Article Date: 11/1/2012

PRACTICE PULSE
PRACTICE PULSE

AMD AND DIABETIC RETINOPATHY PATIENTS BENEFIT

Studies Reveal Additional Perimetry Uses

■ Two separate studies show perimetry is effective in aiding in the diagnosis of age-related macular degeneration (AMD) and in identifying visual function changes in diabetic retinopathy patients.

“Ultimately, I think that this [perimetry] could be another tool in the box for making an accurate and early diagnosis. Where I think that it will really have relevance is down the road when we have more personalized treatments for AMD and diabetes,” explains Jeffry D. Gerson, O.D., F.A.A.O., who sees a great deal of retina patients at his Kansas City, Mo., practice. “What I mean by that is that, ideally, we will identify an AMD patient earlier (by technologies like this), and then get genetic information that will ultimately guide us in how to treat them to prevent any vision loss. Genetics are not at the same place in diabetes as they are in AMD right now, in regards to vision and vision loss, but one would hope that one day we will be able to do the same for diabetes as we do with AMD.”

The AMD study reveals you, the eyecare practitioner, can accurately diagnose the condition with the help of a perimeter and without requiring “dark adaptation,” or having patients sit in a dark room, for 20 minutes pre-testing.1 The reason: The cones of an AMD patient are just about as damaged as the rods, the researchers discovered.

Specifically, the researchers used the TrueField Analyzer (Seeing Machines Limited) to test how pupils at light levels appropriate for rods or cones react to images on LCD screens.2 The device provided an array of stimuli to each eye at 24 locations in the patient’s visual field.

Meanwhile, two video cameras that employed infrared lighting recorded the immediate pupil response, which a computer then analyzed. The researchers found little-to-no difference in the results, regardless of the amount of light to which the eyes were exposed during the test.

The diabetic retinopathy study shows roughly half of those who had no or mild/moderate retinopathy demonstrated deteriorated perimetric sensitivity at 18 months of follow-up. Specifically, more than five points out of 54 in standard perimetry, employing the Swedish Interactive Threshold Algorithm.

1. Rosli Y, Bedford SM, James AC, Maddess T. Photopic and scotopic multifocal pupillographic responses in age-related macular degeneration. Vision Res. 2012 Sep 15;69:42-8.

2. Hellgren KJ, Bengtsson B, Agardh E. Functional and structural change in diabetic eyes. Interim results from an ongoing longitudinal prospective study. Acta Ophthalmol. 2012 Oct 1.

RESEARCHERS TO SPEND THREE YEARS STUDYING N-ACETYLCYSTEINE AMIDE.

Antioxidant Studied to Treat or Cure Degenerative Eye Conditions

■ Missouri University of Science and Technology researchers are working with the antioxidant N-acetylcysteine amide (NACA) to see whether it could effectively treat or cure degenerative eye conditions, such as age-related macular degeneration, says the University.

“NACA’s characteristics as a drug were improved over N-acetylecysteine (NAC) [another experimental treatment] by neutralizing the carboxylic group of NAC, which makes the NACA pass cellular membranes easily,” head researcher Nuran Ercal, M.D. Ph.D., told the University. “And because NACA can be administered at a lower dose, the drug has a greater therapeutic index and lowers the risk of side effects traditionally associated with NAC. NACA is also an excellent source of glutathione, a cell’s main antioxidant power, which is diminished during degenerative eye disorders.”

Dr. Ercal has received a $378,000 three-year research grant from the National Eye Institute for this work.

A FOCUS ON NUTRITION

ONS Launches Fellowship Program

■ The Ocular Nutrition Society (ONS) announced it will launch a new Fellowship program (FONS), which recognizes that formal nutrition science education should be a part of the eyecare professional’s focus in their efforts to prevent disease.

The fellowship program was created in response to the lack of “quality nutrition courses available to eyecare professionals,” according to a press release distributed by ONS during the recent American Academy of Optometry meeting.

Completion of the fellowship program requires 150 hours of nutrition science education, followed by an application process that includes a case report and oral examination.

Upon attaining fellowship status in the ONS, eyecare professionals may continue their educational training in nutrition and receive another 150 hours of credit to become a Diplomate in Nutrition. Accreditation as a diplomate will be provided through the American Clinical Board of Nutrition (ACBM), a professional certification organization that has partnered with ONS. The requirements to earn diplomate status through the ACBM include the presentation of three case studies, authoring an article of publishable quality and the successful completion of a two-part examination.

