Management of glaucoma progression is an ongoing process requiring frequent surveillance and monitoring to prevent visual impairment and maintain the quality of life. Experts in a panel discussion of progression agreed on the importance of frequent testing and the use of computerized diagnostic tools to assist in the monitoring. The glaucoma experts participated in a continuing medical education symposium Saturday evening at the Sheraton New Orleans Hotel.
The incidence of dry eye has been increasing for more than a decade and will continue to do so as the percentage of the population over the age of 50 increases. The impact will be felt on patient quality of life as well as in financial costs directly and indirectly attributable to dry eye, making it all the more urgent for clinicians to become adept at managing this condition.
Irvine, CA-ISTA Pharmaceuticals Inc. has licensed exclusive North American rights to nasal dosage forms of bepotastine, an investigational product for the treatment of allergy symptoms, from Tanabe Seiyaku Co. Ltd.
A new visual function test (Heidelberg Edge Perimeter, Heidelberg Engineering GmbH) has been launched. Developed for the early detection of functional damage in glaucoma patients, the instrument uses a unique stimulus called flicker defined form to target magnocellular projecting retinal ganglion cells.
Although prospective, randomized trials have their limitations, they have been successful at identifying a series of risk factors for development of primary open-angle glaucoma. Population-based studies and the acquisition of clinical data by high-tech instruments also may help identify patients at high risk of developing glaucoma.
The corneal penetration of a proprietary formulation of timolol maleate ophthalmic solution 0.5% (Istalol, ISTA Pharmaceuticals) is significantly greater than that of a proprietary formulation of timolol hemihydrate ophthalmic solution 0.25%/0.5% (Betimol, Vistakon Pharmaceuticals) although both drugs are forms of timolol. Better penetration is correlated with improved safety and efficacy, considerations that are part of the selection of a beta-blocker for control of IOP.
Glaucoma surgery with a novel device (Trabectome, NeoMedix Corp.) is a minimally invasive approach that reduces IOP by about 40% with few complications. Data from a case series of 358 eyes showed that IOP dropped from a preoperative mean of about 24 mm Hg to a mean of 16 mm Hg postoperatively.
The Multicenter Uveitis Steroid Treatment (MUST) trial is a National Eye Institute-sponsored phase IV study comparing the fluocinolone acetonide 0.59-mg implant (Retisert, Bausch & Lomb) with standard systemic therapy for the treatment of noninfectious intermediate, posterior, or panuveitis. Its results are intended to help define the role of implant therapy for the treatment of uveitis. Enrollment is ongoing and referral of potentially eligible patients is encouraged.
Elevated IOP is a common occurrence in patients with uveitis. Management often is quite challenging, however, due to the multiple mechanisms that are at play and the often-countervailing effects of corticosteroids and pressure-lowering agents. Several experts comment on their approaches to managing elevated IOP in patients with uveitis, including the use of drops, laser therapy, and surgery.
Recent advances in anterior segment imaging enable ophthalmic surgeons to evaluate, treat, and follow their cataract, refractive, and glaucoma patients better. Three different technologies-optical coherence tomography, a Scheimpflug camera, and a wide-field contact digital fundus camera-are now being used to assess those patients more precisely for diagnosis, possible treatment, and long-term follow-up.
The methodology of several large, multicenter trials of amblyopia treatment leaves several questions unresolved, according to an orthoptist who reviewed the studies. These questions relate to the association between patient age and treatment results, the treatment protocol, measurement of therapy adherence, visual acuity results, and the definition of therapy success.
The Pediatric Eye Disease Investigator Group has conducted several studies recently that are helping to clarify the effectiveness of various approaches to amblyopia treatment and evaluate the effectiveness of therapies in different age groups.
Prevention of complications associated with implantable contact lenses requires customized sizing based on very high-frequency echography intraocular biometry. The new software, which is based on finite element analysis, is highly predictable and more accurate when compared with the white-to-white rule of thumb.
In a retrospective study including 14 eyes with high astigmatism that was naturally occurring, post-penetrating keratoplasty, or associated with a corneal scar, astigmatic keratotomy using a femtosecond laser (IntraLase FS, IntraLase Corp.) was safe and effective for reducing astigmatism and improving visual acuity.
