire was also published on the original website.

4. A total of 254 people responded to the paper questionnaire, and 21 people participated in the online version, giving an overall number of 275 responses. In addition, 24 individuals participated in one-to-one research and user testing sessions.

5. The new website will take a few days to propagate on some servers. Therefore, some users may see the new site earlier than others. If your browser is still displaying the old site, please try again in 24 hours.

About the General Optical Council:

The GOC is the regulator for the optical professions in the UK. Its purpose is to protect the public by promoting high standards of education and conduct amongst opticians. The Council currently registers around 22,000 optometrists, dispensing opticians, student opticians and optical businesses.


News From The American Chemical Society

Identifying abnormal protein levels in diabetic retinopathy

Researchers in Massachusetts are reporting an advance in bridging huge gaps in medical knowledge about the biochemical changes that occur inside the eyes of individuals with diabetic retinopathy (DR) – a leading cause of vision loss and blindness in adults. In a study scheduled for the June 6 issue of ACS’ monthly Journal of Proteome Research, they report discovery of 37 proteins that were increased or decreased in the eyes of patients with DR compared to patients without the disease.

Edward P. Feener and colleagues point out that DR is a complication of diabetes that affects the eyesight of millions of people. It involves damage to blood vessels in the retina, the light sensitive tissue in the back of the eye. Physicians know that vessels grow abnormally, swell, and leak in DR. However, they have little understanding of the biochemical changes underlying those damaging events.

The researchers studied eye fluid from individuals with and without DR who were undergoing eye surgery. They analyzed proteins in the vitreous, the gel-like material inside the eye between the retina and the lens. The study found 252 proteins in the fluid, including 37 proteins that showed changes that were associated with proliferative diabetic retinopathy, the most severe form of the disease. The study could lead to new insights into disease mechanisms and new treatments, the article states. – MTS

ARTICLE: “Characterization of the Vitreous Proteome in Diabetes without Diabetic Retinopathy and Diabetes with Proliferative Diabetic Retinopathy”

Edward P. Feener, Ph.D.
Joslin Diabetes Center
Boston, Massachusetts 02215

“Super yeasts” produce 300 times more protein than previously possible

Researchers in California report development of a new kind of genetically modified yeast cell that produces complex proteins up to 300 times more than possible in the past. These “super yeasts” could help boost production and lower prices for a new generation of protein-based drugs that show promise for fighting diabetes, obesity, and other diseases, the researchers suggest. Their study is scheduled for the May 14 issue of the Journal of the American Chemical Society, a weekly publication.

In their report, Lei Wang and Qian Wang explain that the yeasts are intended for speeding production of proteins containing so-called “unnatural amino acids” (UAAs). Living things normally use the same basic set of 20 amino acids to make proteins. Scientists have made additional amino acids, the UAAs, which show promise for building new proteins with a broad range of medical and industrial applications. However, researchers had had difficulty in efficiently incorporating these UAAs into useful protein products.

Wang and Wang are reporting a solution to that problem. They inserted parts of the simple but highly efficient protein-making machinery of E. coli bacteria into the advanced but inefficient protein-making machinery of yeast cells. The result was a best-of-both world’s creation: A genetically-engineered yeast cell that produces complex proteins containing UAAs at levels 300 times higher than normal yeast cells. – MTS

ARTICLE: “New Methods Enabling Efficient Incorporation of Unnatural Amino Acids in Yeast”

Lei Wang, Ph.D.
The Salk Institute for Biological Studies
La Jolla, California 92037

Consumers warm up to “greener” personal care products, but labeling controversy broils

From soaps to body lotions to shampoos, consumers are increasingly drawn to personal care products that are labeled “green” or environmentally-friendly, a fast-growing market that chalks-up an estimated $4 billion in sales per year worldwide. Despite the hype over these products, there’s growing confusion by consumers and manufacturers alike over what it really means to be labeled as “green,” according to an article scheduled for the May 12 issue of Chemical & Engineering News, ACS’ weekly newsmagazine.

C&EN Senior Correspondent Marc Reisch, the magazine’s cover story points out that there’s no universal consensus over what is green, organic, or sustainable. To the detriment of consumers, manufacturers sometimes produce misleading labels in an effort to cash-in on the hype, the article notes. Some manufacturers have even begun to certify their products as green under a variety of different standards and criteria or using different certifying bodies.

But change may be around the corner. Some groups in the U.S. and abroad are now working on establishing clearer standards for personal care products. Notes Reisch: “Unless ingredient makers and formulators sort out their differences, the subject of what is natural, organic, and sustainable may have to be sorted out in a court of law.”

