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Combined fluocinolone implant and glaucoma surgery shows promise in eyes with uveitis and glaucoma
Researchers retrospectively evaluated five patients (seven eyes) with uveitis and elevated IOP who underwent combined fluocinolone acetonide implantation and glaucoma tube shunt placement in a single surgery. At 12 to 30 months follow-up, uveitis recurrences decreased, mean visual acuity improved, adjunctive steroid use decreased, and average IOP decreased from 27.3 mm Hg at baseline to 14.6 mm Hg. No adverse events were observed. American Journal of Ophthalmology, May 2010
Age not a risk factor for developing glaucoma after pediatric cataract surgery
Researchers retrospectively analyzed the charts of 71 children (100 eyes) aged 14 and younger who underwent surgery for congenital or developmental cataract at a single center over the last 20 years. At a median follow-up of five years, the overall incidence of glaucoma was 2 percent, a rate that remained consistent even in children who underwent surgery within the first six weeks of life. Eye, April 2010, online publication
ß-Zone parapapillary atrophy linked to higher risk of glaucoma progression
Researchers retrospectively evaluated results from 245 glaucoma patients, 146 with ß-zone parapapillary atrophy (PPA) and 99 without it, who were evaluated for progression for five years. Eyes with PPA progressed more rapidly (-0.84 dB/year) than eyes without it (-0.51 dB/year; P<0.01), and they had faster global rates of progression. The presence of any amount of PPA increased the risk of progression. Multivariate analysis determined that differences in the presence of PPA, mean IOP, and IOP fluctuation were significant predictors of future global visual field injury. Ophthalmology, May 2010
IOP remains stable in patients with early glaucoma
Researchers analyzed changes in IOP among 118 patients with newly diagnosed glaucoma who were part of an untreated control arm of the Early Manifest Glaucoma Trial (EMGT). Patients were examined every three months for six years or until progression, when treatment could be initiated. They found that IOP remained stable for six years, regardless of baseline IOP, except in patients with exfoliation glaucoma, whose IOP increased by almost 1mmHg annually. No other factors were related to longitudinal IOP changes. Archives of Ophthalmology, May 2010
Triamcinolone acetonide after cataract surgery doesn’t adversely impact IOP
This prospective study included 120 patients (120 eyes) randomized to receive a 1 mg injection of intracameral triamcinolone acetonide or placebo after routine cataract surgery. In both groups, mean IOP levels were significantly higher than baseline within 24 hours of surgery (P<0.001) but dropped to near-baseline values within a week and stayed at those levels through six months of follow-up (P>0.05). Visual acuity and anterior chamber cell and flare count were similar in both groups at all postoperative visits (P>0.05). Eye, April 2010
Diabetic Macular Edema
Ranibizumab plus laser therapy more effective than laser alone for DME
Researchers randomized 691 participants (854 eyes) with diabetic macular edema (DME) involving the central macula to one of four groups: sham injections plus prompt focal/grid laser treatment within one week, ranibizumab injections plus prompt laser treatment, ranibizumab plus deferred laser treatment after six months or more or triamcinolone and prompt laser. After one year, nearly 50 percent of eyes treated with ranibizumab and prompt or deferred laser treatment showed a substantial visual improvement (=10 letter gain from baseline), compared with 28 percent of eyes receiving laser treatment alone or triamcinolone plus laser. In pseudophakic eyes, triamcinolone and prompt laser appeared more effective than laser alone but frequently increased the risk of elevated IOP. Ophthalmology, Article in Press, May 2010
Bevacizumab appears more effective than laser therapy in patients with center-involving CSME
This prospective, masked, single-center trial randomized 80 patients (80 eyes) with center-involving clinically significant diabetic macular edema and at least one prior macular laser therapy (MLT) to intravitreal bevacizumab (six weekly) or MLT (four monthly). Mean BCVA at 12 months was 61.3 in the bevacizumab group and 50 in the laser group (P = 0.0006). The bevacizumab group gained a median of eight letters, while the laser group lost 0.5 (P = 0.0002), and the odds of gaining at least 10 letters over 12 months were more than five times greater in the bevacizumab group. Ophthalmology, May 2010, Article in Press
Bevacizumab appears safe for treating PDR after photocoagulation therapy
This prospective study included 24 patients (33 eyes) with proliferative diabetic retinopathy (PDR) who either failed to respond to panretinal photocoagulation or experienced recurrence. After a single dose of bevacizumab, complete resolution occurred in 78.8 percent at one month, 63.6 percent at three months, and 45.4 percent at six months. After a second injection in the third month, the complete resolution rate increased to 60.6 percent in the sixth month. Visual acuity increased (20/225 to 20/108), macular edema decreased (11.65 mm3 to 8.92 mm3) and no complications were observed. Retina, April 2010
Intensive glucose treatment and combination lipid therapy slows progressions of diabetic retinopathy
This prospective, multi-center study randomized 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or Hg). A large subgroup was evaluated for the effects of these interventions at four years follow-up. They found that both intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy by about one-third. New England Journal of Medicine, June 29, 2010.