More information on the society’s fellowship program is available to ONS members at www.ocularnutri tionsociety.org.

PREPARE YOUR PATIENTS, AND PROTECT YOURSELF

O.D.s Play Role in Identifying Common Cold

■ Just as you can identify systemic diseases, such as diabetes, through an eye exam, so too can you “catch a cold” before the patient or other healthcare professionals are aware of it, says Joel Kestenbaum, O.D., who practices in Plainview, N.Y.

“Marked conjunctival redness, watery eyes without itching, follicles or papillae on the conjunctiva, filamentary keratitis and epidemic keratoconjunctivitis, are all telltale signs the patient is developing or already has a cold,” he explains. “Also, obvious preauricular nodes by their ears are a red flag as well.”

Given the common cold usually includes a runny nose, sneezing, coughing and a sore throat, all of which can last for up to two weeks and, therefore, affect work and social plans, patients sans symptoms no doubt appreciate a heads up regarding these ocular signs.1 This way, they can attempt to weaken the cold before it officially strikes.

In keeping in mind that cold and flu patients who have not yet developed symptoms will present to your practice for comprehensive exams, among other eyecare services, through the beginning of spring, Dr. Kestenbaum recommends you do the following to protect you and your staff:

Get the flu shot.
Wash your hands before and after every patient encounter.
Wear gloves when examining patients.
Wash instrumentation with alcohol wipes in between patients.
Wear a mask, if the patient appears to have a cold.

1. Centers for Disease Control and Prevention. Common Cold and Runny Nose. www.cdc.gov/getsmart/antibiotic-use/URI/colds.html (Accessed 11/1/12’)

PERIPHERAL DEFOCUS VIA MULTIFOCAL CLS CHANGES EYE GROWTH AND REFRACTIVE STATE

Multifocal CLs May Reduce Myopia Progression

■ Multifocal contact lenses that add positive defocus to the myopia correction over the retina or confine it to the periphery of the retina may effectively prevent and possibly reverse myopia development, reported David Troilo, Ph.D., F.A.A.O., F.A.R.V.O. at the Optical Society of America’s Annual Meeting in Rochester, N.Y., last month. Dr. Troilo is a professor of biological sciences and vice president and dean for Academic Affairs at the SUNY College of Optometry.

“We know from earlier experimental studies that the eye uses visual stimuli related to defocus imposed on the retina to guide its growth rate and refractive state,” he explains. “We found in marmoset monkeys that soft multifocal contact lenses with a mix of positive and negative power can slow axial growth and shift refraction toward hyperopia. This finding supports the use of similar CLs for refractive therapy in human myopes, and in particular, children, in whom myopia progresses most rapidly.”

When asked where his research now stands, Dr. Troilo says there is more work to do in both the laboratory and the clinic:

“We need controlled clinical trials on larger populations that build on promising earlier, but small scale, clinical studies,” he says. “Right now, we don’t know how much positive defocus in the periphery works best and whether putting more over a smaller area of the retina is different from putting less over a larger area. Also, we know very little about the amount of time needed for these doses of positive defocus to be effective.”

Other researchers, and the CL industry are also working on this, he added. Stay tuned.

FDA News

The LensSX Laser (Alcon) has received FDA clearance for corneal flap creation in refractive surgeries. The femtosecond laser is also approved for capsulotomy, lens fragmentation and all corneal incisions for cataract surgery.

Ocriplasmin injection (Jetera, ThromboGenics NV) has received FDA approval for the treatment of symptomatic vitreomacular adhesion.

The Masterka “pushed” self-retaining monocanalicular nasolacrimal duct intubation stent (FCI Ophthalmics) has received 510k FDA clearance for use on congenital nasolacrimal duct obstructions resistant to probing.



Notes

● Smooth pursuit, fixation stability and free-viewing task tests can detect eye-movement abnormalities implicated in Schizophrenia, with a 98.3% accuracy, says November’s Journal of Biological Chemistry.

● Sustained release OTX-TP2 (travoprost, Ocular Therapeutix, Inc.) demonstrated an IOP decrease of 6.8 mm Hg through two months of treatment in glaucoma and ocular hypertension patients in a pilot Phase II study, the company says.

