Author Interviews, Diabetes, Johns Hopkins, Macular Degeneration, Ophthalmology, PNAS / 29.05.2015

MedicalResearch.com Interview with: Akrit Sodhi, M.D., Ph.D. Assistant Professor of Ophthalmology Retina Division Wilmer Eye Institute Johns Hopkins Medical Institutions Medical Research: What is the background for this study? What are the main findings? Dr. Sodhi: Diabetic eye disease is the most common cause of severe vision loss in the working age population in the developed world, and proliferative diabetic retinopathy (PDR) is its most vision-threatening sequela. In proliferative diabetic retinopathy, retinal ischemia leads to the upregulation of angiogenic factors that promote neovascularization. Therapies targeting vascular endothelial growth factor (VEGF) delay the development of neovascularization, in some, but not all diabetic patients, implicating additional factor(s) in proliferative diabetic retinopathy pathogenesis. In our study, we demonstrate that the angiogenic potential of aqueous fluid from PDR patients is independent of VEGF concentration, providing an opportunity to evaluate the contribution of other angiogenic factor(s) to PDR development. We identified angiopoietin-like 4 (ANGPTL4) as a potent angiogenic factor whose expression is upregulated in hypoxic retinal Müller cells in vitro and the ischemic retina in vivo. Expression of ANGPTL4 was increased in the aqueous and vitreous of PDR patients, independent of VEGF levels, correlated with the presence of diabetic eye disease, and localized to areas of retinal neovascularization. Inhibition of ANGPTL4 expression reduced the angiogenic potential of hypoxic Müller cells; this effect was additive with inhibition of VEGF expression. An ANGPTL4 neutralizing antibody inhibited the angiogenic effect of aqueous fluid from proliferative diabetic retinopathy patients, including samples from patients with low VEGF levels or receiving anti-VEGF therapy. Collectively, our results suggest that targeting both ANGPTL4 and VEGF may be necessary for effective treatment or prevention of proliferative diabetic retinopathy and provide the foundation for studies evaluating aqueous ANGPTL4 as a biomarker to help guide individualized therapy for diabetic eye disease. (more…)
Author Interviews, Genetic Research, NEJM, Ophthalmology / 05.05.2015

Professor James Bainbridge, MA, PhD, FRCOphthProfessor of Retinal Studies, UCL Institute of Ophthalmology NIHR Research Professor, NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyMedicalResearch.com Interview with: Professor James Bainbridge, MA, PhD, FRCOphth Professor of Retinal Studies, UCL Institute of Ophthalmology NIHR Research Professor, NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyConsultant Ophthalmologist, Moorfields Eye Hospital NHS Foundation Trust Medical Research: What is the background for this study? What are the main findings? Prof. Bainbridge : Leber Congenital Amaurosis (LCA) is one of the most common causes of inherited, untreatable blindness in children. There are at least 14 different types of Leber Congenital Amaurosis of which LCA Type 2 (LCA2), caused by defects in the gene RPE65, affects around one in 100,000 people worldwide. Evidence from animal studies support that LCA2 may be amenable to treatment with RPE65 gene replacement therapy. The main findings of this phase I/II clinical trial confirm our preliminary findings (published in NEJM, 2008) that gene therapy can improve night vision. Improvements peak within the first 12 months after treatment but then decline during the three-year follow-up period which is consistent with the published results and interim findings from other studies of RPE65 gene therapy. (more…)
Author Interviews, Cost of Health Care, Medicare, Ophthalmology / 21.04.2015

MedicalResearch.com Interview with: Dan Gong BA Yale University School of MedicineMedicalResearch.com Interview with: Dan Gong BA Yale University School of Medicine ------------ James C. Tsai, M.D., M.B.A. President - New York Eye and Ear Infirmary of Mount Sinai Delafield-Rodgers Professor and Chair Department of Ophthalmology Icahn School of Medicine at Mount Sinai Medical Research: What is the background for this study? What are the main findings?
  • Congress first introduced the Medicare Physician Fee Schedule built on the resource-based relative value scale (RBRVS) in the Omnibus Budget Reconciliation Act of 1989. Until recently, Medicare payments to physicians were adjusted annually based on the sustainable growth rate (SGR) formula.
  • When adjusting physician payments, one controversial belief by policymakers was the assumption that in response to fee reductions, physicians would recuperate one-half of lost revenue by increasing the volume and complexity of services.
  • This study questioned this assumption that this inverse relationship between Medicare payment and procedural volume is uniform across all procedures. In particular, glaucoma procedures have not been studied in the past.
  • Using a fixed effects regression model, we found that for six commonly performed glaucoma procedures, four did not have any significant Medicare payment and procedural volume relationship (laser trabeculoplasty, trabeculectomy with and without previous surgery, aqueous shunt to reservoir). Two procedures, laser iridotomy and scleral reinforcement with graft, did have significant and inverse associations between Medicare payment and procedural volume. (more…)
Author Interviews, Cost of Health Care, NEJM, Ophthalmology, UCSF / 16.04.2015

