Which Questionnaires Best Reflect Dry Eye Symptoms?

MedicalResearch.com Interview with:
Jennifer P. Craig, Associate Professor

Department of Ophthalmology
New Zealand National Eye Centre
Auckland, New Zealand

MedicalResearch.com: What is the background for this study?

Response: Dry eye disease is a complex multi-factorial condition, which affects between 5% to 50% of the adult population in different parts of the world. The condition can have profound effects on the ocular comfort, visual function, and quality of life of sufferers. In both clinical practice and academic research settings, validated questionnaires are frequently used to screen for dry eye symptomology, before clinical assessment of tear film homeostatic markers is conducted to make an overall diagnosis of dry eye disease.

Although a large number of validated symptomology questionnaires has previously been developed, the recently convened Tear Film and Ocular Surface Dry Eye Workshop II (TFOS DEWS II) identified that the considerable heterogeneities in the study populations, methodologies, and reference standards used in earlier diagnostic accuracy studies introduced significant challenges when trying to compare the diagnostic performance of these screening instruments.

The current study is the first to offer a direct comparison of five commonly used validated questionnaires within the same study population, and uses the global consensus criteria for tear film homeostatic disturbance developed by the TFOS DEWS II as the reference standard.

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4-Meds in One Glaucoma Eyedrop May Decrease Preservatives, Lower Cost, Improve Compliance

MedicalResearch.com Interview with:

Nathan Radcliffe, MD Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon Mount Sinai Health System

Dr. Radcliffe

Nathan Radcliffe, MD
Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon
Mount Sinai Health System

MedicalResearch.com: What is the background for this study?

Response: Glaucoma is a leading cause of blindness and the mainstay of therapy is to lower the intraocular pressure (IOP) with topical eye drops.

Up to 40% of patients may require more than one eye drop to control the disease, and yet taking more than one eye drop bottle can result in higher costs, more eye irritation, worse therapeutic compliance, and possibly worse outcomes.  Compounded therapies (not FDA approved, but made at the physician’s request by a compounding pharmacy) can be created to contain multiple glaucoma therapies in one bottle.

We sought to determine if a compounded solution containing three or four drops in one bottle could control glaucoma as well as three or four separate bottles (standard of care) in patients requiring three or four eye drop bottles to control glaucoma.

We performed a multi-center, randomized, observer-masked, parallel-group study comparing a compounded therapy containing latanoprost 0.05%, dorzolamide hydrochloride 2%, timolol maleate 0.5%, brimonidine tartrate 0.2% with 0.01% BAK to standard three or four bottle regaimins.  We measured IOP and corneal staining (a sign of preservative toxicity), as well as other safety measures at week one, month one, two and three.

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NSAID Eyedrop + Eye Patch Better at Reducing Pain After Intravitreal Injection

MedicalResearch.com Interview with:

Ronald Gentile, MD Professor of Ophthalmology Icahn School of Medicine at Mount Sinai New York

Dr. Gentile

Ronald Gentile, MD
Professor of Ophthalmology
Icahn School of Medicine at Mount Sinai
New York

MedicalResearch.com: What is the background for this study?

Response: Intravitreal injections have revolutionized the treatment of some of the most common retinal diseases that cause blindness. These diseases include wet age related macular degeneration and diabetic retinopathy. Intravitreal injections are the most common eye procedure in the world. Pain after an intravitreal injection negatively impacts the patient’s experience. We set out a to find a way to improve the patient’s experience by improving the pain they feel after the intravitreal injection.

MedicalResearch.com: What are the main findings? 

Response: The main finding was that the NSAID we used, Nepafanac 0.3% suspension, and pressure patching resulted in lower pain scores when compared to the tear drop placebo at both 6 and 24 hours after the intravitreal injection. The NSAID had a greater effect on lowering the pain score and was found statistically significance. Even though the eyepatch was associated with lower pain scores than placebo, the difference did not reach statistical significance. 

MedicalResearch.com: What should readers take away from your report?