ARTICLE: “Seeking Sustainability”

The American Chemical Society – the world’s largest scientific society – is a nonprofit organization chartered by the U.S. Congress and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

Source: Michael Woods

American Chemical Society

Novel Test That Identifies River Blindness Developed By Scripps Research Scientists

Scientists from The Scripps Research Institute have developed the first screening method that rapidly identifies individuals with active river blindness, a parasitic disease that afflicts an estimated 37 million people. The test could change the current strategy of mass treatment in areas where river blindness, also known as onchocerciasis, is suspected.

The study was published online on October 5, 2010, by the journal PLOS Neglected Tropical Diseases.

“A sensitive and reproducible diagnostic test for this disease is crucial for the success of worldwide control and elimination programs,” said Kim Janda, Ph.D., a professor in the Departments of Chemistry and Immunology and Microbial Science, member of The Skaggs Institute for Chemical Biology, and director of The Worm Institute for Research and Medicine (WIRM) at Scripps Research. “This diagnostic tool could be a game-changer for how the disease will be treated in the future.”

Judith Denery, Ph.D., a senior research associate in the Janda laboratory and the paper’s first author, adds, “Because current tests often give false negatives, they are unreliable indicators of infection. For organizations such as the World Health Organization and others working to eliminate the disease, this lack of accuracy is frustrating, time-consuming, and costly.”

A Stubborn Disease

The vast majority of onchocerciasis infections occur in sub-Saharan Africa, with the largest disease burden in rural Nigeria, and to a lesser degree in Yemen and in parts of Central and South America. Although control and elimination efforts over the last decade are bearing fruit, and large areas have a much lower infection rate than in the past, the disease still continues to cause misery for millions.

Humans acquire the disease after they are repeatedly bitten by black flies that harbor the worm, Onchocerca volvulus, which breed near fast moving rivers. When the flies bite a human host, O. volvulus larvae, called microfilariae, eventually spread throughout the body. The worms, which congregate in subcutaneous nodules, trigger an immune response that causes acute dermatitis and, if left untreated, tissue destruction that can lead to blindness.

The drug ivermectin, manufactured by Merck and distributed free in affected areas, effectively kills the larvae in most cases, and has served as the principal means of onchocerciasis control. Ivermectin must be taken twice yearly over a period of 15 to 20 years – the life span of the worms.

Even with drug treatment, however, the disease takes a heavy toll.

“The number of those blinded by the disease – who tend to live in areas where there is inadequate treatment – is estimated to be around a quarter million people,” says Scripps Research Assistant Professor Tobin Dickerson, Ph.D., one of the co-authors of the new study. “Most are unable to work and it’s not uncommon to see an older person being led by a young child who acts comparable to a seeing-eye dog. Such children miss out on their own childhoods, often being pulled out of school to help an adult. In addition, fertile land near rivers that otherwise would be used for farming is often abandoned. Onchocerciasis is an insidious disease that affects both the individual and society.”

The New Diagnostic Tool

To develop the test, the Scripps Research scientists used a highly sophisticated process known as metabolomics, the systematic study of the unique chemical fingerprints that specific cellular processes leave behind, in other words of their small-molecule metabolite profiles. Metabolic profiling can give a quick snapshot of the physiology of an organism.

The use of metabolomics on an African sample set comprised of 73 serum and plasma samples revealed 14 biomarkers that showed excellent discrimination between O. volvulus-positive and negative individuals. Application of these biomarkers to an additional sample set from onchocerciasis endemic areas where long-term ivermectin treatment has been successful revealed that the biomarkers could distinguish individuals with worms of compromised viability from those with active infection.

“Ultimately this technology can be expanded for the diagnosis of other filarial and neglected tropical diseases,” Janda said.

Passion for Fighting Disease

The impetus for helping in the fight to eradicate river blindness came from entrepreneur and philanthropist John Moores. Moores is the founder of the River Blindness Foundation, a non-profit organization dedicated to research and treatment of onchocerciasis, and the Worm Institute for Research and Medicine at Scripps Research – which funded the current study with the Skaggs Institute.

“Mr. Moores conveyed his passion for fighting this disease to WIRM here at Scripps,” Dickerson said. “Now, we have a tool that helps face up to one of the major challenges of medicine for this century — true elimination and eradication of infectious disease. Not just treatment, but true eradication. In order to be able to do this we must be able to know for certain whether a disease is no longer present; only then can we declare victory.”

The scientists hope to develop a diagnostic kit that can be used in the field to test for onchocerciasis and other parasitic diseases.

In addition to Janda, Denery, and Dickerson, authors of the paper, “Metabolomics-Based Discovery of Diagnostic Biomarkers for Onchocerciasis,” are Ashlee A.K. Nunes and Mark S. Hixon.