Catherine L. Chen M.D., M.P.H. UCSF Dept of AnesthesiaMedicalResearch.com Interview with: Catherine L. Chen M.D., M.P.H. UCSF Dept of Anesthesia Medical Research: What is the background for this study? What are the main findings? Dr. Chen: Cataract surgery is a very common and safe surgery that most older adults have in their 70's or 80's. It usually happens as a same-day surgery and most patients only need eye drops to numb the eye with little or no intravenous sedation for a procedure that on average is only 18 minutes long. Given their age, these patients typically have other concurrent medical problems, so even though multiple research studies and professional societies have concluded that routine preoperative testing is not necessary before cataract surgery, we found that this testing still frequently occurs in these patients. More than half of the patients in our study had at least one preoperative test performed in the month before their surgery. We hypothesized prior to undertaking this study that the older and sicker patients were the ones who were most likely to get preoperative testing. Instead, what we found was that the most important factor that determined whether or not a patient got tested was the ophthalmologist who operated on the patient. This is an important finding because it shows that most patients are not getting extra testing, but the few that do are getting testing because that's the way their ophthalmologist typically prepares his patients for surgery. Most of the time, this testing is not needed and will not affect how well the patient does during and after surgery. (more…)
Author Interviews, Circadian Rhythm, Ophthalmology, Sleep Disorders, UCSD / 09.04.2015

MedicalResearch.com Interview with: Carolina P B Gracitelli, M.D. Ophthalmology - PhD Candidate/ Research Fellow University of California San Diego - Hamilton Glaucoma Center Medical Research: What is the background for this study? What are the main findings? Dr. Gracitelli: Of all the diseases that can lead to blindness, glaucoma is one of the most important diseases; it affects more than 70 million people worldwide, of whom approximately 10 % are bilaterally blind. Different studies have reported that the damage caused by glaucomatous disease lead to retinal ganglion cell (RGC) loss and consequently loss of intrinsically photosensitive retinal ganglion cells (ipRGCs), which is a subtype of RGC. This subpopulation of RGC is clearly related with non-image-forming visual function such as photic synchronization of circadian rhythms and the pupillary light reflex. However, the true impact of glaucoma on sleep quality, sleep disturbance or circadian rhythm was until nowadays controversial. The main clinical finding of our study was that glaucoma leads to RGC death, including ipRGC death. These cells are connected to several non-image-forming functions, including circadian photoentrainment and pupillary reflexes. Therefore, the image-forming and non-image-forming visual systems are associated with glaucoma. Circadian function has not been well investigated in clinical daily practice, but it can interfere with the quality of life of these patients. Concerns about sleep disturbances in glaucoma patients should be incorporated into clinical evaluations. Medical Research: What should clinicians and patients take away from your report? Dr. Gracitelli: Our data support the concept that glaucoma is associated with a loss of ipRGCs that mediate the pupillary light response, particularly to the sustained component of the blue flash with a luminance of 250 cd/m2. Additionally, glaucoma patients had significant sleep disturbances that were inversely correlated with a measure of ipRGC function, the pupillary light reflex. These results suggest that the loss of ipRGCs in glaucoma may also lead to sleep disturbances. Both non-visual functions of ipRGCs are correlated, indicating that attention should be paid to the non-image forming visual functions in glaucoma patients. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Gracitelli: Sleep disorders is a complex system, therefore, some conclusions in this study should be carefully evaluated. Further studies with larger cohorts could also help to elucidate the association between the pupillary reflex and the polysomnography parameters. And longitudinal studies can better explain the associations between sleep disorders and glaucoma progression. In addition, we know that there are several types of ipRGCs and they have specific functions (pupillary reflex or circadian rhythms), therefore, evaluations would also need to include a more thorough assessment to understand better the specific role of ipRGCs in sleep disturbances. However, it is true that these ipRGCs functions are impaired in glaucoma, affecting the quality of life of these patients. Citation: Intrinsically Photosensitive Retinal Ganglion Cell Activity Is Associated with Decreased Sleep Quality in Patients with Glaucoma Gracitelli, Carolina P.B. et al. Ophthalmology Published Online: April 06, 2015 DOI: http://dx.doi.org/10.1016/j.ophtha.2015.02.030MedicalResearch.com Interview with: Carolina P B Gracitelli, M.D. Ophthalmology - PhD Candidate/ Research Fellow University of California San Diego - Hamilton Glaucoma Center Medical Research: What is the background for this study? What are the main findings? Dr. Gracitelli: Of all the diseases that can lead to blindness, glaucoma is one of the most important diseases; it affects more than 70 million people worldwide, of whom approximately 10 % are bilaterally blind. Different studies have reported that the damage caused by glaucomatous disease lead to retinal ganglion cell (RGC) loss and consequently loss of intrinsically photosensitive retinal ganglion cells (ipRGCs), which is a subtype of retinal ganglion cell. This subpopulation of RGC is clearly related with non-image-forming visual function such as photic synchronization of circadian rhythms and the pupillary light reflex. However, the true impact of glaucoma on sleep quality, sleep disturbance or circadian rhythm was until nowadays controversial. The main clinical finding of our study was that glaucoma leads to retinal ganglion cell death, including ipRGC death. These cells are connected to several non-image-forming functions, including circadian photoentrainment and pupillary reflexes. Therefore, the image-forming and non-image-forming visual systems are associated with glaucoma. Circadian function has not been well investigated in clinical daily practice, but it can interfere with the quality of life of these patients. Concerns about sleep disturbances in glaucoma patients should be incorporated into clinical evaluations. (more…)
Author Interviews, Dermatology, Ophthalmology / 03.04.2015

