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Ophthalmology and Optometry
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EYLEA Injection Receives FDA Approval for DME Treatment PDF
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Ophthalmology and Optometry
Wednesday, 20 August 2014

Regeneron Pharmaceuticals, Inc. announced that the U.S. Food and Drug Administration (FDA) has approved EYLEA® (aflibercept) Injection for the treatment of Diabetic Macular Edema (DME). The recommended dosage of EYLEA in patients with DME is 2 milligrams (mg) every two months (8 weeks) after five initial monthly injections. Although EYLEA may be dosed as frequently as 2 mg every 4 weeks, additional efficacy was not demonstrated when EYLEA was dosed every 4 weeks compared to every 8 weeks.

The approval of EYLEA in DME was based on the one-year data from the Phase 3 VISTA-DME and VIVID-DME studies of 862 patients, which compared EYLEA 2 mg given monthly, EYLEA 2 mg given every two months (after five initial monthly injections), or macular laser photocoagulation (at baseline and then as needed). In the DME studies, after one year, the mean changes in Best Corrected Visual Acuity (BCVA), as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart for the monthly and every two month EYLEA groups, were statistically significantly improved compared to the control group and were similar to each other. Across both trials, patients in both EYLEA dosing groups gained, on average, the ability to read approximately two additional lines on an eye chart compared with almost no change in the control group.

 
Detailed Molecular Eye Map Created to Help Detect Loss of Vision PDF
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Ophthalmology and Optometry
Monday, 11 August 2014

Researchers have created the most detailed map to date of a region of the human eye long associated with blinding diseases, such as age-related macular degeneration. The high-resolution molecular map catalogs thousands of proteins in the choroid, which supplies blood and oxygen to the outer retina, itself critical in vision. By seeing differences in the abundance of proteins in different areas of the choroid, the researchers can begin to figure out which proteins may be the critical actors in vision loss and eye disease.

What vision specialists know is many eye diseases, including age-related macular degeneration (AMD), are caused by inflammation that damages the choroid and the accompanying cellular network known as the retinal pigment epithelium (RPE). Yet they’ve been vexed by the anatomy: Why does it seem that some areas of the choroid-RPE are more susceptible to disease than others, and what is happening at the molecular level? The researchers set about to answer that question with nondiseased eye tissue donated by three deceased older individuals. From there the researchers created a map that catalogs more than 4,000 unique proteins in each of the three areas of the choroid-RPE: the fovea, macula, and the periphery.

Why that’s important is now the researchers can see which proteins are more abundant in certain areas, and why. One such example is a protein known as CFH, which helps prevent a molecular cascade that can lead to AMD, much like a levee can keep flooding waters at bay. The researchers learned, though the map, that CFH is most abundant in the fovea. That helps, because now they know to monitor CFH abundance there; fewer numbers of the protein could mean increased risk for AMD, for instance.

The research has been published in JAMA Ophthalmology journal.

 
More Tears As We Get Older PDF
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Ophthalmology and Optometry
Thursday, 07 August 2014

Dry EyeOur eyes may adapt to help overcome a condition known as meibomian gland dysfunction that causes 'dry eye' and typically worsens with age. Researchers at Brien Holden Vision Institute have found that some people of 54 years and over are more likely to produce tears, a natural eye lubricant, which could counter early stages of dry eye.

In an evaluation of 156 asymptomatic subjects (91 were female) who had no pre- existing ocular or systemic abnormalities, there was a "significant worsening" in the grade severity of meibum quality, meibomian gland expressibility, and meibomian gland loss factor with increasing age. The latter steadily decreased with age, while the first two only began to decline in those older than 44 years. Lipid layer thickness, tear meniscus height, noninvasive and invasive tear breakup times increased after 54 years of age and correlated to a decreased osmolarity.

The research has found that as we get older, eye lubrication from the meibomian gland, a small gland in the eyelids that produces an oily lubricant, decreases. Meibomian gland dysfunction (MGD) is a major cause of dry eye and affects up to 70% of people in some groups, with a greater prevalence in Asian populations. According to the researchers, our tears could make up for a loss of lubrication caused by MGD.

 
AMD Occurs Much Earlier Than Previously Assumed PDF
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Ophthalmology and Optometry
Wednesday, 06 August 2014

It is widely accepted that age-related macular degeneration (AMD) is the most common cause of visual impairment and blindness in industrialized countries. However, it is questionable whether it can continue to be defined as a disease in people in their 50s and beyond. Investigations to determine the incidence of age-related macular degeneration undertaken as part of the Gutenberg Health Study of the University Medical Center of Johannes Gutenberg University Mainz (JGU) have shown that even persons under the age of 50 years may be affected by an early form of the eye disease. Just under 4 percent of the 35 to 44-year-old subjects in the population-based study were found to be suffering from AMD.

In order to identify the age- and gender-specific incidence of AMD, the research team of the Department of Ophthalmology at the Mainz University Medical Center led by Dr. Christina Korb, PD Dr. Alireza Mirshahi, and Professor Norbert Pfeiffer assessed the status of the ocular fundus of 4,340 participants in the Gutenberg Health Study. Evaluated were vascular structure, the head of the optic nerve, and the macula of the eye, which is the point of sharpest vision. The results in general documented that the incidence of AMD increases with age. However, the researchers also discovered to their surprise that even persons under the age of 50 years can already be affected by early stage AMD. In the age group of 35- to 44-year-olds, 3.8 percent of the subjects in the Gutenberg Health Study were found to be suffering from the disease. The findings of the Mainz researchers thus contradict the current assumption that age-related macular degeneration only occurs in the section of the population that is over 50 years old.

