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Ophthalmology and Optometry
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Australian Researchers Find New Laser Therapy Slows Down AMD PDF
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Ophthalmology and Optometry
Friday, 21 November 2014

AMDA new, low impact low energy laser treatment for patients with early age-related macular degeneration (AMD) has produced positive results by reducing indicators of the disease. Researchers from the University of Melbourne found unlike other laser treatments, this new faster laser did not result in damage to the retina, the sensitive light detecting tissue at the back of the eye.

Associate Professor Erica Fletcher from the Department of Anatomy and Neuroscience said this was the first report detailing how this new laser treatment may improve eye health in those with AMD. In the early stages, the disease is characterised by the presence of small fatty deposits called drusen and thickening in a membrane at the back of the eye.

Published in Journal of the Federation of American Societies for Experimental Biology (FASEB), the study explores how this laser may help in limiting retinal disease, showing that it improved the health of important supporting cells at the back of the eye.

"These findings suggest treating people with AMD with this new nanosecond laser reduces signs of the disease. Importantly, unlike other lasers currently used to treat eye disease, the nanosecond laser does not result in damage to the sensitive retina," she said.

The study also showed evidence that nanosecond laser treatment in one eye can also produce positive effects in the other untreated eye. This raises the possibility that monocular treatment may be sufficient to treat disease in both eyes. AMD affects one in seven people over the age of 50 with the incidence increasing in age. It is responsible for 48 per cent of severe vision loss in Australia with an estimated 17,700 new cases each year.

This research was conducted in collaboration with the Centre for Eye Research Australia (CERA) through the ongoing Laser intervention in Early Age-related macular Degeneration (LEAD) study. The laser is manufactured in Australia by Ellex.

 
DNA Sequencing Helps Identify Genetic Defects in Glaucoma PDF
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Ophthalmology and Optometry
Thursday, 20 November 2014

Scientists from the University of Liverpool have sequenced the mitochondrial genome in glaucoma patients to help further understanding into the genetic basis for the disease.

Glaucoma is a major cause of irreversible blindness, affecting more than 60 million people worldwide, increasing to an estimated 79.6 million people by 2020. It is thought that the condition has genetic origins and many experiments have shown that new sequencing approaches could help understand how the condition develops.

Studies on primary open-angle glaucoma – the most common form of glaucoma – have shown that mutations in mitochondria, the energy generating structures in all cells, could give valuable insight into how to prevent the disease.

Using new gene sequencing techniques, called massively parallel sequencing, the Liverpool team have produced data on the mitochondrial genome taken from glaucoma patients from around the world.

The impact that mitochondrial gene change has on disease progression has been difficult to fully determine as cells in the human body can contain mixtures of healthy and mutated mitochondrial genes. Using this new technology, however, the researchers aim to support the delivery of personalised medicines to identify drugs that will target mutated mitochondria.

Professor Colin Willoughby, from the University's Institute of Ageing and Chronic Disease, explains: "Understanding the genetic basis of glaucoma can direct care by helping to determine the patient’s clinical risk of disease progression and visual loss. Increasing evidence suggests that mitochondrial dysfunction results in glaucoma and drugs that target mitochondria may emerge as future therapeutic interventions. Further studies on larger glaucoma numbers of patients are required to firmly establish the link between genetic defects in the mitochondrial genome and glaucoma development. Our research, however, has demonstrated that massively parallel sequencing is a cost-effective approach to detect a wide spectrum of mitochondrial mutations and will improve our ability to understand glaucoma, identify patients at risk of the disease or visual loss and support the development of new treatments."

The research is published in Genetics Medicine and supported by the British Council for the Prevention of Blindness.