Alison Ng PhD, BSc(Hons), MCOptom Post-Doctoral Fellow Centre for Contact Lens Research School of Optometry & Vision Science University of Waterloo Waterloo, Ontario CanadaAlison Ng PhD, BSc(Hons), MCOptom Post-Doctoral Fellow Centre for Contact Lens Research School of Optometry & Vision Science University of Waterloo Waterloo, Ontario Canada Medical Research: What is the background for this study? What are the main findings? Dr. Ng: Eye care practitioners often see patients coming into our clinics with eyeliner “floating” in the tears or adhered to the surface of contact lenses during our routine examinations. When products such as eyeliner enters and contaminates the tear film, some patients complain of temporary discomfort, and if they wear contact lenses, they may report blurred vision if the lenses become spoiled. Specifically in this pilot study, we wanted to look at how differently eyeliner migrated into the tear film when applied in two different ways: inside the lash line and outside of the lash line. (more…)
Author Interviews, JAMA, Ophthalmology / 27.02.2015

Eric Crouch, MD, FAAO, FAAP, FACS Vice Chair, PEDIGAssociate Professor Department of Ophthalmology Eastern Virginia Medical School Assistant Professor Department of Pediatrics Eastern Virginia Medical School Chief of Ophthalmology Children's Hospital of the King's Daughters Norfolk, VirginiaMedicalResearch.com Interview with: Eric Crouch, MD, FAAO, FAAP, FACS Vice Chair, PEDIGAssociate Professor Department of Ophthalmology Eastern Virginia Medical School Assistant Professor Department of Pediatrics Eastern Virginia Medical School Chief of Ophthalmology, Children's Hospital of the King's Daughters Norfolk, Virginia MedicalResearch: What is the background for this study?  Dr. Crouch: In this letter PEDIG is reporting on the improvement in vision during the run-in phase of a study in children 3 years of age to less than 8 years old.  During the run-in phase, the children were followed at 6 weeks intervals and served as the baseline for entering into a randomized trial for increasing the amount of patching. The patients were randomized to either 2 hours of prescribed patching or 6 hours of prescribed patching once they completed the run-in phase. MedicalResearch: What are the main findings? Dr. Crouch: For amblyopic children, even those who have moderate or severe amblyopia in the 20/100 - 20/400 range, clinicians can start treatment with patching two hours a day. (more…)
Author Interviews, Diabetes, Ophthalmology, UCLA / 20.02.2015

