Lynda Charters

Diabetic macular edema responds to treatment with ranibizumab (Lucentis, Genentech), according to results of the RESOLVE study. The patient responses to the drug in the changes in the visual acuity and central macular thickness were significantly better in the groups treated with two concentrations of ranibizumab compared with the sham-treated group.

In a phase I study, E10030 (Ophthotech) combined with ranibizumab (Lucentis, Genentech) in patients with subfoveal neovascular age-related macular degeneration was well tolerated and seemed to have biologic activity against choroidal neovascularization, according to one ophthalmologist.

A hydrophilic IOL (Afinity CQ2015, STAAR Surgical) seems to be a more efficient delivery system of moxifloxacin 0.5% (Vigamox, Alcon Laboratories) than a hydrophobic IOL (AcrySof SA60, Alcon Laboratories), according to the results of a comparison of lenses soaked in the antibiotic. Both lenses appear to be capable of delivering antibiotics to achieve clinically relevant levels, however.

Intravitreal triamcinolone (IVTA) for treating diabetic macular edema (DME) does not seem to be beneficial over the long term compared with focal/grid photocoagulation, and treatment with IVTA results in a higher chance of developing a cataract compared with treatment with the laser, according to a 3-year comparison study. Focal/grid photocoagulation, therefore, remains the most effective treatment for DME, according to one ophthalmologist.

Blink GelTears and Blink Tears Preservative-Free (Advanced Medical Optics) are two new over-the-counter products for the treatment of dry eye disease. These products are gaining in popularity with ophthalmologist because of the rapid long-lasting beneficial response they produce in this patient population and the absence of a preservative. The products are also beneficial for patients who have undergone LASIK and cataract surgery and develop subsequent dry eye signs and symptoms postoperatively.

Ophthalmologists who responded to questions about treatment of dry eye indicated that there are limitations in the available treatment options, especially for patients with moderate to severe cases of the disease, and that only 5% of ophthalmologists saw existing treatments as effective for the patients with the worst cases.

Ecabet sodium (ISTA Pharmaceuticals), an anti-ulcer and gastritis drug under development for the treatment of dry eye, showed positive results in a phase IIb clinical trial of the drug.

A careful look at all the clues can help the clinician differentiate between dry eye and allergies. The patient history may contain the most important clues for establishing a diagnosis.

A new product (NutriDox Convenience Kit, Advanced Vision Research) is designed to make the treatment of meibomitis, posterior blepharitis, and meibomian gland disease more convenient for patients and clinicians. The prescription-only system includes an antibiotic, nutrition therapy, and a lid-cleansing component.

In a small pilot study with limited follow-up, early application of micropulse laser trabeculoplasty (MLT) using a specific diode laser (IQ810, Iridex Corp.) appeared promising. Use of this multifunctional laser may have practical advantages in a clinical setting. Further study of the technology is needed to determine the role of MLT in the treatment of glaucoma.

A topical eye drop (OT-551, Othera) is being investigated to treat geographic atrophy in dry age-related macular degeneration. The treatment is an antioxidant that in vitro protects against antioxidative damage and in vivo protects against light damage. One-year data are expected to be reported in the spring.

JPE1375 (Jerini Ophthalmic), a peptidomimetic inhibitor of the complement factor 5a receptor, blocks the mechanism that draws inflammatory cells into the disease process of age-related macular degeneration. When blocked, the numbers of neutrophils and macrophages decrease substantially and in turn the choroidal neovascularization also decreases.

A phase 1 trial of rapamycin (Sirolimus, MacuSight) indicated that the drug is safe and has biologic activity in patients with diabetic macular edema when injected intravitreally and subconjunctivally.

Microincision vitrectomy surgery has rapidly gained increased popularity. It is associated with many advantages, but there have been some reports of disadvantages such as a significantly higher incidence of endophthalmitis postoperatively, though more recent reports do not substantiate this conclusion. Advances in the technology likely will facilitate safer and more efficient vitrectomy.