More evidence supporting link between sleep apnea and proliferative diabetic retinopathy
Researchers used a pulse oximeter to evaluate items of sleep-disordered breathing in 219 consecutive patients who had type 2 diabetes with either nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR). The lowest mean oxygen saturation levels (SpO2) were significantly lower in the PDR group than in the NPDR group as were the sleeping 4% oxygen desaturation index and cumulative percent time spent at SpO2 < 90% levels. Logistic regression analysis identified being younger, having a lower value for the lowest SpO2, and a high hemoglobin A1c value to be independent risk factors for PDR. American Journal of Ophthalmology, June 2010.
Age-Related Macular Degeneration (AMD)
More Reasons to Eat Fish!
Evidence suggests that the fatty acids in fish help to prevent age-related macular degeneration. Researchers reviewed nine studies involving almost 89,000 people, including 3,200 with age-related macular degeneration (AMD). Their findings, reported in the Achieves of Ophthalmology, show that people who ate fish at least twice a week along with other foods rich in fatty acids, such as flaxseed and walnuts, lowered their risk of both early and late AMD. What's more, those who consumed the highest amounts of fatty acids had a 38% reduction in the risk of developing more advanced AMD than those who consumed the least. Two other major studies, the Blue Mountains Eye Study and the Nurses' Health Study, had similar results.
Omega-3 fatty acids are more abundant in oily fish like tuna, salmon, sardines and trout. One of the fatty acids, docosahexanoic acid, is present in high amounts in parts of the retina, and researchers speculate that a deficiency may trigger AMD. Fatty acids also protect membranes from inflammation, age-related alternations, and oxidative stress caused by an excess of cell-damaging molecules.
More studies are necessary before researchers can say for certain that the fatty acids in fish prevent AMD, but the findings are promising. Regardless, two servings of fish a week is a great way to get lean, heart healthy protein that may protect your eyes.
Eye Tip- For Healthy Eye and Vision Loss Prevention
-Wear sunglasses to protect against damaging ultra-violet (UV) radiation.
-Watch what you eat- little changes in your diet can have a big impact on eye health.
-Give your eyes regular "20-20-20" breaks when using computers or hand-held devices; every 20 minutes, take a 20-second break and view something 20 feet away.
-Dont forget protective eyewear when doing hazardous work around the home.
-And most importantly, have your and your families' eyes examined regularly.
The Eyes Have it - Great Sources of Eye-Friendly Vitamins
According to the eye care provider VSP, the following are great sources of eye-friendly vitamins:
-Vitamin A: Carrots, kale, spinach, dairy products, egg yolks
-Vitamin C: Citrus fruits (especially kiwi fruit) and juices, green peppers, broccoli, potatoes.
-Vitamin E: Eggs, whole grains, vegetable oils, sunflower seeds
-Lutein: Spinach, corn, kale, broccoli, brussels, sprouts
-Fatty acids: Coldwater fish, such as: salmon, mackerel, and rainbow trout; sunflower oil, corn oil
-Zinc: Meat, poultry, fish, whole grains, dairy products
Voluntary Recall of PreserVision Eye Vitamin AREDS 2 Formula in the United States
Bausch + Lomb is conducting a voluntary recall of its PreserVision Eye Vitamin AREDS 2 Formula with Omega 3 soft gels, only available within the United States.
Bausch + Lomb chose to initiate this recall based on a small number of reports predominantly within a specific age group, age 70 and older, who reported difficulty swallowing or a choking sensation when taking the soft gel.
The voluntary recall is limited only to the United States; it does no affect locations in Europe, the Middle East, or Asia-Pacific regions. The PreserVision Eye Vitamin AREDS 2 Formula with Omega 3 is the only supplement affected in the recall; all other PreserVision and Ocuvite Supplements, soft gels and tablets, remain on the market.
To clarify, the formulation of PreserVision Eye Vitamin AREDS 2 Formula with Omega 3 is safe. While many customers can comfortably swallow the supplement, Bausch + Lomb believes the design of the soft gel requires further consideration.