Rohit Varma, MD, MPH Professor and Chair, Department of Ophthalmology USC Eye Institute, Keck School of Medicine University of Southern California, Los Angeles, CaliforniaMedicalResearch.com Interview with: Rohit Varma, MD, MPH Professor and Chair, Department of Ophthalmology USC Eye Institute, Keck School of Medicine University of Southern California, Los Angeles, California Medical Research: What is the background for this study? What are the main findings? Dr. Varma: The Centers for Disease Control and Prevention estimates that 4.4% of adults with diabetes aged 40 and older have advanced diabetic retinopathy that may result in severe vision loss. Clinical trials have shown that intravitreal injections of anti-VEGFs, such as ranibizumab, can reduce visual impairment and even in some cases improve visual acuity outcomes in patients with diabetic macular edema. We developed a model, based on data from the RIDE and RISE clinical trials, to estimate the impact of ranibizumab treatment on the number of cases of vision loss and blindness avoided in non-Hispanic white and Hispanic persons with diabetic macular edema in the United States.Results from the model suggest that, compared with no treatment, every-4-week ranibizumab 0.3 mg reduces legal blindness between 58%-88% and reduces vision impairment between 36%-53% over 2 years in this population. (more…)
Author Interviews, Heart Disease, Ophthalmology / 28.01.2015

MedicalResearch.com Interview with: Ren-Long Jan Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan. Medical Research: What is the background for this study? What are the main findings? Response: The pathologenic factors underlying retinal artery occlusion (RAO) are also associated with acute coronary syndrome (ACS). Previous studies showed the relation but was limited by sample sizes. We used Taiwan Longitudinal Health Insurance Database and found the increased risk of ACS following Retinal artery occlusion. (more…)
Author Interviews, JAMA, Ophthalmology / 26.01.2015

MedicalResearch.com Interview with: Simone L. Li, PhD Retina Foundation of the Southwest Dallas, Texas Medical Research: What is the background for this study? What are the main findings? Dr. Li: In a previous study, we found that binocular iPad game play significantly improved visual acuity in the amblyopic eye. The purpose of the current study was to determine the longevity of these effects and we found that the visual acuity improvements obtained with binocular iPad game play had been retained for at least 12 months after the treatment ended. (more…)
Author Interviews, Genetic Research, JAMA, Ophthalmology / 21.01.2015

Prof. David Mackey Centre for Ophthalmology and Vision Science/Lions Eye Institute Perth Managing Director/Chair of University of Western Australia, Perth, Australia Centre for Eye Research Australia, Melbourne UniversityMedicalResearch.com Interview with: Prof. David Mackey Centre for Ophthalmology and Vision Science/Lions Eye Institute Perth Managing Director/Chair of University of Western Australia, Perth, Australia Centre for Eye Research Australia, Melbourne University MedicalResearch: What is the background for this study? What are the main findings? Prof. Mackey: Too much or too little sun? Excessive sun exposure is associated with the eye disease pterygium, while lack of outdoor activity in childhood increases the risk of myopia (short sightedness). Measuring the amount of early sun damage to a person’s eyes would be of great use to researchers and potential use in clinical practice. Over the last few years we have developed a biomarker for sun exposure to the eye by photographing Conjunctival UV Auto-Fluorescence (CUVAF). The study published in JAMA Ophthalmology looked at the genetic and environmental factors that contribute to CUVAF levels in three Australian studies from Tasmania, Perth and Brisbane. People who live in sunnier environments closer to the equator have more evidence of sun damage using CUVAF.  However, genetic factors also play a role. (more…)
Author Interviews, Blood Pressure - Hypertension, Ophthalmology / 12.01.2015

