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Ophthalmology and Optometry
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Researchers Use App To Image Fundus in Newborns PDF
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Ophthalmology and Optometry
Wednesday, 29 October 2014

Fundus Image AppResearchers at the School of Medicine and Biomedical Sciences  of the University of Buffalo (UB) in the U.S. have successfully used a smartphone app to image the back of the eye, or fundus, in patients who can be particularly challenging to examine: newborn babies and children.

The iExaminer adapter, developed and marketed by WelchAllyn, allows the UB researchers to combine the PanOptic ophthalmoscope, a portable lighted instrument used to look inside the eye, with iPhone technology to instantly take photos and videos of the fundus. The findings were presented earlier this month by the researchers in a poster session and at a news conference at the annual meeting of the American Academy of Ophthalmology in Chicago. 

Conventional fundus cameras, which typically accommodate adult patients, are expensive and generally only available in specialized eye clinics.

The system can capture key structures at the back of the eye in a single view without necessarily needing drops to dilate the eye. The iPhone technology also enables instant electronic transmission of images and consultation between physicians via telemedicine, and facilitates capturing, storing and transferring collected data. 

Reading Glasses a Thing of the Past with Implantable Eye Devices? PDF
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Ophthalmology and Optometry
Thursday, 23 October 2014

A thin ring inserted into the eye could soon offer a reading glasses-free remedy for presbyopia, the blurriness in near vision experienced by many people over the age of 40, according to a study released at AAO 2014, the 118th annual meeting of the American Academy of Ophthalmology. A corneal inlay device currently undergoing clinical review in the United States improved near vision well enough for 80 percent of the participating patients to read a newspaper without disturbing far distance vision needed for daily activities like driving.

The theoretical advantage of using corneal inlays over wearing reading glasses is that corneal inlays prevent the need for constantly putting on and taking off glasses, depending on whether the person needs to see near or far. One of the devices is the KAMRA inlay, a thin, flexible doughnut-shaped ring that measures 3.8 millimeters in diameter, with a 1.6 millimeter hole in the middle. When dropped into a small pocket in the cornea covering the front of the eye, the device acts like a camera aperture, adjusting the depth of field so that the viewer can see near and far. The procedure to insert the implant is relatively quick, lasting about 10 minutes, and requires only topical anesthesia.

To test the inlay's efficacy, clinicians conducted a prospective non-randomized study of 507 patients between 45 and 60 years of age across the United States, Europe and Asia with presbyopia who were not nearsighted. The researchers implanted the ring in the patients and followed up with them over the course of three years. In 83 percent of eyes with the implant, the KAMRA corneal inlay allowed presbyopic patients to see with 20/40 vision or better over the three years. This is considered the standard for being able to read a newspaper or drive a vehicle without corrective lenses. On average, patients gained 2.9 lines on a reading chart. The researchers report that the results remained steady over a three-year period.

Complications from corneal inlays in general have included haziness that is treatable with steroids; however, improvements in inlay design have made the effect less common. If necessary, inlays can be removed, making it a reversible treatment, unlike other procedures such as LASIK for presbyopia.

Smartphone Eye Examination Offers Comparable Results to Traditional Method PDF
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Ophthalmology and Optometry
Monday, 20 October 2014

A smartphone-based tool may be an effective alternative to traditional ophthalmic imaging equipment in evaluating and grading severity of a diabetic eye disease, according to a study released recently at AAO 2014, the American Academy of Ophthalmology's 118th annual meeting. The results of the research indicate the lower-cost method could be useful for bringing the service to patients in isolated or underserved communities.

The traditional method for monitoring the progression of diabetic retinopathy is through retinal slit-lamp biomicroscopy, which enables ophthalmologists to look at the back of the eye's interior. This kind of examination requires a large piece of specialized equipment found only in clinical settings, posing a significant challenge for monitoring patients living in rural or low-resource communities.

In order to find a solution for addressing this challenge, researchers from the University of Brescia, University of Molise and "Federico II" University of Naples, Italy, developed a small optical adapter called D-Eye which could attach magnetically to an iPhone® 5, creating a smartphone ophthalmoscope. They then used the iPhone ophthalmoscope as well as a slit-lamp biomicroscope to perform dilated retinal digital imaging on 120 patients with diabetes who were scheduled to have a routine dilated eye exam. After comparing the results of the smartphone method to the traditional one, an exact agreement between the two methods was found in 85 percent of the eyes and an agreement within one step (or grade of disease progression) was found in 96.7 percent of the eyes. In most of the one- and two-step disagreements, the severity level was graded higher by biomicroscopy grading.

In the smartphone ophthalmoscopy results, nine eyes were not gradable due to small pupil or cataract. In the biomicroscopy results, the number of not gradable images was four. Therefore, while biomicroscopy is still found to be the more accurate method for grading diabetic retinopathy, researchers believe smartphone ophthalmoscopy shows great potential for use in rural or remote communities who would normally receive little to no testing at all.

"Using the iPhone method is thousands of dollars cheaper than using traditional equipment," said lead researcher Andrea Russo, M.D. "The affordability of this option could make it much easier to bring eye care to non-hospital remote or rural settings, which often lack ophthalmic medical personnel."

