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Ophthalmology and Optometry
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Australian Researchers Find Promising Treatment For Keratoconus Patients PDF
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Ophthalmology and Optometry
Monday, 14 April 2014

KeratoconusKeratoconus patients have promising news with CERA (Centre for Eye Research Australia) researchers finding strong new evidence on a promising treatment known as corneal collagen cross-linking (CXL).

Keratoconus is a condition of the eye where the cornea (front window of the eye) gets progressively thinner. As a result, the normally round shape of the cornea becomes distorted and protrudes, causing significant vision loss. It is usually diagnosed in the teenage years and remains the most common reason for corneal transplantation in Australia.

CXL involves the application of riboflavin (vitamin B2) solution to the cornea. The riboflavin is then activated with ultra-violet light. This process strengthens the cornea, which can slow down or even halt the progression of keratoconus.

Since the first clinical study from Germany was published in 2003, there have been an increasing number of studies reporting the safety and effectiveness of CXL. However, there has been a lack of a randomised controlled studies (which compare treated eyes to untreated eyes) with longer-term follow-up to support the widespread use of CXL for keratoconus.

The researchers published their 3 year results from a 5-year randomised, controlled trial of CXL for progressive keratoconus online in January 2014 in 'Ophthalmology'.

They found that CXL was effective in flattening the cornea as well as improving vision both with and without glasses. In contrast there was continued progression of the disease in untreated eyes.

The research was supported by the Royal Victorian Eye and Ear Hospital Research Committee, Melbourne, Australia; Eye Research Australia Foundation, Melbourne, Australia; and Keratoconus Australia, Melbourne, Australia.

 
Scientists Make Major Breakthrough in AMD Therapy PDF
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Ophthalmology and Optometry
Wednesday, 09 April 2014

Sarah Doyle - wet AMD TherapyScientists at Trinity College Dublin have made a major breakthrough with important implications for people affected by the eye disease Age-Related Macular Degeneration (AMD), which can cause central blindness in those living with the condition.

The scientists found that a component of the immune system, 'IL-18', acts as a guardian of eyesight by suppressing the production of damaging blood vessels behind the retina at the back of the eye. In addition, in pre-clinical models, it was shown that 'IL-18' can be administered in a non-invasive way, which could represent a major improvement on the current therapeutic options that are open to patients.

"We were initially concerned that IL-18 might cause damage to the sensitive cells of the retina, because it is typically linked to inflammation. But surprisingly we found that low doses had no adverse effects on the retina and yet still suppressed abnormal blood vessel growth," said Assistant Professor in Immunology at Trinity, Sarah Doyle, who is the first author on the paper. The paper is published online in the journal Science Translational Medicine.

Treatment options for wet AMD are currently limited to the end stages of the disease. Regular injections of antibodies must be made directly into the eye to mop up a problematic molecule termed 'VEGF'. However, the Trinity scientists found that IL-18 directly inhibits VEGF production, and that it can work as effectively as the current treatment when administered via a non-invasive intravenous injection in pre-clinical settings.

"Our findings have highlighted the power of industry-academic collaborations, the results of which should lead to clinical deployment of IL-18 as a treatment for AMD in the short term," added Research Assistant Professor in Genetics at Trinity, Matthew Campbell.

Vice President of Ophthalmology at GlaxoSmithKline, Dr Pete Adamson, said: "A greater understanding of the molecular complexity of diseases such as AMD is critical to the development of new medicines."

 
Caucasian Boys Show Highest Prevalence of Color Blindness PDF
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Ophthalmology and Optometry
Tuesday, 08 April 2014

Color Blindness TestThe first major study of color blindness in a multi-ethnic group of preschoolers has uncovered that Caucasian male children have the highest prevalence among four major ethnicities, with 1 in 20 testing color blind. Researchers also found that color blindness, or color vision deficiency, in boys is lowest in African-Americans, and confirmed that girls have a much lower prevalence of color blindness than boys. The study has been published online April 3 in Ophthalmology, the journal of the American Academy of Ophthalmology.

