Practice Pulse

Eye Test Appears to Identify Patients at Risk for Stroke; Stanford Scientists Developing Retinal Prosthesis; EyeSite; Phase I/II Stem Cell Trial Initiated for Dry AMD; Developmental Optometry Pioneer Dies; Research Notes; Supreme Court Rules Healthcare Act Constitutional; and FDA News.



Eye Test Appears to Identify Stroke Risk

■ Ocular pulse amplitude (OPA) via dynamic contour tonometry appears to detect carotid artery stenosis (CAS), which is a stroke risk factor, says June's Ophthalmology. So, the study's researchers say OPA may be used as a noninvasive and inexpensive screening parameter to detect CAS and possibly to reduce stroke incidence.

Study results showed patients with the lowest OPA scores also had the most blocked arteries. The researchers then employed ultrasound to corroborate that each subject had CAS and to determine blockage severity.

The study was comprised of 134 eyes of 67 patients (25 women, 42 men) with a mean age of 67 + 13 years (range 25 to 87) who were referred for a color duplex ultrasound of the extra- and intra- cranial cerebral arteries.

The researchers performed multivariate analysis (e.g. age, total cholesterol, low-density lipoprotein and trigylcerides) to compare the diagnostic value of OPA measurements with other non- or minimally invasive screening parameters.

Carl Zeiss Launches Web Vision Screening Tool
Through visiting$File/eyetest_en_US.html, patients can access the Zeiss Online Vision Screening, which helps to identify uncorrected vision problems (e.g. visual acuity, contrast and color perception). Also, it includes a link of Zeiss eyecare practices in the patient's area where they can seek a further vision assessment.


Stanford Scientists Developing Retinal Prosthesis

■ Stanford University School of Medicine Scientists are developing a retinal prosthesis to provide sight for those who have retinal degenerative diseases, such as age-related macular degeneration and retinitis pigmentosa, says a Stanford School of Medicine article.

Specifically, the prosthesis includes a pair of goggles armed with a miniature camera and a pocket PC designed to process the visual data stream. A liquid crystal microdisplay implanted in the goggles (akin to what's employed by video game goggles), would display the resulting images, the article explains. How so? The LCD would beam the images using laser pulses of near-infrared light to a photovoltaic silicon chip — one third as thin as a strand of hair — embedded underneath the retina. Electric currents from the chips' photodiodes would then trigger signals in the retina, which are delivered to the brain, enabling the aforementioned patients to regain vision, though not in color and far from normal.

“Since this photovoltaic retinal prosthesis device requires no wires, surgical implantation will be simpler than many current prosthetic retinas, which are driven by coils and often require complex surgery to be implanted,” explains Joseph J. Pizzimenti, O.D., F.A.A.O., associate professor of Optometry at Nova Southeastern University and a member of the Optometric Retina Society. “Therefore, safety and complications, such as fibrotic tissue, may be less of a concern. Of course, any new medical device will require rigorous testing to ensure safety and efficacy.”


Phase I/II Stem Cell Trial Initiated for Dry AMD

■ HuCNS-SC (purified human neural stem cells), from StemCells, Inc., will be undergoing a Phase I/II trial at the Retina Foundation of the Southwest's (RFSW) Anderson Vision Research Center in Dallas, Texas, to determine its safety and efficacy as a dry age-related macular degeneration (AMD) treatment, according to a company press release.

“… Our clinical strategy is to preserve visual function before it is lost,” says StemCells, Inc.'s vice president and head of the Central Nervous System program, Stephen Huhn, M.D., F.A.C.S., F.A.A.P. “Our published preclinical data provides a strong rationale for this approach in dry AMD, and we hope to replicate these results in this clinical trial … ”

The Phase I/II trial will be an open-label, dose-escalation study, which is expected to enroll 16 patients, the press release says. The HuCNS-SC cells will be given via a single injection into the space beneath the retina in the most affected eye. Patients' vision will then be determined using both conventional and advanced methods of ophthalmological assessment. These assessments will be performed at predetermined intervals through a one-year period to assess safety and signs of visual benefit. Patients will also be followed for an additional four years in a separate observational study. Patients interested in participating should call (214) 363 3911.

