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Ophthalmology and Optometry
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Newly Developed Eye Implant Could Lead To Better Glaucoma Treatments PDF
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Ophthalmology and Optometry
Wednesday, 03 September 2014

GlaucomaFor people battling glaucoma, the main course of action for staving off blindness involves weekly visits to eye specialists who monitor and control increasing pressure within the eye. Now, a tiny eye implant developed at Stanford University could enable patients to take more frequent readings from the comfort of home. Daily or hourly measurements of eye pressure could help doctors tailor more effective treatment plans.

Internal optic pressure (IOP) is the main risk factor associated with glaucoma, which is characterized by a continuous loss of specific retina cells and degradation of the optic nerve fiber. The mechanism linking IOP and the damage is not clear, but in most patients IOP levels correlate with the rate of damage. Reducing IOP to normal or below-normal levels is currently the only treatment available for glaucoma. This requires repeated measurements of the patient's IOP until the levels stabilize. The trick with this, though, is that the readings do not always tell the truth. Like blood pressure, IOP can vary day-to-day and hour-to-hour; it can be affected by other medications, body posture or even a neck-tie that is knotted too tightly. If patients are tested on a low IOP day, the test can give a false impression of the severity of the disease and affect their treatment in a way that can ultimately lead to worse vision.

The new implant was developed as part of a collaboration between Stephen Quake, a professor of bioengineering and of applied physics at Stanford, and ophthalmologist Yossi Mandel of Bar-Ilan University in Israel. It consists of a small tube; one end is open to the fluids that fill the eye; the other end is capped with a small bulb filled with gas. As the IOP increases, intraocular fluid is pushed into the tube; the gas pushes back against this flow.

As IOP fluctuates, the meniscus, the barrier between the fluid and the gas, moves back and forth in the tube. Patients could use a custom smartphone app or a wearable technology, such as Google Glass, to snap a photo of the instrument at any time, providing a critical wealth of data that could steer treatment. For instance, in one previous study, researchers found that 24-hour IOP monitoring resulted in a change in treatment in up to 80 percent of patients. The implant is currently designed to fit inside a standard intraocular lens prosthetic, which many glaucoma patients often get when they have cataract surgery, but the scientists are investigating ways to implant it on its own.

The findings have been published in Nature Medicine.

 
DNA Testing Can Diagnose Rare Diseases Marked by Childhood Blindness PDF
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Ophthalmology and Optometry
Monday, 25 August 2014

Researchers in the United Kingdom have demonstrated that advanced DNA testing for congenital cataracts can quickly and accurately diagnose a number of rare diseases marked by childhood blindness, according to a study published in Ophthalmology, the journal of the American Academy of Ophthalmology. Using a single test, doctors were able to tailor care specifically to a child's condition based on their mutations, reducing the time and money spent on diagnosis and enabling earlier treatment and genetic counseling.

Each year, between 20,000 and 40,000 children worldwide are born with congenital cataracts, a disease that clouds the lens of the eye and often requires surgery and treatment to prevent blindness. The disease can arise following a maternal infection or be inherited as an isolated abnormality. Congenital cataracts can also appear as a symptom of more than 100 rare diseases, making mutations in the 115 genes associated with congenital cataracts useful as diagnostic markers for the illnesses.

Diagnosing these rare diseases previously proved a lengthy, costly and inconclusive process involving numerous clinical assessments and taking a detailed family history. DNA testing, one gene at a time, would have taken years to complete. Employing new DNA sequencing technology, called targeted next-generation sequencing, researchers at the University of Manchester sped up diagnosis to a matter of weeks by testing for mutations in all 115 known congenital cataracts genes at one time.

In 75 percent of the 36 cases tested, the DNA test determined the exact genetic cause of congenital cataracts. In one case, the DNA test helped diagnose a patient with Warburg Micro syndrome, an extremely rare disease that is marked by an abnormally small head and the development of severe epilepsy, among other medical issues. Having a clear diagnosis allowed for genetic counseling and appropriate care to be delivered quicker than previously possible without the test.

 
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.

 
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