Article Date: 9/1/2007

PST Success In AMD Patients is Likely Contingent on Long-Term Treatment

PST Success In AMD Patients is Likely Contingent on Long-Term Treatment


■ The success of problem-solving treatment (PST) in preventing age-related macular degeneration (AMD)-induced depressive disorders may depend on treatment length, says a study in August's Archives of General Psychiatry. PST is a manual-driven psychological treatment that imparts problem-solving skills to patients by defining problems, establishing goals, implementing solutions and evaluating outcomes.

Results of the randomized, controlled two-month trial, revealed that the PST group (105) had a significantly lower incidence rate of depressive disorders than the control group (101), which received usual care (eyecare practitioner treatment). Also, PST was shown to decrease the odds of abdicating a valued activity. At six months, however, most of the earlier-observed benefits decreased, though those in the PST group were less likely than the control group to be affected by constant depression.

Subjects were aged 65 and older from a tertiary eye center who were recently diagnosed with neovascular AMD in one eye and pre-existing AMD in the fellow eye and had no history of depression.

As a result of these findings, the researchers conclude that booster or rescue treatments may be needed to buttress the effect of PST.

Short-term PST may not be effective long-term because AMD patients often have successive decreases in vision, requiring them to re-learn methods of coping, says Goldie Dersh, Ph.D., and vice president of The Jewish Guild for the Blind's Behavioral Health Services. To assess the mental health of your AMD patient, Dr. Dersh suggests you ask:

  1. During the past month, have you often been troubled by feeling depressed or hopeless?
  2. During the past month, have you often been bothered by little pleasure in doing things?

A positive response to either question indicates the patient may require a mental-health assessment to determine if depression is present and impacting his or her adjustment to vision loss, she says.

Gene Variations Raise AMD Risk

While previous studies have shown the single-nucleotide polymorphisms in the CFH and LOC387715 genes are linked with AMD, Boston researchers have found that common polymorphisms in these genes are actually independently related to the progression of the advanced disease, even when controlling for demographic factors, smoking, body mass index (BMI) and age-related eye disease study (AREDS) vitamin-mineral treatment, says a study published in the Journal of the American Medical Association.
So, can patients determine if they have polymorphisms in the CFH and LOC387715 genes? At this point, not commercially, says Sherry J. Bass, O.D., a professor at the State University of New York (SUNY) State College of Optometry, who lectures extensively on retinal disease.
"If your patient is interested, however, you could refer him to researchers who are conducting similar studies to determine whether he carries one or both of these single nucleotide polymorphisms or SNPs-pronounced "snips," she says. (For additional information contact and/or www. "If we knew a patient had these SNPs, and he is in the early stage of the disease, we might conceivably now follow him more frequently, though the literature has not indicated this change in management thus far."

Zinc May Play AMD Formation Role


■ High concentrations of "free" or "mobilized" zinc may play a role in the formation of the sub-retinal pigment epithelial deposits, such as drusen and basal laminar deposits in Bruch's membrane — seen in AMD, says a study published in Experimental Eye Research.

This could mean the possible development of new drugs that can capture this mobilized zinc, decreasing the degenerative process of AMD. Researchers have already begun doing this with Alzheimer's disease, as mobilized zinc has been implicated in deposit formation in this neurodegenerative disease.

Optometrist Reviews iPhone Components He's Used Most.


John Warren, O.D. Racine, Wis.

■ Although I was going to defer buying an iPhone until August or September to let Apple update the software and firmware (a computer program imbedded in a hardware device), my plan was foiled. (The iPhone is a hand-held instrument, from Apple, that houses a phone, iPod [music and movie software] and Internet access.)

I stopped by a friend's AT&T store and took a 4gigabyte iPhone for a "test drive." (The iPhone is also available in 8gigabyte). After spending three minutes working on the device's stunning interface, which is incredibly intuitive and easy to learn and master, and feeling the physical design in my hands and experiencing the user interface, I decided I couldn't wait to buy one.

Having used the instrument for three months now, here are my impressions of the iPhone components I've used the most:

► Weather icon. The weather icon, which you can select for a report in your or other areas, is a very helpful application, though a bit more information, such as the ability to see an hour-by-hour forecast about each day would be even better, even if this meant sacrificing the broad list of future forecasts the device offers.

Phone. This component of the iPhone enables you to call someone by tapping a name or number in the device's address book (which you create), a call log or a favorites list. The phone also automatically synchronizes all your contacts from your Mac, PC or Internet service provider.

Being a busy professional, I've greatly appreciated the ease with which I've been able to handle call-waiting and call switching with this component. In other words, starting conference calls, adding people to an existing call and ignoring unwanted calls has been very easy.

The "Visual Voicemail" aspect of the phone, which lets you see who left you an individual voicemail and enables you to only listen to the ones you want is a great feature, though I've been a bit annoyed by some of the delays I've experienced in retrieving a few of my voicemails.