Despite the name, color blindness is not a type of blindness, but an inability to see colors accurately. The most common form of color blindness is genetic and involves a mutation or lack of genes that help the eye see red or green. People with this form of color blindness cannot tell the difference between the two colors. As this can negatively impact performance in school, early diagnosis of color deficiency is important so that parents and teachers of color blind children are aware and able to provide adaptive learning tools and strategies for these children.

Researchers from the Multi-Ethnic Pediatric Eye Disease Study Group tested 4,005 California preschool children age 3 to 6 in Los Angeles and Riverside counties for color blindness. They found the following prevalence by ethnicity for boys:

  • 5.6 percent of Caucasian boys
  • 3.1 percent of Asian boys
  • 2.6 percent for Hispanic boys
  • 1.4 percent of African-American boys

The prevalence of color blindness in girls measured 0 percent to 0.5 percent for all ethnicities, confirming findings in prior studies. However, the numbers were so low overall for girls that researchers say they cannot statistically compare rates between females among the four ethnicities studied.

While the researchers found that children at the youngest ages could not accurately complete testing, they say the findings suggest that successful color vision screening can begin at age 4. Many times children with color blindness will perform poorly on tests or assignments that employ color coded materials, leading color blind children to be inappropriately classified by ability at school, said the study's principal investigator Rohit Varma, M.D., chairman of the Department of Ophthalmology at the University of Southern California (USC) Keck School of Medicine and director of the USC Eye Institute.

"It's not that the child is not smart enough or bright enough, it's that they see the world a little differently," Dr. Varma said.

According to Dr. Varma, children with color blindness can benefit from different kinds of lesson plans or homework to demonstrate their understanding of concepts despite their inability to see colors correctly. "That needs to start early on because labeling a child as not smart or bright enough is a huge stigma for the child and causes significant anxiety for the parents and family," he added.

 

 
Contacts Preferred for Babies after Cataract Surgery PDF
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Ophthalmology and Optometry
Friday, 28 March 2014

Contact Lens for BabiesFor adults and children who undergo cataract surgery, implantation of an artificial lens is the standard of care. But a clinical trial suggests that for most infants, surgery followed by the use of contact lenses for several years—and an eventual lens implant—may be the better solution. The trial was funded in part by the National Eye Institute (NEI), a component of the National Institutes of Health.

A cataract is a clouding of the eye's lens, and can be removed through a safe, quick surgical procedure. After cataract removal, most adults and children receive a permanent artificial lens, called an intraocular lens (IOL). This is an option for infants, too, but the trial found that the use of contact lenses is safer than, and just as effective as, an IOL for infants under seven months old. The most recent data from the trial were published recently in JAMA Ophthalmology.

"When we began this study, the prevailing theory was that IOLs would be the better option for cataract in infants because they correct vision constantly, while contact lenses can be removed or dislodged from the eye. But our data suggest that if the family can manage it, contact lenses are the better option until the child gets older," said Scott Lambert, M.D., the study's lead investigator and a professor of ophthalmology at Emory University in Atlanta.

Although cataracts are often tied to aging, it's estimated that 1,200-1,600 infants are diagnosed with congenital cataracts (present from birth) each year in the United States. The condition can affect both eyes, but it often affects just one, which is called unilateral cataract. The new study compared the use of IOLs versus the use of contact lenses during infancy for treating congenital unilateral cataract.

Some prior research suggested that using an IOL to treat cataract during infancy can improve long-term visual outcomes, he said. IOLs can also spare babies—and their parents—the discomfort of daily contact lens changes, and reduce the risk of introducing germs into the eye. On the other hand, the use of IOLs during infancy also has some drawbacks. Surgeons have difficulty judging the right focusing power of the artificial lens for an infant, because it's a time of rapid eye growth. Also, while IOL implants are typically safe and complication-free for adults, they are more likely to cause postoperative problems for infants.