MedicalResearch.com Interview with: Zheng He and Bang V. Bui Department of Optometry & Vision Sciences University of Melbourne, Parkville, Australia Medical Research: What is the background for this study? What are the main findings? Response: Glaucoma, the second leading cause of blindness in the world, is a condition that occurs when too much pressure builds up inside the eye. This excess pressure injures the optic nerve (the wire that transmits visual information to the brain) resulting in vision loss. Many risk factors for glaucoma are not well understood. High blood pressure (> 140/90 mmHg) is probably the most common comorbidity in patients presenting to optometry clinics. The overall prevalence of hypertension worldwide is over 26%, and increases dramatically with advancing age. Long-term hypertension leads to remodeling of the heart and blood vessels, promoting the risk of multiple end organ damage. Whilst chronic hypertension is a well-documented risk factor for stroke, the link between hypertension and glaucoma remains unclear. Previously, it was thought that high blood pressure could counteract high intraocular pressure, which is a clear risk factor for glaucoma. However, this issue may be more complicated than first thought. The Baltimore Eye Survey compared the prevalence of glaucoma in young and older patients with hypertension. They found that young patients with high blood pressure were at lower risk of glaucoma compared to the entire cohort. This outcome is consistent with the idea that higher blood pressure provides better perfusion pressure to the eye. Paradoxically systemic hypertension in older subjects actually increased the risk of glaucoma. Its seems that longer durations of systemic hypertension impact glaucoma risk negatively. One explanation for this is that any benefit from high blood pressure counteracting high eye pressure is lost as damage to blood vessels — a consequence of hypertension — becomes more dominant. This hypothesis was tested by comparing the effect of acute (one hour) and chronic (four weeks) hypertension in lab rats with elevated eye pressure. When blood pressure was raised for four weeks, there was less functional protection against eye pressure elevation compared with the one-hour case. This shows that having high blood pressure for a longer time compromises the eye's capacity to cope with high eye pressure. This impairment was associated with thicker and narrower blood vessels and a reduced capacity for the eye to maintain blood flow at normal levels in response to eye pressure elevation (this process is known as autoregulation). Thus in chronic hypertension, smaller reduction in ocular perfusion pressure can result in blood flow deficiency. (more…)
Author Interviews, Diabetes, Ophthalmology, Telemedicine / 08.01.2015

MedicalResearch.com Interview with: Shi Lili Department of Medical informatics and Nantong University Library Nantong University, Nantong, China Medical Research: What is the background for this study? What are the main findings? Response: Diabetic retinopathy (DR) is the most frequently occurring complication of diabetes and one of the major causes of acquired blindness in the working-age population around the world. DR can be detected using various methods. Telemedicine based on digital photographs of the fundus is being used with increasing frequency to detect DR, and especially for Diabetic retinopathy screening. The purpose of our study was to assess the diagnostic accuracy of telemedicine in the full range of DR and DME severity compared with the current gold standard. We found that the diagnostic accuracy of telemedicine using digital imaging in DR was overall high. It can be used widely for Diabetic retinopathy screening. (more…)
Author Interviews, Ophthalmology, Weight Research / 13.12.2014

MedicalResearch.com Interview with: Rui Azevedo Guerreiro Centro Hospitalar de Lisboa Central Portugal Medical Research: What is the background for this study? What are the main findings? Response: This article aims to summarise the current state of understanding on the possible ophthalmic complications that can occur after a bariatric surgery. The main finding of this review article is that ophthalmic complications after bariatric surgeries are more frequent that we could thought initially, especially in patients not adherent to their vitamin supplements. In one study, the percentage of patients with vitamin A deficiency 4 years after the surgery reached up to 69%. (more…)
Author Interviews, Ophthalmology / 06.12.2014

MedicalResearch.com Interview with: Lilach Bareket School of Electrical Engineering, ‡Tel Aviv University Center for Nanoscience and Nanotechnology, and ⊥School of Chemistry, Tel Aviv University, Tel Aviv 69978, Israel Medical Research: What is the background for this study? Response: Neuro-prosthetic devices aim to restore impaired function through artificial stimulation of the nervous system. Visual prosthetic devices, operating by light activation of neurons, are presently developed as an approach to treat blindness. In particular, in the case of patients suffering from age-related macular degeneration in which the photoreceptors in the retina degenerate. (more…)
Author Interviews, Ophthalmology, Statins / 02.12.2014

B. John Mancini, MD, FRCPC, FACP, FACC Professor of Medicine; University of British Columbia; Department of Medicine, Division of Cardiology; Research Director, Division of Cardiology; Director, Cardiovascular Imaging Research Core Laboratory (CIRCL); President, Vancouver Hospital Medical, Dental and Allied Staff; Staff Cardiologist, VH Cardiology Clinics and Cardiac Computed Tomographic Angiography Program; Staff Cardiologist, St. Paul's Hospital Healthy Heart/Prevention Clinic.MedicalResearch.com Interview with: B. John Mancini, MD, FRCPC, FACP, FACC Professor of Medicine; University of British Columbia; Department of Medicine, Division of Cardiology; Research Director, Division of Cardiology; Director, Cardiovascular Imaging Research Core Laboratory (CIRCL); President, Vancouver Hospital Medical, Dental and Allied Staff; Staff Cardiologist, VH Cardiology Clinics and Cardiac Computed Tomographic Angiography Program; Staff Cardiologist, St. Paul's Hospital Healthy Heart/Prevention Clinic. MedicalResearch: What are the main findings of this study? Dr. Mancini: The main findings are that we found evidence of a relationship between statin use and the need for cataract surgery. The unique nature of the study is that it looked for the association in two distinctly different populations (a Canadian database and a separate, American database) and found a consistent association in both populations. (more…)
Author Interviews, Ophthalmology / 11.11.2014