Virtual keyboard. This component enables you to type e-mails and enter Web addresses. The buttons are large enough to type with ease, though you do need to follow Apple's advice and learn to trust the spelling/word completion that the device does for you. This has been challenging, as the instrument modifies some proper nouns and enters text automatically.

Internet. This component of the iPhone boasts a rich Hyper Text Markup Language (HTML) e-mail client and the Safari Web browser, which automatically synchronizes book-marks from your Mac or PC. In addition, the Internet component allows you to browse a Web page while downloading your e-mail via Wireless Fidelity (Wi-Fi) or Enhanced Data GSM Environment (EDGE) (the AT&T data service the iPhone uses).

I've found Safari very easy for accessing Web pages, and I've greatly enjoyed the ability to automatically switch from portrait to landscape modes when I'm viewing a web page that runs more horizontally than vertically.

The Google Maps aspect of the iPhone Internet has been a wonderful help, as it has allowed me to obtain driving directions for my contacts and myself and avoid traffic. Google maps has also enabled me to search for businesses and free nearby Wi-Fi locations.

Drawbacks. The Internet characteristics with which I'm not thrilled: iPhone does not yet support Flash — precluding me from accessing certain Web pages. Also, the e-mail system does not contain a unified inbox, "filters" or "rules" as of yet — meaning I can't filter my business and personal e-mails into different inboxes. Also, while the EDGE data access works fine for e-mails, it lacks the necessary speed for Web browsing. Thankfully, free Wi-Fi access is plentiful in my area, and I use my network at home, my office and my favorite coffee shop to surf the net.

Battery life. Although this isn't a usable component, due to the recent media coverage of battery-life lawsuits, I feel compelled to comment on this. The battery life of the iPhone has, in fact, been good, in my experience. In fact, I've been able to get 14-hours of use from one charge, and my battery level has never gone below 20%. For these reasons, I feel all the threatened- and real lawsuits over battery life are unsubstantiated.

Overall, I'd give the iPhone 4 stars out of five. While it's initial feature set list isn't much longer than other phones, I've found that it does what I need it to do better than my former phone. OM

Dr. Warren is in private practice in Racine, Wis. Contact him by e-mail at

B&L Acquires Soothe Brand


► Bausch & Lomb (B&L) has acquired Soothe brand emollient eye drops from Alimera Sciences. B&L plans to expand the line of over-the-counter (OTC) products that relieve dry-eye symptoms to include Soothe, now renamed Soothe XP, and Soothe Lubricant Eye Drops Long Lasting Relief Preservative Free.

Soothe uses a hydrophilic polymer to interact with the eye's mucin layer. This interaction allows water and the product's demulcent active ingredients, which stabilize and rebuild tear film, to be retained in the cornea, according to B&L. Soothe XP works with the lipid layer of the tear film to reduce evaporation and seal in moisture.

In late 2006, B&L purchased Alimera's OTC allergy line, including Alaway antihistamine eye drops.

In related news:

  • B&L recently launched Ocuvite DF eye vitamin supplement. This contains the antioxidant genistein. In combination with other nutrients and antioxidants such as alpha-lipoic acid, genistein combats free radicals and reduces oxidative stress, both of which are associated with diabetic retinopathy.
  • B&L's Greenville, S.C. solutions manufacturing and distribution facilities are in acceptable compliance, based on an FDA inspection.
  • B&L and Alcon Laboratories, Inc. have settled the civil suit B&L filed against Alcon in June for false and misleading advertising claims about the company's ReNu MultiPlus multipurpose contact-lens solution.
  • VCA Promotes Politics produced by the Vision Council of America, contains vision-care-related legislation. The site facilitates grass roots action by providing legislative alerts, news studies and a variety of tools to help you and your patients communicate effectively with elected representatives, VCA says.

    Topcon Web Site Boasts Easy Navigation
    ■ Topcon Medical Systems (TMS), launched a new, interactive website ( that offers an internal search engine and a user-friendly visual interface for easier site navigation. The site displays company products as picture thumbnails, allowing you to directly click on the product without having to navigate through drop-down menus. Topcon has also added video testimonials and digital brochures, trade articles and instruction manuals to the site. Finally, you can request technical support and additional product information.

    The terms of the settlement: Alcon has agreed to change the red-yellow color scheme used in its promotional materials on optometrist Gary Andrasko's corneal staining grid, which B&L felt implied ReNu MultiPlus was unsafe and should therefore be avoided.

    Vote for Your Favorite Practice Tip
    On October 24, Optometric Management will publish the 300th Management Tip of the Week, an e-newsletter of practice management pearls written by Neil Gailmard, O.D. OM invites you to take part in this special occasion by voting for your favorite tip and telling us how it impacted your practice.
    We will publish the favorites in Tip 300 as well as in OM. Dr. Gailmard will revisit and expand upon popular topics in future editions of Tips. Please send your nominations to by October 5, 2007. In your e-mail, include a brief summary of how the tip changed your practice. Names will be withheld from publication unless you include permission to publish your name with your submission.
    To subscribe to the weekly Tips e-mail, or to view the Tips archive, log on to Optometric Management's site at

    Bausch & Lomb has named Jeffrey Nardoci vice president and general manger – U.S. Lens Care and over-the-counter (OTC) products. Nardoci is responsible for the strategic direction of B&L's lens care and OTC products and for overseeing the company's marketing, sales and advertising initiatives.

