News

With diabetes cases worldwide expected to double in the first 30 years of the 21st century, telemedicine might be a pathway to ensuring that more patients receive care, and thus, prevent complications from retinopathy, said P. Lloyd Hildebrand, MD, Dean A. McGee Eye Institute, Oklahoma University Health Sciences Center.

Ophthalmologists should assess disease progression in patients with established and suspected glaucoma, should confirm with repeat testing any visual function loss that is seen, should remember that structural measurements have variability, and should consider using structural and functional testing together to detect disease progression, said Robert Weinreb, MD. The distinguished professor of ophthalmology and director, Hamilton Glaucoma Center, University of California in San Diego, LaJolla, CA, concluded a course about detecting progression in glaucoma by highlighting points made in the preceding presentations.

Intravitreal and subconjunctival injections of rapamycin (Sirolimus, Wyeth) are both effective against diabetic macular edema. Interestingly, the subconjunctival route had a greater beneficial effect and the lower doses were more effective, said Mark Blumenkranz, MD, professor and chairman, Department of Ophthalmology, Stanford University, Stanford, CA.

New investigative drugs for age-related macular degeneration (AMD) may complement the vascular endothelial growth factor (VEGF) agents, improve the visual results, and require fewer injections. Various routes of administration are under investigation and combination treatments are likely to provide more favorable results, said Lawrence Singerman, MD, Case University School of Medicine, Cleveland, OH.

The presence of an afferent pupillary defect is the best indicator of visual loss in patients with open-globe injuries, said Michael Grant, MD, PhD, of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

Is there a place for traditional Chinese medicine in modern ophthalmology? Quite possibly, said Dennis Lam, MD, FRCS, Chinese University of Hong Kong. Acupuncture, for example, has been used in China and other Asian countries for thousands of years, and such therapies still may have applications in the world of medicine to this day, he said.

Should the initial treatment in angle-closure glaucoma be laser, lens removal, or trabeculectomy? The answer depends on the patient, said Clement C.Y. Tham, department of ophthalmology and visual sciences, Chinese University of Hong Kong. "There's not a single answer," Dr. Tham said. "Drug therapy and other procedures must be considered, too."

Antioxidants, such as the polyphenols found in green tea, have been championed for their protective value in cancer protection. Their role in eye disease prevention, however, is still unclear. Dorairajan Balasubramanian, director of research, L.V. Prasad Eye Institute, Hyderabad, India, reported on in vitro tests he has performed on cells and polyphenols such as epigallocatechin gallate (ECGC) and catechin, and their protective value against cytotoxic agents.

Detecting a macular hole or photoreceptor detachment is critical for obtaining good surgical results in patients with myopic foveoschisis. Patients with the foveal detachment type seem to benefit the most from vitrectomy. Spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) are valuable for managing these patients, said Yasushi Ikuno, MD, Osaka University Medical School, Osaka, Japan.

Prophylactic intracameral cefuroxime injections prevent development of endophthalmitis after cataract surgery, according to Peter Barry, MD, FRCS, from Royal Victoria Eye and Ear Hospital, Dublin, Ireland. He reported the results of the European Society of Cataract and Refractive Surgeons Endophthalmitis Study.

Small-molecule drugs are being developed for topical application via the transconjunctival/transscleral route. The topical drugs that are under development have shown good posterior segment penetrance, safety, and efficacy in animal models. Clinical studies are now under way.

Although leaking filtering blebs often can be managed with conservative measures, surgery to stop the leak is indicated in some cases. A surgical approach may be indicated especially in certain high-risk eyes, such as those with a history of bleb-related infection. Several surgical techniques may be used to control a leaking bleb effectively.

Customized hyperopia treatment with the Technolas 217z Zyoptix wavefront excimer laser system (Bausch & Lomb) has excellent predictability, with 69% of patients within 0.5 D of the intended correction.

Centering the corneal ablation profile over the corneal vertex when treating hyperopia using an excimer laser platform (Schwind Esiris, Schwind eye-tech-solutions) results in better visual outcomes compared with ablations that were centered over the pupil centroid.

From the sixth postoperative month, the corneal power tended to decrease continuously with respect to preoperative data.

A prospective, randomized, contralateral eye study including an extensive list of outcome measures is under way comparing sub-Bowman's keratomileusis performed with two different femtosecond lasers (IntraLase FS60, Advanced Medical Optics; Femto LDV, Ziemer). Early data show that both lasers create good-quality, planar thin flaps, and their use is associated with excellent vision and safety outcomes.

Equivalent keratometer readings (EKRs) from a novel rotating Scheimpflug camera system (Pentacam, Oculus Inc.), calculated by version 1.16r04 software, are still inaccurate for eyes with a history of LASIK, PRK, or RK. The EKR measures steeper than true corneal power.

A study was conducted in rabbit eyes to compare flap adhesion strength of LASIK flaps created with different techniques and technology. The results indicate that significantly greater force is needed to dehisce flaps created with a 150-kHz femtosecond laser (IntraLase, Advanced Medical Optics) versus a mechanical microkeratome. Femtosecond laser-created flaps with a 150° side-cut design adhere more strongly relative to those with a 70° side-cut design.

Using a simple nomogram can substantially improve flap centration with a proprietary femtosecond laser. When considering the question of how big the LASIK flap should be, a large flap is good because ablation performed on the epithelium induces aberrations. A small flap, however, also is good because corneal strength is impaired less and less dry eye may be induced by the procedure, although the latter is still uncertain.

Patients who have suspected keratoconus based on topography may be candidates for LASIK based on a study that showed refractive stability 1 year after LASIK in patients where keratoconus was excluded preoperatively using epithelial thickness mapping obtained with a VHF ultrasound eye scanner (Artemis 1, ArcScan).

Many ophthalmologists are familiar with Eyemaginations' 3D-Eye in-office educational tools. Now, a home version is available that lets you extend your patient education reach beyond the walls of your office and into your patients' homes.

Uveitis associated with juvenile idiopathic arthritis can result in significant vision loss. Systemic immunosuppressive therapy may protect against that outcome. Identifying predictors of ocular complications and vision loss may help to select patients who can best benefit from aggressive medical treatment.

Surgical therapy for age-related macular degeneration in the form of macular translocation, injection of tissue plasminogen activator, and gas tamponade provides some improvements in visual acuity for patients whose conditions do not respond to the anti-vascular endothelial growth factor drugs.

New York-Pfizer officials have decided not to launch global phase III trials of NicOx’s PF-03187207 glaucoma drug but plan to continue collaborating with the French company.

Miami-OPKO Health has acquired Vidus Ocular, a privately held company developing a shunt (Aquashunt) to treat glaucoma.

Santa Ana, CA-Advanced Medical Optics (AMO) has received FDA clearance for a fifth-generation femtosecond laser (iFS).

In a point-counterpoint debate at the annual meeting of the American Academy of Ophthalmology, one clinician contended that the rate of post-LASIK ectasia is declining and that, with careful screening and other preparatory steps, the rate of ectasia can be kept very low. The counter-argument by another clinician suggested that the multifactorial basis of ectasia as well as unknown risk factors make it impossible to prevent a certain percentage of cases from developing.

In a debate at the American Academy of Ophthalmology annual meeting, one surgeon contended that surface ablation is safer and more effective than LASIK because of complications associated with flap creation in lamellar procedures. His counterpart, however, suggested that LASIK is preferable because of risks associated with surface procedures, including ectasia, infections, and haze.