Response: Readers should understand that patients not only have a fear going blind, they also fear the pain of the treatment. Physicians should place more emphasis on the patients experience and try to decrease or eliminate any pain a patient may have from the intravitreal injections. It would be expected that this should help patient compliance, especially for those patient who need regular intravitreal injections. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should focus on the patients experience and find ways to eliminate any pain a patient may have before, during, and after the intravitreal injections. 

MedicalResearch.com: Is there anything else you would like to add?

Response: Yes. Patient satisfaction and the patient experience is something that all ophthalmologists and all doctors need to put on the top of their priority list. Physicians have the greatest ability and insight into this. Having the greatest medicines in the world cant help if a patients fear of pain prevents them from being compliant.

I have no disclosures.

Citation: AAO 2018 abstract

Pain Control Following Intravitreal Injection Using Topical Nepefanac 0.3% or Pressure Patching: A Prospective, Randomized, Placebo Controlled Trial

Nov 2, 2018 @ 6:24 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Why Are So Many People Near-Sighted?

MedicalResearch.com Interview with:
Andrei V. Tkatchenko, M.D., Ph.D.
Associate Professor
Columbia University Medical Center
Edward S. Harkness Eye Institute
New York, NY 10032

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Clear distance vision is rapidly becoming a rare privilege around the world, especially in Asia, due to increasing prevalence of myopia.

Although much effort has been directed towards elucidating the mechanisms underlying refractive eye development and myopia, treatment options for myopia are mostly limited to optical correction, which does not prevent progression of myopia or pathological blinding complications often associated with the disease. During early childhood development, the axial length of the eye normally grows to match its optical power in a process called emmetropization, producing focused images on the retina. However, very often environmental and genetic factors lead to a mismatch between the optical power of the eye and its axial length resulting in the development of myopia if eyes grow too long for their optical power. Experimental studies in many animal species suggest that emmetropization is regulated by optical defocus. The eye can compensate for imposed negative and positive optical defocus by increasing or decreasing its growth rate, respectively. However, the molecular mechanisms underlying emmetropization are poorly understood which prevents development of anti-myopia drugs.

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AI Screening for Diabetic Eye Disease May Save Time and Money

MedicalResearch.com Interview with:

Prof. Yogesan Kanagasingam, PhD Australian of the Year 2015 (WA Finalist) Research Director, Australian e-Health Research Centre Visiting Scholar,  Harvard University Adjunct Professor, School of Medicine University of Notre Dame

Prof. Kanagasingam

Prof. Yogesan Kanagasingam, PhD
Australian of the Year 2015 (WA Finalist)
Research Director, Australian e-Health Research Centre
Visiting Scholar,  Harvard University
Adjunct Professor, School of Medicine
University of Notre Dame

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to evaluate how an artificial intelligence (AI)–based grading system for diabetic retinopathy will perform in a real-world clinical setting, at a primary care clinic. 

MedicalResearch.com: What should readers take away from your report?

Response: Sensitivity and specificity of the AI system compared with the gold standard of ophthalmologist evaluation is provided.

The results demonstrate both the potential and the challenges of using AI systems to identify diabetic retinopathy in clinical practice. Key challenges include the low incidence rate of disease and the related high false-positive rate as well as poor image quality.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Low incidence rate of disease is an issue. May be a controlled environment, e.g. endocrinology clinic, may overcome this low incidence rate of diseases and high number of patients with diabetes.

Another research direction is how to improve image quality when capturing retinal images from a fundus camera.

How to overcome the issues related to sheen reflection is another research direction.  

MedicalResearch.com: Is there anything else you would like to add?

Response: At present, ophthalmologists or optometrists read all images.

If AI is introduced for image reading then, based the results from this study, ophthalmologists have to check only 8% of the images. This is a huge cost savings to the health system and save lot of time.

The accuracy rate (sensitivity and specificity) from this study is better than human graders.

