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Ophthalmology and Optometry
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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.

Study Reveals How Brain Processes Color and Motion PDF
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Ophthalmology and Optometry
Tuesday, 23 September 2014

Despite the barrage of visual information the brain receives, it retains a remarkable ability to focus on important and relevant items. How the brain accomplishes this, however, has been poorly understood. Now, University of Chicago scientists have identified a brain region that appears central to perceiving the combination of color and motion. They discovered a unique population of neurons that shift in sensitivity toward different colors and directions, depending on what is being paid attention to. The study, published Sept. 4 in the journal Neuron, sheds light on a fundamental neurological process that is a key step in the biology of attention.

"Most of the objects in any given visual scene are not that important, so how does the brain select or attend to important ones?" said study senior author David Freedman, PhD, associate professor of neurobiology at the University of Chicago. "We've zeroed in on an area of the brain that appears central to this process. It does this in a very flexible way, changing moment by moment depending on what is being looked for."

The visual cortex of the brain possesses multiple, interconnected regions that are responsible for processing different aspects of the raw visual signal gathered by the eyes. Basic information on motion and color are known to route through two such regions, but how the brain combines these streams into something usable for decision-making or other higher-order processes remained unclear.

To investigate this mechanism, Freedman and postdoctoral fellow Guilhem Ibos, PhD, studied the response of individual neurons to a simple task. Monkeys were shown a rapid series of visual images. An initial image showed either a group of red dots moving upwards or yellow dots moving downwards, which served as an instruction for which specific colors and directions were relevant during that trial. The subjects were rewarded when they released a lever when this image later reappeared. Subsequent images were composed of different colors of dots moving in different directions, among which was the initial image.

Scientists Develop Eye Drops to Treat Molecular Basis of Glaucoma PDF
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Ophthalmology and Optometry
Monday, 15 September 2014

Northwestern University scientists in the U.S. have discovered a novel cause of glaucoma in an animal model, and related to their findings, are now developing an eye drop aimed at curing the disease. They believe their findings will be important to human glaucoma.

A cure for glaucoma, a leading cause of blindness, has been elusive because the basis of the disease is poorly understood. In glaucoma, pressure builds from poor drainage of fluid from the anterior chamber of the eye, destroying retinal ganglion cells and eventually the optic nerve. The eye becomes like a bathtub that can’t drain because the pipe is clogged. The clogged or defective vessel, known as Schlemm’s canal, is part of the lymphatic system that is essential for drainage in the eye.

The new study for the first time identifies the molecular building blocks needed to make the 'drainage' vessels, providing the necessary chemical tools to repair the eye's plumbing and restore normal drainage. Up until now, the molecular basis of the disease caused by an absent or defective canal was unknown.

The study was published Sept. 9 in The Journal of Clinical Investigation.

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