 
New Properties of Microbes That Cause Conjunctivitis Discovered PDF
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Ophthalmology and Optometry
Monday, 17 November 2014

streptococcus pneumoniaeScientists from Massachusetts Eye and Ear/Harvard Medical School Department of Ophthalmology have used the power of new genomic technology to discover that microbes that commonly infect the eye have special, previously unknown properties. These properties are predicted to allow the bacterium ― Streptococcus pneumoniae ― to specifically stick to the surface of the eye, grow, and cause damage and inflammation. Researchers are now using this information to develop new ways to treat and prevent this bacterium, which is becoming increasingly resistant to antibiotics. Their findings are published in the the paper, entitled "Unencapsulated Streptococcus pneumoniae from conjunctivitis encode variant traits and belong to a distinct phylogenetic cluster," and appeared in the Nov. 13 issue of issue of the prestigious international science journal, Nature Communications.

S. pneumoniae is a leading cause of infection and is responsible for diseases ranging from infection of the lungs, pneumonia, to infection of the brain, to infection of the surface of the eye known as conjunctivitis. Although infection of the eye can usually be safely treated, S. pneumoniae infection is a leading cause of illness and death worldwide.

According to Mass. Eye and Ear researcher Michael S. Gilmore, Ph.D., Sir William Osler Professor of Ophthalmology, Harvard Medical School, an effective vaccine is available that helps prevent many of the most severe types of infection. "I believe it is especially important for children and the elderly to be vaccinated. The vaccine causes the body to react to a slimy coating on the bacterial surface called a 'capsule.' The capsule allows S. pneumoniae to escape from white blood cells that try to eliminate it, and S. pneumoniae goes on to cause lung and other infections."

However, the strains of S. pneumoniae that cause eye infection have been known to lack this capsule, yet they still cause infection. "Because they lack the capsule, they are not affected by the vaccine either," he continued.

To design a better vaccine, and to understand how these 'unencapsulated' strains of S. pneumoniae are still able to cause infection of the ocular surface, the research team, spearheaded by postdoctoral researcher Michael Valentino and including Mass. Eye and Ear scientists Wolfgang Haas and Paulo Bispo, as well as a collaborative team from the Broad Institute of Harvard University and Massachusetts Institute of Technology, the U.S. Centers for Disease Control and Prevention, and elsewhere, examined the genomes of a large collection of S. pneumoniae strains collected from across the United States.  

 
Study Finds Retinal-scan Analysis Can Predict Advance of AMD PDF
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Ophthalmology and Optometry
Monday, 10 November 2014

wet AMD (Courtesy of Daniel Rubin)Researchers from Stanford University School of Medicine have found a new way to forecast which patients with age-related macular degeneration (AMD) are likely to suffer from the most debilitating form of the disease. The new method predicts, on a personalized basis, which patients' AMD would, if untreated, probably make them blind, and roughly when this would occur. Simply by crunching imaging data that is already commonly collected in eye doctors' offices, ophthalmologists could make smarter decisions about when to schedule an individual patient's next office visit in order to optimize the chances of detecting AMD progression before it causes blindness.

While about four of every five people with AMD have the dry form of the disease, it's the so-called "wet" form that most concerns ophthalmologists, because it accounts for 80-90 percent of all legal blindness associated with the disease. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly.

But until now, there has been no effective way to tell which individuals with AMD are likely to progress to the wet stage. Current treatments are costly and invasive — they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of AMD a non-starter. Doctors and patients have to hope the next office visit will be early enough to catch wet AMD at its onset, before it takes too great a toll.

In a study published in the November issue of Investigative Ophthalmology & Visual Science, the researchers derived a formula that they say predicts, with high accuracy, whether a patient with mild or intermediate AMD will progress to the wet stage. The formula distinguishes likely from unlikely progressors by analyzing patient data that's routinely collected by ophthalmologists and optometrists when they perform retinal scans with an imaging technique called spectral domain optical coherence tomography.

This imaging technique is analogous to ultrasound: The macula is scanned with a beam of focused laser light, and the amount of reflected light coming back at each point is measured and recorded. The resulting stream of data is computationally converted into an extremely high-resolution, three-dimensional image.