Citation: 

Kanagasingam Y, Xiao D, Vignarajan J, Preetham A, Tay-Kearney M, Mehrotra A. Evaluation of Artificial Intelligence–Based Grading of Diabetic Retinopathy in Primary Care. JAMA Network Open. 2018;1(5):e182665. doi:10.1001/jamanetworkopen.2018.2665

Oct 6, 2018 @ 12:17 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Most Eye Trauma Occurs in Elderly After a Fall

MedicalResearch.com Interview with:
Syed Mahmood Ali Shah, M.D. Associate Professor of Ophthalmology University of Pittsburgh School of MedicineSyed Mahmood Ali Shah, M.D.
Associate Professor of Ophthalmology
University of Pittsburgh School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Eye trauma is a significant cause of morbidity throughout the world. In the United States, the incidence of individuals hospitalized with eye trauma from 2001 through 2014 increased. Most of these individuals were above the age of 65 and suffered a fall. This is a worrisome trend in light of an increased awareness and continued and concentrated effort to reduce falls. This is a critical point: We need to improve our existing strategies to reduce falls.

The second at-risk group is children and adolescents. Previous studies have shown that effective widespread implementation of injury prevention efforts can lower trauma rates. While we did observe a small decrease in eye trauma as a primary admitting diagnosis, the fact that it was more common in children and adolescents (for whom eye trauma carries devastating consequences and can significantly reduce quality of life) highlights the significance of continued efforts to prevent eye trauma.  Continue reading

Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti-VGEF Therapy for Macular Edema Secondary to Retinal Vein Occlusion

MedicalResearch.com Interview with:

Amy Babiuch, M.D.  Medical Retina Specialist  |  Cole Eye Institute Assistant Professor Ophthalmology Case Western Reserve University WPSA Regional Focus Committee Chair Cleveland Clinic

Dr. Babiuch

Amy Babiuch, M.D.
Medical Retina Specialist  |  Cole Eye Institute
Assistant Professor Ophthalmology Case Western Reserve University
WPSA Regional Focus Committee Chair
Cleveland Clinic

MedicalResearch.com: What is the background for this study?

Response: In previous studies, the disorganization of retinal inner layers (DRIL) has demonstrated its ability to help determine visual acuity (VA) prognosis in diabetic macular edema that requires treatment. Given this association, the research group at Cole Eye Institute studied how DRIL may affect VA outcomes in patients with retinal vein occlusion (RVO) undergoing treatment for secondary macular edema.

DRIL is defined as the extent to which there is a failure in the recognition of any of the demarcations between the ganglion cell-inner plexiform layer complex, inner nuclear layer, and outer plexiform layer on optical coherence tomography (OCT).

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Cadmium, Smoking and Atherosclerosis Linked to Decreased Visual Function

MedicalResearch.com Interview with:
“Vision” by Victoria Ford is licensed under CC BY 2.0Adam J. Paulsen MS

Associate Researcher
EpiSense Research Program
Department of Ophthalmology&  Visual Sciences
University of Wisconsin – Madison

MedicalResearch.com: What is the background for this study?

Response: Contrast Sensitivity is a measure of visual function that indicates how well a person is able to distinguish an object against its background.  Tests of CS determine how faint a visual signal can be identified.  CS can be diminished even in those with appropriately corrected visual acuity, has been shown to have effects on daily activities (including near vision tasks), risk of falls, and driving ability.  The causes of and risks for CS impairment are understudied.  Cadmium (Cd) and Lead (Pb) are known neurotoxins that have been shown to accumulate in the retina.  Both Cd and Pb have common sources of exposure in the general population.  Our studied aimed to investigate risk factors for incident CS impairment, including Cd and Pb exposure.

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Primary Care Providers Can Encourage Patients To Focus on Vision Health

MedicalResearch.com Interview with:

Joshua Ehrlich, MD, MPH Assistant Professor of Ophthalmology and Visual Sciences University of Michigan

Dr. Ehrlich

Joshua Ehrlich, MD, MPH
Assistant Professor of Ophthalmology and Visual Sciences
University of Michigan 

MedicalResearch.com: –Describe the “important role” that primary care providers play in promoting eye health?

Response: Primary care is the entryway into the health system for many individuals. The poll suggests that when primary care providers discuss vision with their patients, they are more likely to get eye exams. It also suggests that primary care providers are having these conversations most often with those who have certain risk factors for eye disease, such as diabetes or a family history of vision problems, as well as those with fewer economic resources. Promoting these kinds of conversations could bolster this trend, increasing the number of diabetics and other high risk individuals who get appropriate eye care.