• Patients who received bevacizumab (Avastin, Genentech) were 12 times more likely to develop severe intraocular inflammation post each injection than those who took ranibizumab (Lucentis, Genentech), says a retrospective chart review study of 1584 patients (693-Avastin, 891-Lucentis) in June's Canadian Journal of Ophthalmology.
• One third of Marfan Syndrome patients surveyed by the National Marfan Syndrome Association said a dislocated lens was the disease's first sign, though just 20% of respondents indicated an O.M..D.(15%) or O.D. (4%) was the first to suspect the condition. Visit
• Nonmydriatic ultrawide field images appear to compare favorably with dilated ETDRS 7-standard field 35mm color 30° fundus photos and dilated fundus exam in assessing diabetic retinopathy and diabetic macular edema severity. This imaging takes less than half the time of dilated photography, says the May 24 American Journal of Ophthalmology online issue.
• Neuro Kinetics, Inc., which makes eye-tracking and noninvasive medical diagnostic equipment used mostly for neurophysiologic and neuro-otologic testing, has partnered with the Johns Hopkins University School of Medicine's Wilmer Eye Institute in clinical trials of Neuro Kinetics' I-Portal Retinopathy, a diabetic retinopathy diagnostic device.

NOVEMBER 28, 1921 - JUNE 17, 2012
Harold Solan, O.D., M.A.,
Developmental Optometry Expert
Optometrist Harold Solan, 90, died June 17 in Cliffside Park, N.J. He was a pioneer in developmental optometry.
Dr. Solan opened a practice in Teaneck, N.J. A prolific author of learning and the visual system, he co-authored almost 30 published studies on the topic and wrote the books The Psychology of Learning and Reading (Simon & Schuster, 1973) and The Treatment and Management of Children with Learning Disabilities (Charles C. Thomas, 1982). In 1981, the SUNY College of Optometry recruited Dr. Solan to serve as chief of its new Learning Disabilities Clinic.
“ … I had the daunting task of being Harold Solan's nominal boss …” wrote Leonard J. Press, O.D., F.A.A.O., F.C.O.V.D. on a College of Optometrists in Vision Development blog. “But we quickly agreed what the real relationship would be, and I welcomed the opportunity to have Harold as my mentor.”
Dr. Solan's work earned him the SUNY College of Optometry's Benjamin Franklin Society Award in 2001, in recognition of his 43 years of dedication to the Optometric Center of New York and to the College, and he became an inductee in the American Optometric Association's National Optometry Hall of Fame in 2003.
He is survived by his wife of 66 years, Shirley, his children, Lawrence and Debra Solan, who live in New Jersey and Fern Dougherty, who lives in Pa. In addition, he leaves behind four grandchildren.


Supreme Court Rules Healthcare Act Constitutional

■ As we go to press, the U.S. Supreme Court has narrowly ruled the 2010 Affordable Care Act (ACA) as Constitutional in a five to four decision.

“The Affordable Care Act's requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” wrote Chief Justice John Roberts in the Court's majority opinion. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”

Chief Justice Roberts added, however, that the Medicaid Expansion portion of the ACA violates the constitution by threatening existing Medicaid funding. The reason: Congress has no power to order the States to regulate according to its instructions. “Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer…” he wrote. The States are given no such choice in this case. They must either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding.”

The cure for this Constitutional violation is to prevent the Federal Government from charging such a sanction, “which does not require striking down other portions of the Affordable Care Act,” Chief Justice Roberts wrote.

The bottom line: Although the ACA is alive for now, the November elections will decide its ultimate fate.

Shortly after President Obama signed the ACA into law in March 2010, 26 states challenged its constitutionality, encouraging the Supreme Court to omit the individual mandate, and therefore, kill the law.

FDA News
■ At press time, Bausch + Lomb announced that Biotrue ONEday, a daily disposable contact lens, has been issued marketing clearance by the FDA. The lens is made from HyperGel (nesofilcon A), a material that offers a high water content and delivers 42 DK/t @ center for -3.00D. The FDA classifies Biotrue ONEday as a conventional Group 2 (non-ionic, high-water) hydrogel material. The base curve of the lens is 8.6mm with a diameter of 14.2mm and an optical zone of 9.00mm @ -3.00D. The center thickness of the lens is 0.1mm for -3.00D. Biotrue ONEday is available in -0.25D to -6.25D (in 0.25D steps) and -6.50D to -9.00D (0.50D steps). The company says it expects to release powers up to +6.50D soon. Other attributes: The lens offers UV protection and comes with a light blue visibility tint. For more information, visit