The Micro-Surgical Safety Task Force analyzed potential complications associated with sutureless vitrectomy and disseminated guidelines to reduce the rate of endophthalmitis associated with 25-gauge vitrectomy.

A new surgical platform (Constellation Vision System, Alcon Laboratories) incorporates advanced design features for improved surgical efficiency and safety. Vitrectomy probes (Ultravit, Alcon) facilitate high-speed cutting and control of the duty cycle.

The FDA approved a multifocal IOL (Tecnis, Advanced Medical Optics) for implantation in patients with cataract and presbyopia.

Retinal specialists seemed to hold their collective breaths in 2008 in anticipation of the results of a number of ongoing trials of drugs for various retinal pathologies. Medical retina and the anti-vascular endothelial growth factor therapies were center stage again this year. Some of the highlights include bevacizumab (Avastin, Genentech) for retinopathy of prematurity, sustained-release ciliary neurotropic factor for dry age-related macular degeneration, anti-complement drugs, and the results of the Diabetic Retinopathy Clinical Research study.

A new hyperspectral camera can measure the oxygen level of the retinal tissues non-invasively. This may allow detection of retinal changes in patients with diabetes, and other retinal vascular diseases, before structural changes in the capillaries occur.

Clinical trials provide far more information than just the safety and efficacy of a treatment. Information about the natural course and the risk factors of the disease can be gathered. Of equal importance is the collaboration of clinical investigators as they develop and carry out protocols facilitates incorporation of new ideas into medical practice.

Collagen cross-linking, the newest advancement in the refractive arena, possibly will stabilize keratoconic and ectatic corneas. LASIK, an area that always is improving, has seen changes in flap sizes and lasers. Knowledge of corneal biomechanics also is progressing to provide more information than ever before with new instrumentation. The phakic IOL market has expanded considerably, catering to those with high myopia. IOL options for pseudophakia also are expanding, and refractive lens exchange remains popular for hyperopia. In addition, questions of patient satisfaction postLASIK are being answered by an FDA task force.

Adjuvant use of bromfenac ophthalmic solution 0.09% (Xibrom, ISTA Pharmaceuticals) with ranibizumab (Lucentis, Genentech) reduced the reduced the number of ranibizumab injections needed to control choroidal neovascularization secondary to age-related macular degeneration. Use of the two drugs together resulted in better visual acuity outcomes than those achieved with ranibizumab alone.

A prismatic IOL (P-Flex, Rayner) is giving hope to patients with advanced age-related macular degeneration because of its novel design. A Fresnel prism in the IOL reflects images onto healthy retinas in patients with small macular lesions. No scotoma or diplopia has resulted from implantation of this IOL in two patients.

Wavefront-guided spectacles may provide a better solution than standard eyeglasses for patients with subjective complaints stemming from higher-order aberrations after LASIK.

Analysis programs for longitudinal assessment of glaucoma are advancing. A new optical coherence tomography software analysis program provides overlays of the retinal nerve fiber layer (RNFL) thickness plots as well as regression

Micropulse laser trabeculoplasty (MLT) using a specific diode laser seems to be a safe and effective approach to performing trabeculoplasty.

A proprietary retina tomograph (Heidelberg Retina Tomograph 3, Heidelberg Engineering) can help ophthalmologists differentiate patients at risk of progression to glaucoma from those patients who are not, based on structural and functional findings in the optic nerve and visual fields.

A proprietary miniature glaucoma device implanted under a partial-thickness scleral flap is safe and predictable compared with trabeculectomy.

A better visual outcome can be achieved after corneal transplantation surgery in pediatric patients with Peters' anomaly type 1 if the surgery is performed when the patients are aged approximately 10 to 15 weeks and if the glaucoma and astigmatism are well controlled.

Monocyte chemoattractant protein 1 (MCP-1) seems to be responsible for apoptosis of the photoreceptors in certain visual disorders. MCP-1 seems to have a critical role in mediating photoreceptor apoptosis after retinal detachment in an experimental murine model. Specifically, MCP-1 causes macrophages and microglia to accumulate and generate oxidative stress in the retina.