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Over 20% of Macular Degeneration Patients Lost to Followup After Treatment

MedicalResearch.com Interview with:

Picture of the back of the eye showing intermediate age-related macular degeneration

Picture of the back of the eye showing intermediate age-related macular degeneration: Wikipedia image

Jason Hsu, MD
Retina Service, Wills Eye Hospital
Associate Professor of Ophthalmology
Thomas Jefferson University
Mid Atlantic Retina
Anthony Obeid MD MPH
School of Public Health
The University of Sydney ·

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Neovascular age-related macular degeneration (nAMD) is a vision-threatening disease that often afflicts elderly patients. The introduction of intravitreal anti-vascular endothelial growth factor treatment drastically improved the prognosis of eyes with nAMD. Despite its efficacy, patients require consistent follow-up (sometimes as often as monthly), with ongoing injections to maintain the visual benefits of the drug. Unfortunately, few studies have reported the number of patients that do not follow-up with recommended guidelines. Moreover, there remains limited evidence on the risk factors associated with loss to follow-up.

Our study, consisting of 9007 patients with a history of nAMD receiving treatment between 2012 and 2016, evaluated both these parameters. We defined loss to follow-up as having at least one injection without a subsequent follow-up visit within 12 months post-treatment.

Using this definition, we found that over 20% of patients are lost to follow-up over the entire study period. We further identified key risk factors associated with loss to follow-up, which included patients of older age, race, patients residing in a region of a lower average adjusted gross income, patients living at greater distances from clinic, patients with active nAMD in only one eye, and patients with worse visual acuity. Continue reading

Visual Problems Common in Children with Dyslexia

MedicalResearch.com Interview with:

Aparna Raghuram, OD, PhD Optometrist, Department of Ophthalmology Instructor, Harvard Medical School

Dr. Raghuram

Aparna Raghuram, OD, PhD
Optometrist, Department of Ophthalmology
Instructor, Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Developmental dyslexia is a specific learning disability of neurobiological origin whose core cognitive deficit is widely believed to involve language (phonological) processing. Although reading is also a visual task, the potential role of vision has been controversial, and experts have historically dismissed claims that visual processing might contribute meaningfully to the deficits seen in developmental dyslexia.

Nevertheless, behavioral optometrists have for decades offered vision therapy on the premise that correcting peripheral visual deficits will facilitate reading. Yet there is a surprising dearth of controlled studies documenting that such deficits are more common in children with developmental dyslexia, much less whether treating them could improve reading.

In the present study, we simply assessed the prevalence and nature of visual deficits in 29 school aged children with developmental dyslexia compared to 33 typically developing readers. We found that deficits in accommodation 6 times more frequent in the children with developmental dyslexia and deficits in ocular motor tracking were 4 times more frequent.

In all, more than three-quarters of the children with developmental dyslexia had a deficit in one or more domain of visual function domain compared to only one third of the typically reading group.

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Vision and Cognition Change Together As Older Adults Age

MedicalResearch.com Interview with:
“Old Eyeglasses” by Leyram Odacrem is licensed under CC BY 2.0Diane Zheng MS
NEI F-31 Research Fellow and a Ph.D. candidate in Epidemiology
Department of Public Health Sciences
University of Miami

MedicalResearch.com: What is the background for this study?

Response: Worsening vision and declining cognitive function are common conditions among older people. Understanding the association between them could be beneficial to alleviate age related cognitive decline.

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Children With Amblyopia and Strabismus Take Longer To Complete Answer Forms

MedicalResearch.com Interview with:
multiple choice test takingKrista Kelly, PhD

Postdoctoral Fellow
Crystal Charity Ball Pediatric Vision Evaluation Center
Retina Foundation of the Southwest
Dallas, TX 75231

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We were interested in seeing whether the fine motor deficits typically seen in amblyopia (lazy eye) and strabismus (crossed eyes) translate to an academic setting. Namely, transferring answers to a multiple choice answer form widely used in standardized testing in schools.