Mika Ono
Scripps Research Institute

2 Million Dollars Grant For Innovative Glaucoma Research Announced

With itemized gifts in their estate planning of $1 million each, Frank Stein and Paul S. May will establish “The Frank Stein and Paul S. May Grant for Innovative Glaucoma Research,” they announced to guests at the Glaucoma Research Foundation’s (GRF) Annual Dinner following GRF’s Annual Meeting.

“A leadership gift like this is particularly valuable right now,” said GRF President and CEO Thomas M. Brunner. “There is a real threat of an epidemic of blindness from glaucoma looming, and the kind of research this grant will make possible is essential if we are to get ahead of this imminent threat. Furthermore, it reminds us all that there are several ways we can all do our part to beat this silent thief of sight, and making glaucoma research a priority of our personal estate planning should be at the top of all our lists.”

“I am too well aware of how this disease can silently impact a person’s sight,” said Frank Stein. “This is why I have supported to Glaucoma Research Foundation from the very beginning.” Paul May is also personally aware of what glaucoma can do to a person’s sight. His mother was legally blind due to glaucoma. And while he also has glaucoma, Paul has been spared any loss of vision.

The terms of the grant, Brunner reported, are restricted to support research, with principal and income utilized over a period of ten years from receipt to fund grants. It is expected that each $1 million bequest will make possible a significant grant for glaucoma research of approximately $100,000 annually for ten years, after receipt of funds. The scientist-recipient of the “Frank Stein and Paul S. May Grant for Innovative Glaucoma Research” will be selected by GRF’s Scientific Advisory Committee in consultation with the GRF Board and will be announced each year at GRF’s Annual Meeting.

Glaucoma Research Foundation

Patients Win With Immediate Avastin Payment Reversal

Following efforts by the American Academy of Ophthalmology with the help of the American Society of Retina Specialists, the Macula Society, the Retina Society and Congressional allies, the Center for Medicare and Medicaid Services (CMS) said that it will retract an Oct. 1 payment policy for small doses of Avastin. Avastin, a cancer drug, is used in smaller doses to treat eye diseases such as age-related macular degeneration (AMD).

The reimbursement rate change for Avastin heralded drastic cost consequences for patients and taxpayers. The new payment policy cut the reimbursement rate of small doses of Avastin to the point that ophthalmologists could not recoup their costs for the drug. As a result, treatment for AMD would likely have shifted from Avastin to the drug Lucentis, which has a substantially higher cost. Currently the lower-cost Avastin is the more prevalent treatment choice but that would have changed with the new policy.

“Congress worked along with ophthalmologists to make CMS aware of shared concerns to patient care, and the agency reversed implementation of its new reimbursement rate,” said David W. Parke II, MD, CEO of the Academy. “This is a win-win for all, particularly patients. CMS heard our concerns and acted in the best interests of everyone.”

American Academy of Ophthalmology

View drug information on Avastin; Lucentis.

Annual Treatment For Trachoma, As Recommended By WHO, May Be Unnecessary, If Treatment Coverage High

Five year study indicates one or two treatments may be enough to eliminate infection

One or two rounds of high coverage mass treatment with azithromycin, rather than the annual treatment recommended by the World Health Organisation, may be enough to eliminate the eye disease trachoma in communities with moderate levels of infection.

The London School of Hygiene & Tropical Medicine’s Trachoma Group has written a letter to the New England Journal of Medicine, outlining the findings of a trial some of its members carried out in Kahe Mpya, Tanzania, and calling for a re-think on the way communities affected with trachoma are treated.

As part of the trial, 97.6% of residents were treated with single-dose azithromycin and the prevalence of trachoma fell from 9.5% to 0.1% after two years. A second round of mass treatment was carried out at 24 months, and residents were examined at 42 and 60 months. Those with active trachoma were offered a course of tetracycline eye ointment. After 60 months, three years after the second round of mass treatment, trachoma DNA was not detected in the conjunctiva of any of the 859 patients swabbed, suggesting that the infection had been eliminated.

The World Health Organisation currently recommends three years of annual mass azithromycin treatment before reassessment in communities where prevalence in children aged between one and nine years is 10% or greater.

Dr. Anthony Solomon, lead author of the letter, comments ‘Had WHO recommendations on antibiotic use been followed, three or possibly six annual rounds of mass treatment would have been offered in this community, whereas our data suggest that one round was sufficient. The less antibiotic we can use in each community, the more people we’ll be able to use donated antibiotic for, and the lower the likelihood of the emergence of antibiotic-resistant strains’.

Keppel Street

$14.6 Million NIH Grant Will Build On Macular Degeneration Findings

A five-year, $14.6 million grant from the National Eye Institute of the National Institutes of Health (NIH) will fund an international, multidisciplinary effort led by the University of Iowa to leverage two recent genetic discoveries into possible treatments for age-related macular degeneration (AMD). The grant was awarded Aug. 1.