Dr. Andrea Russo Medico Chirurgo - Specialista in Oculistica Università degli Studi di Brescia Brescia ItalyMedicalResearch.com Interview with: Dr. Andrea Russo Medico Chirurgo - Specialista in Oculistica Università degli Studi di Brescia Brescia Italy Medical Research: What is the background for this study? What are the main findings? Dr. Russo: When I finished my residency program in Ophthalmology two years ago I realized that many patients were referred to me to assess and classify diabetic and hypertensive retinopathy. Therefore, I started wondering if there was an ophthalmoscopy method to make General Practitioners and Internist Physicians independent for these screening retinal assessments. I thought that we all own a personal computer connected with a (high quality) camera in our pocket and therefore smartphone ophthalmoscopy was feasible. Both the indirect and direct ophthalmoscopy techniques were suitable, however the latter was much easier to obtain. Furthermore, direct ophthalmoscopy can exploit smartphones’ autofocus and flash LED light making the required optics very simple and inexpensive. I purchased my 3D printer and started realizing very first working prototypes. A few months were required to improve the light path to eliminate internal and corneal reflections. Finally, I patented the optical solution and joined my partner Si14 S.p.A. (Padova, Italy) for the industrialization process. The main findings are that that smartphone ophthalmoscopy with the D-Eye system can accurately detect retinal lesions for grading diabetic retinopathy. Furthermore, we noticed an amazing convenience in the assessment of babies, since they seem to be spontaneously attracted by the non-disturbing light emitted by the device, making the fundus acquisition straightforward. The advantages of smartphone-based retinal image acquisition for remote, non-hospital settings include portability and immediate upload/analysis. Indeed, telemedicine has the potential to reach patients and communities that currently receive negligible or suboptimal eye care as a result of geographic or sociocultural barriers, or both. (more…)
Author Interviews, Macular Degeneration, Radiology, Stanford / 10.11.2014

Daniel L. Rubin, MD, MS Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488MedicalResearch.com Interview with: Daniel L. Rubin, MD, MS  Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488 Medical Research: What is the background for this study? What are the main findings? Dr. Rubin: Age-Related Macular Degeneration is the leading cause of blindness and central vision loss among adults older than 65. An estimated 10-15 million people in the United States suffer from the disease, in which the macula — the area of the retina responsible for vision — shows signs of degeneration. While about one of every five people with AMD develop the so-called “wet” form of the disease that can cause devastating blindness. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly. Until now, there has been no effective way to tell which individuals with AMD are likely to convert to the wet stage. Current treatments are costly and invasive — they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of Age-Related Macular Degeneration a non-starter. In our study, we report on a computerized method that analyzes images of the retina obtained with a test called spectral domain optical coherence tomography (SD-OCT), and our method can predict, with high accuracy, whether a patient with mild or intermediate Age-Related Macular Degeneration will progress to the wet stage. Our method generates a risk score, a value that predicts a patient’s likelihood of progressing to the wet stage within one year, three years or five years. The likelihood of progression within one year is most relevant, because it can be used to guide a recommendation as to how soon to schedule the patient’s next office visit. In our study, we analyzed data from 2,146 scans of 330 eyes in 244 patients seen at Stanford Health Care over a five-year period. Patients were followed for as long as four years, and predictions of the model were compared with actual instances of conversion to wet AMD. The model accurately predicted every occurrence of conversion to the wet stage of AMD within a year. In approximately 40% of the cases when the model predicted conversion to wet AMD within a year, the prediction was not borne out, however. We are currently refining the model to reduce the frequency of these false positives. (more…)
Author Interviews, Biomarkers, Ophthalmology, Stanford / 07.11.2014