Children with amblyopia and strabismus took about 28% longer than their peers transferring answers to a multiple choice answer form, even though they have good vision in one or both eyes.  Continue reading

Shire Launches ‘Screen Responsibly’ To Reduce Dry Eye Symptoms

MedicalResearch.com Interview with:
“pplkpr phone” by Kyle McDonald is licensed under CC BY 2.0Michelle Nguyen
Senior Director, Consumer Marketing Lead Shire
Ophthalmics

MedicalResearch.com: What is the background for this initiative? How does screen time affect eye health? 

Response: Screen responsibly is an educational initiative about the intersection between our screen use and eye health. This initiative is underscored by new national survey data and aimed at increasing our dialogue about how to love both our screens and our eyes. Screen responsibly is an extension of the eyelove campaign, which Shire launched in 2016 to elevate the importance of eye health and raise awareness of the signs and symptoms of Chronic Dry Eye, commonly referred to as Dry EyeSince being glued to your screen can trigger Dry Eye symptoms, it is important that people are aware of ways to screen responsibly. 

Senior Director, Consumer Marketing Lead Shire Ophthalmics

Michelle Nguyen

MedicalResearch.com:  How common is the problem of Dry Eye? How is it related to excessive screen time?

Response: In the United States, nearly 30 million adults report symptoms consistent with Dry Eye. Dry Eye symptoms include a burning, itchy, stinging or gritty feeling in the eyes, episodes of blurred vision, eye redness and watery eyes. Shire is committed to addressing unmet needs within the Dry Eye patient community, and to do so, we sought to better understand their current behaviors, perceptions and knowledge around a common trigger of Dry Eye symptoms – intense screen usage.

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Mouse Model Shows Gene Therapy Can Reverse Blue Cone Vision Disorder

MedicalResearch.com Interview with:

Wen-Tao Deng,

Dr. Wen-Tao Deng

Wen-Tao Deng, Ph.D.
Department of Ophthalmology, College of Medicine|
University of Florida, Gainesville, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Blue cone monochromay (BCM) is a devastating vision disorder characterized by loss function of both L- and M-cones due to mutations in the L- and M-opin gene cluster on the X chromosome. BCM patients display severely reduced visual acuity, loss of color-vision, myopia, nystagmus, and minimally detectable cone-mediated electroretinogram. In our studies, we showed that an M-opsin knockout mouse model resembles human BCM, and expression of either human M- or L-opsin individually or combined through adeno-associated viral vector promotes regrowth of cone outer segments and rescues M-cone function in the treated M-opsin dorsal retin

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Optic Nerve Stroke: Bone Marrow Stem Cells Offer Hope of Vision Improvement

MedicalResearch.com Interview with:
Steven Levy MD

CEO, MD Stem Cells
Study Director, Stem Cell Treatment Studies

MedicalResearch.com: What is the background for this study?

Response: MD Stem Cells is the sponsor of the Stem Cell Ophthalmology Treatment Study II (SCOTS 2) the largest stem cell study currently addressing retinal and optic nerve disease (NCT 03011541). SCOTS uses autologous bone marrow derived stem cells (BMSC) typically provided to the eyes by combining retrobulbar, subtenons and intravenous injections. Many retinal and optic nerve diseases are eligible including Retinitis Pigmentosa (RP), Age Related Macular Degeneration (AMD), Stargardts, Ushers, Glaucoma, Ischemic Optic Neuropathy, Optic Atrophy and others. Statistically significant improvements have been documented in key diseases and positive responses have been noted across most conditions treated. Mechanisms of action may include differentiation of the CD34 cells into neurons, secretion of neurotrophic factors, transfer of mitochondria and release of mRNA. These may benefit existing stressed cells as well as provide replacement of damaged or absent cells.