Frequent follow-up visits are necessary to monitor for endothelial cell loss in patients in whom phakic IOLs have been implanted, according to one surgeon who has 5 years of experience with the lens.
Mistaken patient identity during keratorefractive surgery is devastating for the patient and surgeon. A "foolproof" method for avoiding mistaken identity involves obtaining the patient's autorefraction moments before surgery and taping the autorefractor strip to the patient. The patient's individual autorefraction, cylinder axis, and other data stay with the patient at all times, enabling the surgeon to make sure the information on the laser computer matches the information on the strip.
Implantation of two different multifocal IOLs-an apodized diffractive lens (AcrySof ReSTOR, Alcon Laboratories) and a refractive lens (ReZoom, Advanced Medical Optics)-may provide increased ranges of near and intermediate vision for a patient undergoing refractive lens exchange compared with bilateral implantation of the diffractive IOL, according to a study of 20 patients.
Surgeons reviewing their outcomes with an implantable contact lens (Visian Implantable Collamer Lens, STAAR Surgical Co.) reported high-quality visual acuity results and low complication rates over both short-term and long-term follow-up periods.
A study of a subgroup of 11 patients who participated in a multicenter trial found no significant distance changes between the anterior crystalline lens surface of the eye and the posterior surface of iris claw-style phakic IOLs during accommodation. This finding lends further credence to the belief that the IOL and the iris move forward together as a unit during accommodation.
A study using optical coherence tomography (Visante, Carl Zeiss Meditec) found that a single-piece acrylic, hydrophobic phakic IOL (AcrySof phakic IOL, Alcon Laboratories); a single-piece, hydrophilic acrylic IOL (ICare IOL, Corneal); and a newer, trimmed version of the latter (ICare Evolution IOL, Corneal) did not produce anatomic distortion of the iris or the chamber angle. The study compared angle-to-angle distances ≥6 months after lens implantation.
Creating channels using a femtosecond laser (IntraLase FS, IntraLase Corp.) to insert a corneal implant (Intacs, Addition Technology Inc.) has some advantages, but the procedure also has the potential for complications. Both are detailed.
Multifocal and accommodative IOLs can be implanted safely in patients who have undergone prior refractive surgery, and visual results can be good. Frequently, however, enhancements are necessary, and decreased best-corrected visual acuity may be seen more often than with aspheric monofocal IOL insertion, according to the results of a prospective study of 22 eyes in 18 patients.
To address a perceived unmet need for comprehensive refractive surgery training, Sunil Shah, FRCOphth, FRCSEd, FBCLA, and colleagues in England developed an electronically based course for those wanting to develop their knowledge and skills in cataract and refractive surgery.
The growing popularity and long-term use of phakic IOLs inevitably will lead to more explantations, with cataract removal and with or without clear lens removal. An ophthalmologist outlines key steps to success.
Torsional phacoemulsification reduces chatter and energy delivered to the eye. It is safer than longitudinal phaco because torsional phaco is associated with a reduced risk of wound burn, less fluid usage, better followability, less turbulence, and less second instrument manipulation.
Management of patients with neovascular age-related macular degeneration has evolved, but clinicians are at a crossroads when considering continuation of treatment. Evidence suggests that monthly treatment and less frequent treatment regimens are better than no treatment. The best treatment regimen remains elusive.
In a phase II study, implantation of the artificial silicon retina microchip (ASR, Optobionics) improved visual acuity in some patients for up to two years. A phase III study is possible if someone interested in continuing these trials purchases the company, now in bankruptcy.
The AWARE Study (Analysis of Safety Outcomes with Anti-VEGF Treatment) is expected to expand retinal specialists' knowledge of the short- and long-term risks of anti-vascular endothelial growth factor treatments for neovascular age-related macular degeneration and diabetic retinopathy. The study may help identify a subset of patients susceptible to adverse events.
Testing of a retinal prosthesis shows that blind subjects who receive the implant have predictable spatial vision and that more electrodes provide higher spatial resolution. Scientists at Second Sight Medical Products have tested a 16-electrode prosthesis for several years and have received approval to conduct tests with a newer, 60-electrode device.
The development of customized component corneal transplantation techniques could enable a single donor cornea to be used to treat multiple patients. The practice could help address tissue shortages and reduce the wait time for surgery in developing countries. A researcher formerly practicing in India talks about the first published report of this strategy.