● Lifitegrast ophthalmic solution 5.0% (SARcode Bioscience), a small-molecule integrin antagonist, demonstrated superiority vs. placebo in the improvement of inferior and total corneal staining scores from baseline to week 12, the end point, says the OPUS-1 Phase III study, presented at the American Academy of Ophthalmology Meeting in Chicago, this month. Further, the mean ocular discomfort score and mean eye dryness score were lower in the lifitegrast patients vs. the placebo patients at week 12.

● As-needed ranibizumab (Lucentis, Genentech) injections for the treatment of diabetic macular edema (DME) appear safe three years post-use, reported researchers at the European Association for the Study of Diabetes Meeting, held in Berlin, Germany last month.

● A meta-analysis study reveals smoking is linked with an increased risk of nuclear cataract and posterior subcapsular cataract, says June’s Investigative Ophthalmology & Visual Science.

● The genetic risk factors of age-related macular degeneration are present in the Irish population at high levels, revealing Irish individuals are at an increased risk of developing the condition, say researchers at the Department of Genetics, Trinity College, and the Royal Victoria Eye and Ear Hospital, both in Dublin.

● Dry eye symptoms (DES) and chemosis are common post-blepharoplasty, and the risk for developing these conditions may grow with postoperative temporary lagophthalmos, concurrent upper and lower blepharoplasty, intraoperative canthopexy and transcutaneous approaches that violate the orbicularis oculi muscle, says October’s Archives of Facial Plastic Surgery. Further, patients who have a preoperative DES history, eyelid laxity, scleral show or who use hormone therapy may be at greater risk for developing dry eyes or chemosis after surgery.

● A diagnosis of celiac disease for more than 10 years in patients who have type 1 diabetes is a risk factor for the development of diabetic retinopathy, says September’s Diabetes Care.

● Three cups of caffeinated coffee daily is associated with an increased risk of exfoliation glaucoma or exfoliation glaucoma suspect status, says September’s Investigative Ophthalmology & Visual Science.

● Hyperlipidemia patients who took statins continuously for two years had an 8% reduced risk of developing open-angle glaucoma (OAG) vs. hyperlipidemia patients who didn’t use statins, says October’s Ophthalmology. Also, the chance of progressing from the glaucoma suspect diagnosis to OAG decreased 0.4% for every additional month of statin use. Further, those who used statins continuously for two years had a 9% reduced risk of progressing from glaucoma suspect to OAG vs. those who received no statin therapy. Finally, the chance of needing medical treatment for OAG decreased 0.4% for every additional month of statin use.

● Antidepressant use in patients with a mean age of 74 is linked with an increased risk of acute angle-closure glaucoma (AACG), says June’s Journal of Clinical Psychopharmacology.

● Xoma Corporation has announced the initiation of a Phase III clinical trial on the efficacy of the company’s GevokizUmAb (a monoclonal antibody with allosteric modulating properties) in the treatment of Behcet’s Disease uveitis.

● Accelerated collagen cross linking applied concurrently with LASIK provides an uncorrected distance visual acuity and manifest refraction equal to or better than the refractive procedure alone, says August’s Journal of Cataract & Refractive Surgery.

● At one year, vascular endothelial growth factor (VEGF) Trap-Eye treatment on diabetic macular edema patients resulted in significant gains in best-corrected visual acuity vs. laser photocoagulation, says August’s Ophthalmology. Further, VEGF Trap-Eye generally was well tolerated.

● The early loss of estrogen appears to lead to premature aging and increased predisposition of the optic nerve to glaucomatous damage, says August’s Menopause.

● The loci rs11024102 in PLEKHA7, rs3753841 in COL11A1 and rs1015213 located between PCMTD1 and ST18 on chromosome 8q have been found associated with primary angle closure glaucoma, says August’s Nature Genetics.

● The risk factors linked with being a member of the costliest 5% for glaucoma-related care are young age, Northeastern United States residence, undergoing cataract surgery and having ocular comorbidities, says September’s American Journal of Ophthalmology.

● Genetic variation in the protein delta catenin may underlie both cortical lens opacities in mid-life and subsequent MRI and cognitive changes that presage the development of AD, says the Sept. 11 online version of PLoS One.



Optometric Management, Volume: 47 , Issue: November 2012, page(s): 12 - 16