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Single-Dose LipiFlow® Treatment Relieves Dry Eye Symptoms

MedicalResearch.com Interview with:

Dr. Caroline A. Blackie, OD PhD FAAO Medical Director, Dry Eye Johnson & Johnson Vision

Dr. Caroline Blackie

Dr. Caroline A. Blackie, OD PhD FAAO
Medical Director, Dry Eye
Johnson & Johnson Vision

MedicalResearch.com: What is the background for these studies? Would you briefly explain the problem of dry eye, how common it is and why it is difficult to treat? 

Response: Dry eye disease is a condition where the eyelids and/or the tear film are unable to protect the ocular surface from the negative effects of desiccating stress. If left untreated, a vicious cycle ensues resulting in a broad spectrum of sequelae, including ocular discomfort and compromised vision. The result is partial or pervasive reduced quality of life for the individual along with a significant economic burden on our society. Conversely, when the ocular surface is healthy, patients feel better, see better and live better.

Meibomian gland health is essential for ocular surface health. Meibomian glands secrete the oils necessary to protect the ocular surface from the negative effects of desiccating stress. Predictably, meibomian gland dysfunction (MGD) is a leading cause of dry eye disease. MGD is almost always the result of thickened and stagnated gland secretions. These stagnated secretions obstruct and/or limit the flow of functional oil into the tear film. MGD is the most common form of dry eye disease and is also known as evaporative dry eye. While management of dry eye in general can be complex, the management of MGD affords a relatively straightforward approach, which is to improve meibomian gland function by treating obstruction.

Dry eye disease is pretty common – more than 340 million people suffer from it globally. Short-term management of dry eye involves improving signs and symptoms of the condition, including the use of tear supplementation and reducing ocular surface inflammation.

Long-term dry eye management requires that the cause (or causes) of the condition is also diagnosed and treated. That cause is often MGD, and MGD can be successfully managed with LipiFlow®.  Continue reading

Ophthalmology Consultation for Emergency Care at a University Hospital

MedicalResearch.com Interview with:

Maria A. Woodward, MD, MSc Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor, MI

Dr. Woodward

Maria A. Woodward, MD, MSc
Department of Ophthalmology and Visual Sciences
W. K. Kellogg Eye Center
Institute for Healthcare Policy and Innovation
University of Michigan
Ann Arbor, MI

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Many people go to emergency departments seeking care for their eye problems. We wished to investigate which factors are associated with the involvement of ophthalmologist consultants in the care of these patients and whether any disparities exist.  Continue reading

Oral vs IV Steroids for Acute Optic Neuritis

MedicalResearch.com Interview with:

Sarah A. Morrow MD, MS, FRCPC Associate Professor of Neurology Department of Clinical Neurological Sciences University of Western Ontario (Western)

Dr. Morrow

Sarah A. Morrow MD, MS, FRCPC
Associate Professor of Neurology
Department of Clinical Neurological Sciences
University of Western Ontario (Western)

MedicalResearch.com: What is the background for this study?

Response: Acute demyelinating optic neuritis, which presents with loss of vision and painful eye movements, is common in multiple sclerosis (MS) occurring 50% of persons with MS. High dose (≥ 1g) corticosteroids administered through an IV became the standard of practice after the landmark Optic Neuritis Treatment Trial as IV administration. However, in that study the IV dose of corticosteroids was much higher (1 gram daily) than the oral dose (1 mg/kg). Thus, it is not clear if IV administration is still better if equivalent doses are used orally. Oral administration is much more convenient for patients and less expensive, and previous studies showed that it is preferred by patients.

In this study, we asked the following question: are high dose (≥ 1000mg) IV corticosteroids superior to equivalent doses of oral corticosteroids for the acute treatment of optic neuritis?

We randomly assigned fifty-five cases of acute optic neuritis to 1000mg IV methylprednisolone or 1250mg oral prednisone daily for three days and compared recovery of their vision over the next 6 months.  Continue reading

Genetic Link Between Corneal Thickness and Risk of Glaucoma

MedicalResearch.com Interview with:

Eldon E. Geisert, PhD Professor of Ophthalmology Emory School of Medicine

Dr. Geisert

Eldon E. Geisert, PhD
Professor of Ophthalmology
Emory School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the late 1990s a group of doctors began a study of glaucoma patients to determine if there were phenotypes that are predictive for developing glaucoma.