Bausch + Lomb expects to release an AREDS 2 formulation in a smaller soft gel which will be dosed twice per day, two pills per dose. The immediate redesign is expected to be available to customers by later this year.
Bausch + Lomb is asking that consumers who currently have this product to return it, even if consumers are comfortable swallowing the soft gel. Consumers who have this product in their home should call customer service for instruction on returning and reimbursement at 1-800-553-5340.
Stem Cells Breakthrough for Blind Patients: After Treatment Restores Vision
Italian researchers have claimed that they restored the sight of patients who were left blind after chemical accidents, using corneas grown from the patient’s own stem cells. In the study, reported in the New England Journal of Medicine, researchers successfully extracted adult stem cells from healthy eye tissue before growing additional stem cells that were placed over damaged eye tissue. The stem cells were extracted from the limbus of the patient's healthy eye; only a millimeter of this tissue was required.
The treatment was successful in more than three quarters of the 112 patients, allowing them to see well again, although some needed more than one graft.
Experts have said that this study, undertaken between 1998 to 2007, offers new hope to thousands of people who suffer from chemical burns on their corneas. The research is being hailed as key breakthrough in scientific regeneration to persons with otherwise irreversible eyesight.
Omega-3 fats: Various Types
There are three main types of omega-3 fats to keep track of: eicosapentaenoic aid (EPA), docosahexanoic acid (DHA), and alpha-linolenic acid (ALA). EPA and DHA are found mainly in fish, so they're sometimes called marine omega-3s. ALA is found in plant-based foods, such as flaxseed, walnuts, and canola and soybean oils.
So far, the evidence for EPA and DHA having health benefits is more extensive than for ALA. Studies have shown that EPA and DHA offer some measure of protection against heart attacks and strokes. EPA and DHA also have anti-inflammatory effects that may be useful in preventing or treating conditions like rheumatoid arthritis and inflammatory bowel disease. Some well-designed studies of ALA are under way, but right now there just aren't enough data to be confident about ALA having the same effects of EPA and DHA. And there's reason for doubting whether it does. The body converts ALA to EPA and then to DHA, but happens only in small amounts. If you're aiming to increase your omega-3 intake to accomplish all the things that omega-3s are thought to do, increasing the amount of fish you eat is probably the best way to go. That said, flaxseed and the other ALA-rich oils may still be a healthful choice, if you are using them to replace trans or saturated fat.
The American Heart Association recommends that adults eat two serving of omega-3 rich fish (salmon, for example) per week, which works out to about 400 to 500 milligrams (mg) of EPA and DHA per day. People with heart disease are advised to double that, so their daily intake is 1,000 mg, or a full gram. Taking fish oil capsules is often the most practical way to get that amount of omega-3s. If you choose to take fish oil capsules, note that the amount of EPA and DHA provided is often only about a third of that listed on the front of the bottle. Check the Nutrition Facts label on the back for the actual amount. -JoAnn Manson, M.D., Dr. P.H.
Treating ocular hypertension appears cost-effective only in patients younger than 65
Researchers used a Markov simulation model to estimate the costs and benefits of treating a patient with ocular hypertension over his remaining lifespan. With cost effectiveness defined as willingness to spend $50,000 to $100 000/quality adjusted life year, they found that it is cost-effective to treat a patient who has a 2 percent or greater annual risk of developing glaucoma only when the person is aged 45 and has a life expectancy of more than 20 remaining years. Treatment of those aged 55 requires a life expectancy of 24 remaining years. Treatment of people older than 65 did not meet most accepted standards of cost-effectiveness. Archives of Ophthalmology, May 2010
Endonasal DCR with MMC shows high success rate
This retrospective study analyzed outcomes in 193 consecutive adult patients (224 eyes) with unilateral or bilateral nasolacrimal duct obstruction who underwent nonlaser endonasal dacryocystorhinostomy with adjunctive mitomycin C (MMC). At a mean follow-up of 18.3 months, the procedure was successful in 95 percent, and no significant complications were observed. The author notes this technique has the added advantages of leaving no scar and preserving the medial canthal structures. It may also be performed successfully as a simultaneous bilateral procedure. Ophthalmology, May 2010
Topical voriconazole appears an effective option for fungal keratitis
Researchers extensively reviewed the literature and major case studies on the effectiveness and safety of topical voriconazole for ophthalmic fungal keratitis. The voriconazole eye drops used are typically of 1% concentration, appear to be well tolerated and stable, and demonstrate good penetration into the aqueous and vitreous humors of the human eye. However, more studies are needed, especially in relation to larger dosing, dosing frequency, and use as first-line or stand-alone treatment. Clinical Ophthalmology, May 2010