People with Visual Impairment More Likely Suffer From Multiple Health Conditions PDF
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Ophthalmology and Optometry
Friday, 17 October 2014

Researchers at the University of Glasgow and University of Dundee have found that people with visual impairment are more likely to suffer from multiple health conditions than those without sight problems.

The researchers analysed data provided by the Primary Care Clinical Informatics Unit at the University of Aberdeen for all 1,751,841 registered patients who were alive and permanently registered with 314 Scottish general practices on March 31, 2007. Data on the presence of 29 common chronic physical health conditions, including visual impairment, and eight mental health conditions were extracted. They identified 5,348 – 1.8% of the sample – patients with visual impairment.

They also found that 27 of the 29 physical health conditions and all eight mental health conditions were significantly more likely to be recorded for individuals with visual impairment compared to individuals without visual impairment, after standardising for age, gender and social deprivation. Individuals with visual impairment were also significantly more likely to have more comorbid conditions with 95% of individuals with visual impairment having at least one other health problem compared to 84.5% of the control group. Visually impaired people were significantly more likely to have four or five additional health conditions. 

Dr Court, Research Associate in the Institute of Health and Wellbeing at the University of Glasgow, said: "Our study has important implications for clinical practice and for the future design of integrated services to meet the complex needs of patients with visual impairment, such as embedding depression and hearing screening within eye care services".

The findings have been published in the journal BMC Medicine.

Erectile Dysfunction Drugs Could Damage Vision PDF
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Ophthalmology and Optometry
Monday, 06 October 2014

ViagraAustralian researchers from the University of New South Wales (UNSW) have found that erectile dysfunction drugs could damage vision. Sildenafil, the active ingredient in the erectile dysfunction drug Viagra®, could cause unusual visual responses in people who carry a common mutation for eye disease and may have long-term detrimental effects on their vision, UNSW researchers warn.

Sildenafil can inhibit an enzyme which is important for transmitting light signals from the retina to the brain, and it is already known from clinical trials of Viagra® that its use in high doses can cause transient disturbances in the vision of some healthy people.

"Side effects can include sensitivity to bright light, blurred vision and altered colour vision," says Dr Lisa Nivison-Smith, of the UNSW School of Optometry and Vision Science.

"We are concerned that people who have normal vision but who carry a single copy of the mutant gene for the blinding disease, Retinitis Pigmentosa, could be more susceptible to these changes."

A team led by Dr Nivison-Smith and UNSW's Professor Michael Kalloniatis studied the effects of a single dose of sildenafil on normal mice and mice with a single copy of the mutant gene.

The results are published in the journal Experimental Eye Research.

They found the normal mice had a transient loss of visual function after sildenafil treatment, but this effect was heightened in the mice with the mutation, and the response lasted longer. They also found early signs of cell death in the eyes of carrier mice, but not in the normal mice, suggesting sildenafil may cause degeneration in carriers of retinal disease.

"These finding are highly significant because about one in 50 people are likely to be carriers of recessive genes which cause retinal disease but are unlikely to know this, because their vision is normal," says first author of the study, Dr Nivison-Smith.

The researchers are conducting further studies to work out the mechanisms behind long term effects of sildenafil on the eyes of carrier mice.

"A better understanding of the effect of this family of erectile dysfunction drugs could help scientists and clinicians plan more successful strategies to account for factors such as a patient’s medication and genetic makeup in diseases which cause blindness," says Dr Nivison-Smith.

Retinitis Pigmentosa is the most common genetic disease which leads to blindness. It can be caused by a mutation in the gene that produces the enzyme PDE6. People with two copies of the mutant PDE6 gene get the disease, while carriers, with just one copy, have normal vision.

Sildenafil is part of a family of drugs which inhibit the enzyme PDE5, to treat erections, but they can also inhibit PDE6. This is likely to be a problem for carriers of a mutant PDE6 gene, because they produce less of the enzyme than normal. To study the eyes of the mice, the team used a technique called electroretinography, which measures the electrical signals of cells in the eye when they are activated by light.

Researchers Find No Link Between Swimming Goggles and Glaucoma PDF
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Ophthalmology and Optometry
Friday, 03 October 2014

Lions Eye Institute (LEI) medical researchers have found no link between the regular use of swimming goggles and glaucoma. Reporting in the British Medical Journal, LEI Managing Director Professor David Mackey said previous studies had found a small but significant transient increase in intraocular pressure (IOP) – a risk factor in the development of glaucoma - in people wearing certain types of swimming goggles.

The studies found this increase was maintained while the goggles were on but returned to normal levels as soon as they were taken off.

"These past findings suggested that wearing goggles could represent a significant risk factor for developing or worsening of glaucoma in people who swim regularly," Professor Mackey said. "We performed comprehensive eye exams on 231 members of local swimming clubs and 118 non-swimmers. "Their IOP and retinal nerve fibre layer thickness were measured, with the result that we did not detect any new cases of glaucoma in our cohort of frequent swimmers. We also found no difference in the thickness of the retinal nerve fibre layers between swimmers and non-swimmers."

The research team concluded that frequent use of swimming goggles did not lead to an increased risk of glaucoma over time in adults.

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