In this Ocular Hypertension Treatment Study (OHTS) one of the highly correlated ocular traits was central corneal thickness (CCT). The early clinical studies found that people with thinner corneas were at a higher risk of developing glaucoma. In two large studies, examining thousands of people a number of genes were identified that were risk factors for glaucoma or that controlled CCT in humans. In both cases the identified genes accounted for less than 10% of the genetic risk for glaucoma and less than for 10% of the genetic control for CCT. There was little data linking the genetic control of CCT to the glaucoma risk.

Our group has taken an indirect approach to the question, using well-defined mouse genetic system to identify genes modulating CCT and then interrogating human glaucoma data to determine if these genes are associated with glaucoma risk.   Continue reading

Unnecessary Routine Preoperative Cataract Testing Costs Medicare Millions

MedicalResearch.com Interview with:
Catherine L. Chen, MD, MPH

Assistant Professor
UCSF Department of Anesthesia & Perioperative Care

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Routine preoperative medical testing (such as common laboratory tests looking at a patient’s blood cell counts and kidney function, or cardiac tests like an EKG) are not recommended in patients undergoing cataract surgery, but these tests still occur quite frequently among Medicare cataract surgery patients because these patients tend to be older and sicker than the general population. In the past, researchers have used a 30-day window counting backwards from the date of surgery to determine whether a given test should be categorized as a routine preoperative test. However, we know that testing often takes place outside this window and therefore, the frequency and cost of routine preoperative medical testing has generally been underreported.

In our study, we used a new method to figure out how to determine the start of the routine preoperative testing period. In cataract patients, ocular biometry is a diagnostic test that is performed in anticipation of cataract surgery, and this test is only performed in cataract patients who will be having cataract surgery in the near future. For each patient, we calculated the elapsed time between the ocular biometry and cataract surgery dates to get a better idea of when to start looking for unnecessary routine preoperative testing. Our goal was to identify all the routine preoperative medical testing that occurs once the decision has been made to operate and better estimate the cost to Medicare of this unnecessary testing.

In a previous study that we published in the New England Journal of Medicine, we reported a significant spike in the rate of routine preoperative medical testing that occurs in the 30 days before surgery compared to the baseline rate of testing. In our current study, we discovered that there is a second spike in testing that occurs in the 30 days after ocular biometry. In fact, even if you exclude the testing that takes place during the 30 days before surgery, there is still a 41% increase in testing rates during the interval between ocular biometry and cataract surgery over the baseline rate of testing. In addition, we found that the cost of routine preoperative testing was 47% higher when looking at the entire biometry to surgery timeframe compared to testing that occurs just in the 30 days before surgery.

We estimate that the cost to Medicare of all of this unnecessary testing approaches $45.4 million annually. Continue reading

Tunable Lens Allows Detailed Imaging of Entire Eye

MedicalResearch.com Interview with:

Ireneusz Grulkowski, PhD Assistant Professor Bio-Optics & Optical Engineering Lab Institute of Physics Nicolaus Copernicus University

Dr. Grulkowski

Ireneusz Grulkowski, PhD
Assistant Professor
Bio-Optics & Optical Engineering Lab
Institute of Physics
Nicolaus Copernicus University

MedicalResearch.com: What is the background for this study?

Response: The ophthalmic diagnostics has undergone a revolution over the last 30 years. The access to new modalities allowed to understand the process of development of different eye diseases of the retina and the anterior segment. In particular, optical coherence tomography (OCT) demonstrated the feasibility in visualization of microarchitecture of the ocular tissues. However, most of the ophthalmic equipment is dedicated either to imaging the anterior segment of the eye (e.g. the cornea) or to retinal imaging. This is due to the fact that the eye is composed of the elements, such as the cornea and the lens, that refract the light.

In this report, we wanted to address that challenge. We compensated the refractive power of the eye by the application of the tunable lens. The focus tunable lens is the example of active optical element that changes its focal distance with the applied electric current.