 
Visually-impaired Children To Live Independently With Help of Computer Game PDF
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Ophthalmology and Optometry
Thursday, 06 November 2014

Eyelander GameResearchers are to begin testing a new computer game which they hope could hold the key to helping visually-impaired children lead independent lives. Developed by a team of neuroscientists and video game designers from the University of Lincoln, UK, and the WESC Foundation, one of the UK's leading specialist schools for visually impaired children, the Eyelander game features exploding volcanoes, a travelling avatar and animated landscapes. 

The idea is to improve the functional vision of children who have sight issues due to a brain injury rather than damage to the eye itself. Functional vision is used to perform everyday tasks such as safely crossing the road or finding a book on a bookshelf, but when the visual pathways between the brain and the eyes become damaged, the messages aren't correctly relayed and the visual field becomes reduced. 

Gamers begin by helping the main character, Eyelander, safely escape an erupting volcanic island. The animated character then has to navigate a series of obstacles across 12 levels, ranging from a stampede of angry cows and an oversized baby, to a UFO and a naughty panda. The scenes change and include an enchanted forest, a swamp owned by a friendly alligator called Barry, a fairground, and a secret laboratory. In the early levels, players must find a shape on the screen which is surrounded by a group of similar 'distracting' shapes, and track its movement. As the game progresses, multiple colours and more distracting shapes are introduced. The game also features advanced options to adapt the difficulty to the specific cognitive and visual impairment of the person playing, such as changing the size or number of shapes, and the amount of time the player has to complete each level.

During the clinical trial phase visually-impaired children and young adults from ages eight to 25 will have the game installed on a home computer and complete the tasks in their own time to emulate the environment in which the software would be used. 

 
Whole Eye Transplant Under Development PDF
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Ophthalmology and Optometry
Monday, 03 November 2014

With a US$1million grant from the U.S. Department of Defense, researchers at University of California, San Diego School of Medicine hope to someday make implantation of an entire, functional eye a reality.

"A whole eye transplant could be a holy grail for vision restoration," said Jeffrey Goldberg, MD, PhD, professor of ophthalmology and grant co-recipient with colleagues at University of Pittsburg Medical Center and Boston Children’s Hospital/Harvard University. "It is in the realm of scientific plausibility."

The basic idea is straightforward: Doctors would implant a donor eye in the recipient's eye socket. The vascular system to the eye would be re-established, as would the eye’s musculature to enable normal movement. The greater challenge – and focus of the two-year project – would be devising effective methods to reconnect the eye's neuronal wiring to the brain through the optic nerve, which contains more than 1 million nerve cells and transmits visual information from the retina. Past experiments at University of Pittsburg Medical Center have demonstrated the ability to perform whole eye transplants in genetically inbred rats (selected to minimize issues of tissue rejection). But while retinal tissue in the transplanted eyes appeared healthy, the optic nerves did not recover and regenerate connections, eliminating the possibility of restored sight.

"We know from previous experiments that the biggest scientific hurdle is not hooking up all the eye's tiny blood vessels or its musculature," said Goldberg, who is also director of research at UC San Diego Shiley Eye Center. "It's that when you cut the optic nerve, the nerve cells do not regrow. Our goal for this project is to be able to transplant a whole eye in an animal model and successfully demonstrate neuronal regrowth from the donor’s eye to the recipient’s optic nerve”.

Researchers at UC San Diego and Harvard University have developed a variety of molecular techniques for enhancing optic nerve regeneration. One of the primary objectives is to assess whether these different techniques can be combined for greater therapeutic effect. Among the most promising is restoring the embryonic ability of adult nerve cells to grow and blocking production of molecules that squelch nerve cells’ initial intrinsic regenerative properties. This loss of regenerative capacity is similar to what happens in spinal cord injuries that result in permanent paralysis. Scientists have also identified proteins in the optic nerve known as neurotrophic factors that are involved in growth, survival and maintenance of developing neurons and have developed techniques for enhancing their signaling to nerve cells. Other "molecular tricks" will be used to try to overcome the inhibitory environment for re-growth normally found in the optic nerve.

 
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