    Crowell Systems, manufacturer of Medformix electronic medical records (EMR)- and practice-management software solution, has named Shawn Gupton vice president of sales.

    Cooper Companies named Robert Weiss to succeed Cooper Chief Executive Officer Thomas Bender. Mr. Weiss, currently chief operating officer, will assume his new role in November.

    Andreas Dreher, Ph.D., who has served as chairman of the board and chief technology officer of Ophthonix will leave the company, but continue to assist Ophthonix as a consultant.

    Kent Daum, O.D., M.S., and Ph.D., has been appointed vice president and Dean for Academic Affairs of the Illinois College of Optometry.

    VSP Vision Care honored Army Reservist Curtis Gales, O.D., of Colorado Springs, Colo., with the "National People First" award. He was given this award for his dedicated humanitarian efforts. While serving in the armed forces, Dr. Gales provided eye care for countless soldiers, Department of Defense civilians and contract workers. In 2005, he was deployed to Iraq, where he was stationed at a prison outside Baghdad.

    Prevent Blindness America chose actress Jane Seymour as the recipient of the 2008 Visionary Award. Ms. Seymour was selected because of her support of sight-saving programs and initiatives related to age-related macular degeneration (AMD).

    □ Using an FDA-validated driving simulator, race-car driver Liz Halliday identified road hazards an average of 25.83 feet sooner using iZon High Resolution lenses than with standard eyeglass lenses. Ms. Halliday's results were similar to those of a study conducted by the U.S. Navy, in which drivers identified road hazards approximately 20 feet sooner with the iZon Wavefront Lenses.


    CooperVision offers an information kit to help you communicate key benefits of the daily disposable modality to your patients. Request the CooperVision "1 Day No Solution Solution Kit" online at

    Transitions Optical has announced that its Ocular Side Effects Database is now available for download to a Personal Digital Assistant (PDA) at

    □ In preparation for the 2008 Olympic games in Beijing, Johnson & Johnson's Vision Care Institute will offer its new AchieveVision program to Olympic athletes and hopefuls. AchieveVision is a customized visual skills assessment and improvement program designed to maximize vision for a specific sport or lifestyle.

    □ Give the Gift of Sight honored Santinelli International as a "20/20 Visionary" and as a "Decade Donor." Each year, Give the Gift of Sight volunteers and optometrists, in partnership with Lions Clubs International members, hand-deliver eye exams and recycled eyewear to underprivileged individuals in developing countries around the world.

    VSP Vision Care celebrates the 10th anniversary of its Sight for Students program (, which provides free, comprehensive eye exams and prescription eyeglasses to low-income, uninsured children. The program has delivered free eye care to 410,000 children.

    Silhouette's Blue Light/Advanced Macular Degeneration (AMD) Awareness campaign was named a finalist in the competition for the Delta Awards honoring excellence in medical marketing and bestowed by the Medical Marketing Association (MMA). The campaign discusses AMD prevention and the link between retinal damage and blue light.


    Heidelberg Engineering introduced a new perimeter technology, Heidelberg Edge Perimeter (HEP), that uses a stimulus called Flicker Defined Form, which targets M-cells. Using flickering black-and-white patterns, the stimulus creates an illusory edge where the patient perceives a circular stimulus. This methodology targets early glaucoma and results in higher re-test reliability than conventional methods, says Heidelberg.

    WaveTouch Technologies now certifies the Marco 3D Wave Analyzer as one of the in-office aberrometers that will provide the necessary patient information for the production of fully individualized WaveTouch wavefront-guided soft contact lenses.

    □ The FDA has approved the Advanced CustomVue Monovision Procedure (Advanced Medical Optics) as a wavefront-guided laser vision correction procedure for myopic presby-opic patients with and without astigmatism.

    Accutome, Inc. has received Health Canada's approval on its new B-Scan Plus. The new B-Probe links directly to a laptop or PC computer by USB Port, says Accutome.

    University of Virginia's (UVA) Health System has installed the Optomap Panoramic200 (P200) scanning laser ophthalmoscope and will offer the retinal exam as part of the primary care services within their Department of Internal Medicine. UVA's Health System is an integrated network of primary and specialty care services ranging from wellness programs and routine checkups to advanced care.


    The Contact Lens Council (CLC) has launched to educate contact-lens wearers on how to care for their lenses, among other contact-lens-related information.

    The American Academy of Dermatology reports that more than one million new cases of skin cancer will be diagnosed in the United States this year, making it the most common form of cancer. Further, the organization says an an estimated 10,850 people will die of this form of cancer this year.

    Optometric Management, Issue: September 2007