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LUXTURNA Proves Effectiveness of Single Gene Therapy To Cure Rare Cause of Blindness

MedicalResearch.com Interview with:

Dr. Stephen M. Rose, PhD Chief Research Officer Foundation Fighting Blindness

Foundation Fighting Blindness

Dr. Stephen Rose PhD
Chief Research Officer
Foundation Fighting Blindness (FFB)

Dr. Rose comments on the announcement of the FDA approval of voretigene neparvovec (LUXTURNA™) gene therapy for inherited blindness due to mutations in the RPE65 gene.

What is the background for this announcement? What were the main findings from the study?

Response: While it has been 30 years since the RPE65 gene was identified as causing Leber’s Congenital Amaurosis, this shows that it is possible to have an effective gene therapy for an inherited disease. As the first gene therapy for the eye or for an inherited disease, LUXTURNA is a historic milestone in the search for cures for all inherited retinal diseases (IRDs). As a one-time gene therapy, LUXTURNA will not only be life-changing for patients with vision loss due to mutations in the RPE65 gene, it also provides critical momentum for gene therapies – for the eye and other diseases – now in the clinic.  Continue reading

Retinopathy in Premature Infants: Low Dose Ranibizumab May Be Effective Without Systemic Side Effects

MedicalResearch.com Interview with:

Prof. Dr. Andreas Stahl
Geschäftsführender Oberarzt
Leiter Arbeitsgruppe Angiogenese
Universitätsaugenklinik Freiburg | University Eye Hospital Freiburg
Freiburg, Germany

MedicalResearch.com: What is the background for this study?

Response: Retinopathy of prematurity (ROP) is a sight-threatening disease and one of the main reasons for irrreversible bilateral blindness in children. Particularly infants born at very early gestational ages or with very low birth weight are affected. In these infants, vascularization of the retina is unfinished at the time of birth. Severeal weeks into the life of these very prematuerly born infants, angiogenic growth factors, mainly vascular endothelial growth factor (VEGF), become upregulated in the avascular parts of the retina, leading to a re-activation of physiologic vascular growth. If all goes well, these re-activated retinal blood vessels progress towards the periphery and lead to a fully vascularized and functional retina. If, however, the vascular activation by VEGF is too strong, then vascular growth becomes disorganized and vessels are redirected away from the retina and into the vitreous. If left untreated, these eyes can then proceed towards tractional retinal detachment and blindness.

Since the 1990s, the standard method of treating ROP has been laser photocoagulation of avascular parts of the retina. This treatment is sensible because VEGF as the main angiogenic driver of pathologic blood vessel growth is expressed in these avascular parts of the retina. The downside of laser treatment, however, is that treated retinal areas are turned into functionless scar tissue and are lost for visual function. In addition, infants treated with laser need to be under general anesthesia for hours during treatment which can be troublesome in very young and fragile preterm infants. And in the long run, infants treated with laser have a high risk of developing high myopia in later life.

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Does Restasis Work For Dry Eye Disease?

MedicalResearch.com Interview with:
Steven Woloshin, MD MS

Steven Woloshin, MD Professor of The Dartmouth Institute Professor of Medicine Professor of Community and Family Medicine

Dr. Steven Woloshin

Professor of The Dartmouth Institute
Professor of Medicine
Professor of Community and Family Medicine
The Center for Medicine in the Media
Dartmouth Institute for Health Policy and Clinical Practice
Lebanon, New Hampshire

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been a lot of debate about the legal maneuvers (ie, transferring patents to the Mohawk Indians) Allergan has employed to delay marketing of generic alternatives to Restasis (cyclosporine ophthalmic emulsion 0.05%).   But there is a more fundamental question that has received little attention:  Does Restasis work?  It is not approved in the European Union, Australia or New Zealand where registration applications were “withdrawn prior to approval due to insufficient evidence of efficacy” in 2001.   Although Canada approved Restasis, its national health technology assessment unit, unconvinced of meaningful benefit, recommended Canada not pay for it – according to our research, no Canadian provincial or federal drug plan currently does.   Nevertheless, Americans have spent $8.8 billion in total sales between 2009 and 2015 on Restasis, including over $2.9 billion in public monies through Medicare Part D.

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