 
Active Lifestyle and Occasional Drinking Reduce Risk of Developing Visual Impairment PDF
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Ophthalmology and Optometry
Monday, 24 March 2014

A physically active lifestyle and occasional drinking is associated with a reduced risk of developing visual impairment, according to a study published online this month in Ophthalmology, the journal of the American Academy of Ophthalmology.

Visual impairment – sight loss often caused by eye disease, trauma, or a congenital or degenerative condition that cannot be corrected with glasses or contact lenses – is associated with a poorer quality of life and, when severe, loss of independence. In 2020, the number of people in the United States with visual impairment is projected to increase to at least four million. This is a 70 percent increase from 2000 and is due to the growing aging population and prevalence of age-related eye diseases.

To help determine ways to decrease the growing burden of visual impairment, researchers from the University of Wisconsin School of Medicine and Public Health examined the relationships between the incidence of visual impairment and three modifiable lifestyle behaviors: smoking, drinking alcohol and staying physically active. The research was conducted as part of the Beaver Dam Eye Study, a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 adults aged 43 to 84 years.

The researchers found that over 20 years visual impairment developed in 5.4 percent of the population and varied based on lifestyle behaviors as follows:

  • Physically active persons (people who engage in regular activity three or more times a week): Over 20 years, 6.7 percent of sedentary persons and 2 percent of physically active persons developed visual impairment. After adjustment for age, these figures show a 58 percent decrease in odds of developing visual impairment in those who were physically active compared to those who were sedentary.
  • Occasional drinkers (those who have consumed alcohol in the past year, but reported fewer than one serving in an average week): Over 20 years, 11 percent of non-drinkers (people who have not consumed alcohol within the past year) developed visual impairment while 4.8 percent of occasional drinkers did so. After adjustment for age, these figures show a 49 percent decrease in odds of developing visual impairment in those who were occasional drinkers compared to those who consumed no alcohol.
  • While the odds were higher in heavy drinkers and smokers compared to people who never drank heavily and never smoked, respectively, the associations were not statistically significant.

While the study provides risk estimates of associations of lifestyle factors with the incidence of visual impairment, the researchers caution that a limitation to their study – which is present in all epidemiologic research – is that the findings may be due, in part, to unmeasured factors related to both lifestyle behaviors and development of visual impairment. The data does not prove that these lifestyle behaviors are directly responsible for increased risk.

"While age is usually one of the most strongly associated factors for many eye diseases that cause visual impairment, it is a factor we cannot change," said Ronald Klein, M.D., MPH, lead researcher of the study. "Lifestyle behaviors like smoking, drinking and physical activity, however, can be altered. So, it's promising, in terms of possible prevention, that these behaviors are associated with developing visual impairment over the long term. However, further research is needed to determine whether modifying these behaviors will in fact lead to a direct reduction in vision loss."

 
Vision Test May Help Diagnose Concussion PDF
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Ophthalmology and Optometry
Wednesday, 12 March 2014

ConcussionA simple vision test performed on the sidelines may help determine whether athletes have suffered a concussion, according to a study that will be presented at the American Academy of Neurology's 66th Annual Meeting in Philadelphia, April 26 to May 3, 2014. The study provides more evidence that the King-Devick test, a one-minute test where athletes read single-digit numbers on index cards, can be used in addition to other tests to increase the accuracy in diagnosing concussion.

For the study, 217 members of the University of Florida men's football, women's soccer and women's lacrosse teams took the King-Devick test and other concussion tests, including components of SCAT3, a tool for evaluating injured athletes, at the beginning of the season for baseline scores. A total of 30 of the athletes had a first concussion during the season and were tested again at the time of the injury or when it was reported. The time to complete the King-Devick test (usually less than one minute) was longer for 79 percent of the athletes after the injury. A test of rapid number naming, the King-Devick test requires intact eye movements, language and concentration, all of which can be impaired as a result of concussion. When the test results were combined with those of the Standardized Assessment of Concussion and the Balance Error Scoring System, 100 percent of the concussions were identified. Athletes with worse scores on the King-Devick test also were more likely to have concussion symptoms, especially sensitivity to light and noise.

 
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