With the help of their findings, the researchers were also able to gain insights into how frequently the various forms of age-related macular degeneration occur. On average, about 12 percent of the examined 35- to 74-year-olds had early stage AMD, but only 0.2 percent of the study participants exhibited symptoms of late stage AMD, which is often associated with severe visual impairment. "Our research shows that age-related macular degeneration can already occur much earlier than previously thought. This means there may also be possible consequences with regard to the screening examinations for these diseases," concluded Dr. Christina Korb.

The findings have been published in Graefe's Archive for Clinical and Experimental Ophthalmology.

 
Rehabilitation Prevent Depression From AMD PDF
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Ophthalmology and Optometry
Thursday, 31 July 2014

Depression is a common risk for people who have lost their vision from age-related macular degeneration (AMD), but a new study shows that a type of rehabilitation therapy can cut this risk in half.

As the AMD progresses, it can cause a growing blurred area near the center of vision, and lead to difficulty with everyday activities, including the ability to drive, read, write, watch television, cook, and do housework. Activities that used to be fun and fulfilling may begin to seem burdensome or even impossible. With loss of the ability to drive and navigate unfamiliar places, it becomes easier to stay at home than to see friends or meet new people. All of this can take a toll on mental health, and past studies have found that as many as one-third of people with bilateral AMD develop clinical depression.

In a trial researchers recruited 188 participants with bilateral AMD. Participants were 84 years of age on average, 70 percent were women, and 50 percent lived alone. All had a best-corrected vision of less than 20/70. Each participant had mild depressive symptoms and was at risk for developing clinical depression, based on a nine-item depression subtest of the Patient Health Questionnaire, or PHQ-9. During the trial, the participants had two visits with an optometrist, during which they were prescribed low-vision devices such as handheld magnifiers. After those initial visits, the participants were randomly split into two groups.

One group received behavior activation from an occupational therapist specially trained in the approach. The occupational therapist worked with participants to guide them on using the low-vision devices, to make changes around the home (such as using brighter lights and high-contrast tape), to increase their social activities, and to help them set personal goals and break these down into manageable steps.

The second group of participants served as a control group. They talked about their difficulties to a therapist, but did not receive behavior activation or low-vision occupational therapy. Both groups had six one-hour therapy sessions in their homes over a two-month period. All participants were allowed to take antidepressants, but less than 10 percent did so. All received medical management of AMD as prescribed by their primary eye care providers.

By four months, 12 participants in the control group and seven participants in the behavior activation group had withdrawn from the trial or passed away. Of the remaining 169 participants, 18 (23.4 percent) in the control group and 11 (12.6 percent) in the behavior activation group developed clinical depression, based on retesting with the PHQ-9. Behavior activation had the most benefit for participants with the worst vision (less than 20/100), reducing the risk of depression by about 60 percent compared to controls. When the data were adjusted for vision status, physical health and baseline PHQ-9 score, behavior activation reduced the risk of depression by 50 percent compared to the control treatment.

 

 

 
Human Eye Movements Reveal Love and Lust PDF
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Ophthalmology and Optometry
Wednesday, 23 July 2014

Eye Movements - Love and LustA new study by University of Chicago and University of Geneva researchers suggests the difference between love and lust might be in the eyes. Specifically, where your date looks at you could indicate whether love or lust is in the cards. The new study found that eye patterns concentrate on a stranger's face if the viewer sees that person as a potential partner in romantic love, but the viewer gazes more at the other person's body if he or she is feeling sexual desire. That automatic judgment can occur in as little as half a second, producing different gaze patterns. (Photo : Courtesy of Stephanie Cacioppo)

Previous research by lead author Stephanie Cacioppo, director of the UChicago High-Performance Electrical NeuroImaging Laboratory, has shown that different networks of brain regions are activated by love and sexual desire. In this study, the team performed two experiments to test visual patterns in an effort to assess two different emotional and cognitive states that are often difficult to disentangle from one another—romantic love and sexual desire (lust).

Male and female students from the University of Geneva viewed a series of black-and-white photographs of persons they had never met. In part one of the study, participants viewed photos of young, adult heterosexual couples who were looking at or interacting with each other. In part two, participants viewed photographs of attractive individuals of the opposite sex who were looking directly at the camera/viewer. None of the photos contained nudity or erotic images.

In both experiments, participants were placed before a computer and asked to look at different blocks of photographs and decide as rapidly and precisely as possible whether they perceived each photograph or the persons in the photograph as eliciting feelings of sexual desire or romantic love. The study found no significant difference in the time it took subjects to identify romantic love versus sexual desire, which shows how quickly the brain can process both emotions, the researchers believe.

But analysis of the eye-tracking data from the two studies revealed marked differences in eye movement patterns, depending on whether the subjects reported feeling sexual desire or romantic love. People tended to visually fixate on the face, especially when they said an image elicited a feeling of romantic love. However, with images that evoked sexual desire, the subjects' eyes moved from the face to fixate on the rest of the body. The effect was found for male and female participants.

According to the researchers: "By identifying eye patterns that are specific to love-related stimuli, the study may contribute to the development of a biomarker that differentiates feelings of romantic love versus sexual desire. An eye-tracking paradigm may eventually offer a new avenue of diagnosis in clinicians' daily practice or for routine clinical exams in psychiatry and/or couple therapy."

The research has been published in the journal Psychological Science.

 

 
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