Gregory Hageman, Ph.D., professor of ophthalmology and visual sciences at the University of Iowa Roy J. and Lucille A. Carver College of Medicine, will lead the multi-institutional effort.

AMD is the most frequent cause of irreversible blindness in developed countries. People with AMD lose the central part of their vision when the macula, a part of the retina, degenerates. No treatment currently exists for early stages of AMD, which affects nearly 50 million people worldwide. Treatment for advanced stages is very limited.

In the past year, the UI, Columbia University Medical Center and the National Cancer Institute (NCI), along with several other institutions, determined that two genes — complement factor H and factor B — account for nearly three out of four cases of AMD. Variations in these two genes somehow alter the function of a key pathway in the immune system, which researchers suspect leads to AMD. The factor H gene also is linked to similar eye problems associated with membranoproliferative glomerulonephritis type II (MPGN II), a rare kidney disease.

Now, the scientists will begin a series of investigations to learn more about the genes’ role in the immune system, with the goal of developing diagnostic tools and treatments. The team will explore how the gene variations affect function of the factor H protein and explore the idea that replacing, augmenting or removing the malfunctioning protein can delay or even prevent the eye disease caused by AMD and MPGN II.

“For the first time, we have strong data on which to base the next phases of research into AMD. We’re excited that the NIH grant will allow us to explore and advance our ideas related to the role of these genes in development of AMD,” Hageman said.

“This research requires a multidisciplinary team capable of approaching this challenge from many different investigational angles. I’m enthusiastically looking forward to working with my co-investigators, all of who share the overall dream of ultimately developing therapies for AMD,” he added.

The investigation includes efforts to determine whether other genes are associated with AMD and whether other inflammation-based diseases, such as Alzheimer’s disease, are caused by dysfunction of the same, or a related, pathway. Additional aims involve studying the biology of the eye’s complement system to determine whether proteins and markers, other than a vision test, can reveal vision decline due to AMD. Other efforts funded by the grant would involve drug design and development and clinical trials.

One of the international collaborators is Giuliana Silvestri, M.D., head of surgery and perioperative care in ophthalmology at Queen’s University in Belfast, Ireland. “Silvestri’s extensive clinical expertise in the diagnosis and management of AMD patients will be essential to the project, especially as it enters any translational, or treatment-related, phase,” Hageman said.

The participation of patients and families in Iowa, Ireland and other sites will play a critical role in the research program. Silvestri, for example, already has identified many large families with AMD.

“The DNA resource is of particular value given that the Irish population is characterized by large families and stability,” she said. “The addition of these families to this research program may provide additional insights into other genes implicated in AMD.

“This project has the potential to make significant inroads into real treatment benefits for AMD patients, which for a clinician at the bedside is very exciting. Secondly, from a personal viewpoint as a non-U.S. investigator, the opportunity to collaborate on such a project is a great honor,” Silvestri added.

As part of the research, Brian Martin, Ph.D., UI assistant professor of microbiology, will lead efforts to clone and express the complement genes associated with AMD and to develop an animal model of the disease.

“It is very exciting to be working on a research project that might lead to an AMD treatment in the near future,” Martin said.

In addition, Richard Smith, UI professor of otolaryngology and the Sterba Hearing Research Professor, will contribute to efforts to understand the links between MPGN II and AMD.

“The particular variation in the factor H protein that predisposes persons to developing AMD is found even more frequently in people with MPGN II, suggesting that intense, focused efforts on MPGN II will provide a unique opportunity to understand the cause and to develop treatments for both of these diseases,” Smith said.

In addition to the UI, Columbia University Medical Center, the NCI, and Queen’s University, other institutions involved in the NIH study include Washington University in St. Louis, University of California at Santa Barbara, University of California at Los Angeles, University College of London, the University of Helsinki in Finland, the University of Melbourne in Australia, the Shangdong Eye Institute and Beijing University, both in China, Centre de Neurochimie in Strasbourg, France, and Clinica Las Condes in Santiago, Chile.

“In the United States alone, nearly one-quarter of individuals age 70 and older show signs of AMD, a devastating eye disease that has a huge impact on individuals’ lives and society as a whole,” said Jean Robillard, M.D., dean of the UI Carver College of Medicine. “The NIH study led by Dr. Hageman has tremendous potential for translating important recent discoveries into patient care.”

“It’s wonderful for the University of Iowa to take the lead in advancing such a promising line of research,” said Meredith Hay, Ph.D., UI vice president for research. “We are fortunate to have Dr. Hageman coordinating this AMD project. It reflects the innovative thinking and insightfulness that characterize our researchers and could bring real change to treatment options for people with this debilitating disease.”

These UI news releases provide additional information about the earlier genetic findings:

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at uihealthcare/.

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178

MEDIA CONTACT: Becky Soglin,

Contact: Becky Soglin
University of Iowa