News

1-year results from the HORIZON open-label extension study of ranibizumab (Lucentis, Genentech) for the treatment of exudative age-related macular degeneration show that treatment beyond 2 years relatively is safe and well tolerated, but previously treated patients who received ranibizumab monthly for 2 years may be susceptible to loss of vision with less-frequent dosing during the third year of treatment.

A novel gene therapy approach for the treatment of a type of inherited retinal disease appears to be safe and effective in initial trials. Results offer hope for the treatment of a gamut of eye diseases that once were thought to be untreatable, according to one researcher.

In a dose-ranging phase IIb study, microplasmin 125 micrograms (ThromboGenics) was safe and demonstrated significant efficacy compared with placebo for inducing posterior vitreous detachment in eyes with macular holes or macular edema related to vitreomacular traction. Pivotal phase III trials are being planned.

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.

Visual acuity gains occurring in a 12-week, fixed-dose period were maintained throughout the 52-week trial of a novel agent (VEGF Trap-Eye, Regeneron Pharmaceuticals) for neovascular age-related macular degeneration. During the 9-month, as-needed dosing phase, the mean number of injections for all patients was two, and gains in visual acuity of up to nine letters were reported.

When data were analyzed from 25 patients who reached the 18-month visit in a phase II trial evaluating epiretinal brachytherapy (EpiRad90 Ophthalmic System, NeoVista) with bevacizumab (Avastin, Genentech), they demonstrated that the novel combination was associated with a significant gain in vision, an acceptable safety profile, and with minimal need for additional anti-VEGF treatment beyond an initial two injections.

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.

Sirion Therapeutics Inc. announced that a difluprednate ophthalmic emulsion 0.05% (Durezol) indicated for the treatment of inflammation and pain associated with ocular surgery is now commercially available.

Drug development for retinal disease is particularly challenging because traditional routes of drug delivery often are unable to achieve desired therapeutic levels, and the disease process often involves multiple complex pathways. An unmet medical need still exists-particularly for the two most prevalent diseases, age-related macular degeneration and diabetic retinopathy-but several phase III trials show promise.

Akorn Inc. has announced approval of an FDA new drug application (NDA) for ophthalmic gel 3.5% (Akten), a topical, ocular anesthetic formulation.

Advanced Medical Optics (AMO) announced that the FDA has granted premarket approval of a clear dispersive ophthalmic viscosurgical device (OVD) (Healon D) for use as a surgical aid in cataract extraction, IOL implantation, corneal transplant, and glaucoma filtration surgery.

A new intravitreal insert (Iluvien, Alimera Sciences) currently in clinical trials manages a slow, long-term release of corticosteroid into the vitreous chamber. Preliminary results show the device to be very promising and possibly more favorable than other similar devices used for the treatment of diabetic macular edema.

A collaborative effort to design an intracortical visual prosthesis has progressed to the point that tests of a prototype in a human volunteer are being planned. The results of psychophysical testing in normal volunteers indicate that the prosthesis could provide sufficient visual functionality to enable users to perform useful visual tasks.

Parents of children with amblyopia may have several reasons (or excuses) for not following a prescribed patching regimen. Ophthalmologists who are following the Pediatric Eye Disease Investigator Group guidelines but are not achieving the desired results, should first examine whether patients are adhering to the prescribed therapy.

The adequate management of posterior uveitis in children is difficult but imperative. Many treatment options exist, but to determine the best one for patients, it may be best to divide them into two groups at least initially: those with unilateral disease and those with bilateral disease. Treatment decisions then will follow, based on the severity of the disease.

A 19-year-old Latin female presented to the Bascom Palmer emergency room complaining of transient black spots in the right eye.

In the past year, the world of ophthalmology has seen some significant headlines. They captured numerous issues that included patient satisfaction and quality of life, infectious outbreaks, and controversy over treating patients with unapproved drugs. In a press briefing at the American Academy of Ophthalmology (AAO) meeting, "2008 year in review: An update on key issues in the news," ophthalmologists provided an update.

An undiagnosed problem plagues ophthalmology practices, according to Shani Lenard, who believes that the relationship between physicians and administrators can affect the success of a practice. Lenard, practice management consultant, MediScend, Pembroke Pines, FL, and panel members Ann M. Hulett, COE, CAE, Rocky Mountain Eye Center, Murray, UT; Gregory S. Brinton, MD, MBA, founding partner of Retina Associates Utah, Layton; and Traci Fritz, COE, administrator, Fite Eye Center, Clinton Township, MI, discussed the characteristics that build good relationships and key behaviors and explained why they foster success.

Visual hallucinations caused by Charles Bonnet Syndrome (CBS) are not infrequent in older individuals with decreased visual function. While individuals who experience these hallucinations, which are usually generic people, animals, patterns, or scenes, understand that what they are seeing is not real and often are not disturbed by the images, they are worried about the reaction of their families, friends, and physicians.

When faced with a postcataract surgery refractive surprise, implanting a secondary piggyback IOL can be a successful option with careful attention to selecting appropriate candidates, IOL model, and power calculation technique, said Warren E. Hill, MD, a private practitioner, Mesa, AZ.

The difficulty of accurate IOL power calculation in postLASIK eyes is an issue being faced increasingly by cataract surgeons. Jack T. Holladay, MD, clinical professor of ophthalmology, Baylor College of Medicine, Houston, offered several tips for achieving better refractive outcomes in this growing population of eyes.

If the posterior capsule breaks during cataract surgery and vitreous presents to the anterior chamber, patients are best served by anterior vitrectomy using a pars plana technique, said Louis "Skip" Nichamin, MD, medical director, Laurel Eye Clinic, Brookville, PA.

Instead of combined surgery, cataract extraction alone by phacoemulsification through a clear corneal incision with posterior chamber IOL implantation may be the most appropriate procedure for patients with controlled or modestly uncontrolled glaucoma as well as for patients with ocular hypertension or glaucoma suspects, said Richard L. Lindstrom, MD, in his delivery of the Kelman Lecture during the Spotlight on Cataract Surgery session of the annual meeting of the American Academy of Ophthalmology.

A new how-to guide for dispensary issues, entitled "The Dispensing Ophthalmologist," outlines what ophthalmologists and administrators need to know to operate a profitable dispensary. The book is written by Arthur De Gennaro, president of Arthur De Gennaro & Associates LLC, Lexington, SC, an ophthalmic practice management firm that specializes in optical dispensary issues.

The launch of a specialized dietary supplement (DiaVis, ScienceBased Health) to support the visual and overall health of those with diabetes was announced at the American Academy of Ophthalmology meeting.

Dry eye disease and cataract and refractive surgery are intertwined closely. Pre-existing dry eye can affect surgical outcomes and, in severe cases, is a contraindication for surgery, whereas surgery causes trauma to the ocular surface and may lead to signs and symptoms of dry eye. To break this cycle, a two-pronged approach of treating dry eye before surgery and taking steps to prevent its development postoperatively is advisable.

At the American Academy of Ophthalmic Executives (AAOE) meeting, Derek A. Preece, MBA, from the BSM Consulting Group, Orem, UT, talked about the importance of understanding exactly what benchmarks are and how to use them effectively during his presentation, "Using benchmarks to improve your practice."

A novel drug delivery device using a punctal plug to provide pressure-lowering medication to patients with glaucoma could improve compliance and reduce the amount of medication required to maintain pressure control, said Richard A. Lewis, MD, a cataract surgeon and glaucoma specialist based in Sacramento, California.