21 Nov NYU Study To Evaluate Long-Term Treatment of Painful Shingles of the Eye
MedicalResearch.com Interview with:
Elisabeth J. Cohen, MD
NYU Langone Medical Center
MedicalResearch.com Editor’s note: Elisabeth J. Cohen, MD, of NYU Langone Medical Center, will head a five year study to evaluate new treatment protocols for herpes zoster ophthalmicus (HZO).
Herpes zoster ophthalmicus is a form of shingles that can cause prolonged pain and permanently damage the eye. Dr Cohen and NYU have received a grant from the National Institutes of Health to investigate the longer-term use of suppressive antiviral medication to reduce complications of HZO,
MedicalResearch.com: What is the background for this study? Can you tell us a little about herpes zoster/shingles?
Response: The rationale for the study is two-fold:
First: the accumulating evidence that zoster is followed by chronic active infection caused by the varicella zoster virus (VZV) that contributes to complications including vision threatening eye disease and life threatening stroke.
Second: the proven efficacy of suppressive antiviral treatment in reducing recurrent herpes simplex virus eye disease, caused by a different herpes virus, but with similar disease manifestations.
Zoster/shingles is caused by localized, unilateral reactivation of varicella zoster virus (VZV) in people who have had varicella/chicken pox resulting in a painful blistering rash that can be followed by chronic pain/postherpetic neuralgia. There are over one million new cases of zoster per year, and the incidence has increased over the past 6 decades for unknown reasons. Although the rate of zoster increases with age, the largest number of cases occur in people in their fifties.
MedicalResearch.com: How does it affect the eye?
Response: Zoster can affect all parts of the eye and orbit. Eye involvement occurs when the trigeminal nerve supplying the forehead is affected, as happens in ~15% of cases, and is called Herpes Zoster Ophthalmicus (HZO).
Common manifestations include inflammation and infection of the cornea (keratitis) and iris (iritis) that can be chronic or recurrent, and require prolonged or indefinite treatment.There are also serious complications due to loss of sensation (neurotrophic keratopathy) and secondary glaucoma.
MedicalResearch.com: Does the shingles vaccine prevent this infection?
Response: The zoster vaccine live is CDC recommended for immunocompetent people age 60 years and older, and FDA approved for similar people age 50 years and older.
The vaccine decreases the incidence of zoster in people age 60 and older by 50%, and the disease severity by 66%. It reduces zoster by 70% in people age 50-59. The American Academy of Ophthalmology encourages vaccination for eligible people age 50 and above (see aao website).
MedicalResearch.com: What do you hope to learn from this study?
Response: The ZEDS study hope to show as its primary objective that suppressive valacyclovir for one years delays the development of new or worsening keratitis or iritis.
As a secondary endpoint, it hopes to determine if this treatment deceases postherpetic neuralgia.
There are a number of other secondary endpoints as well. We hope to reduce complications of HZO and improve outcomes of this common and serious disease.
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National study led by NYU Langone seeks innovative treatment for shingles of the eye
NIH pledges $15 million to support research into herpes zoster ophthalmicus
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