Theodore Leng, MD, MS , one of the article’s senior authors Byers Eye Institute at Stanford Stanford University School of Medicine Palo Alto, CA 94303MedicalResearch.com Interview with: Theodore Leng, MD, MS , one of the article’s senior authors Byers Eye Institute at Stanford Stanford University School of Medicine Palo Alto, CA 94303   Dr. Leng: What is the background for this study? What are the main findings? Medical Research: Age-related macular degeneration (AMD) is the leading cause of blindness and central vision loss among adults older than 65 years. 80-85% of patients have the dry, non-exudative, form of the disease, but the wet, exudative, form of advanced AMD is of primary concern as it accounts for a majority of severe vision loss in Age-related macular degeneration. In wet AMD, abnormal blood vessels grow under the retina and can leak blood and fluid. Until now, there has been no effective way to tell which patients with dry AMD are likely to progress to the wet stage. In our recent Investigative Ophthalmology & Visual Science article, we describe a new mathematical model that can predict which patients are likely to progress. The predictive model identifies likely progressors by analyzing 3D spectral domain optical coherence tomography (SD-OCT) retinal imaging data that’s routinely obtained during retinal encounters. We analyzed data from 2,146 SD-OCT scans of 330 eyes in 244 patients seen at The Byers Eye Institute at Stanford over a five-year period. We found that the area and height of drusen, the amount of reflectivity at the macular surface and the degree of change in these features over time, could be weighted to generate a patient’s risk score. Predictions from the model were compared with cases where patients actually progressed to wet Age-related macular degeneration. Our model accurately predicted every occurrence of progression within a year. There was a false positive rate of around 40%, but we thought this was a good tradeoff because we would not miss any potential progressors by using this sensitivity threshold. (more…)
Author Interviews, General Medicine, Macular Degeneration, Stroke / 31.10.2014

MedicalResearch.com Interview with: Takashi Ueta, M.D., Ph.D. Assistant Professor, Department of Ophthalmology Graduate School and Faculty of Medicine The University of Tokyo Medical Research: What is the background for this study? What are the main findings? Dr. Ueta: In 2009 we had reported an initial systematic review and meta-analysis which include pivotal RCTs but the number of the included studies were only 3 (MARINA, ANCHOR, FOCUS). During the following several years, more trials comparing different dosages and frequencies of ranibizumab treatment were conducted, which made us to update our meta-analysis. Based on our updated meta-analysis, increase in several systemic vascular adverse events was observed: 86% increase in odds ratio (OR) for the risk of cerebrovascular accident (CVA) when 0,5 mg ranibizumab used. 89% increase in OR for the risk of CVA when monthly ranibizumab of any dosage is used. 57% increase in OR for the risk of non-ocular hemorrhage when ranibizumab of any dosage with any frequency is used. (more…)
Author Interviews, JAMA, Macular Degeneration / 28.10.2014

Ronald Klein, MD, MPH, Professor Department of Ophthalmology and Visual Sciences University of Wisconsin School of Medicine and Public Health Madison WIMedicalResearch.com Interview with: Ronald Klein, MD, MPH, Professor Department of Ophthalmology and Visual Sciences University of Wisconsin School of Medicine and Public Health Madison WI Medical Research: What are the main findings of the study?  Dr. Klein: We found that more severe age-related macular degeneration (AMD) in 1 eye was associated with increased incidence of age-related macular degeneration [levels 1-2: hazard ratio [HR], 4.90 [95%CI, 4.26-5.63] and accelerated progression [levels 2-3: HR, 2.09 [95%CI, 1.42-3.06]; levels 3-4: HR, 2.38 [95%CI, 1.74-3.25] and incidence of late age-related macular degeneration [levels 4-5: HR, 2.46 [95%CI, 1.65-3.66] in its fellow eye. Less severe AMD in 1 eye was associated with less progression of AMD in its fellow eye. We estimated that 51% of participants who develop any age-related macular degeneration maintained age-related macular degeneration severity states within 1 step of each other between eyes and 90% of participants stay within 2 steps. (more…)
Author Interviews, Melanoma, Ophthalmology / 17.10.2014

MedicalResearch.com Interview with: Prof I. Jolanda M. de Vries Professor, Dept of Tumor Immunology Radboud University Nijmegen Medical Research: What are the main findings of the study? Prof. de Vries: Dendritic cells are antigen-presenting cells with the unique capacity to activate naive antigen-specific T cells, and by this means are very suitable to induce immunologic antitumor responses. Dendritic cells cultured from monocytes can be matured and loaded with tumor antigen ex vivo and administered back into the patient. Within the lymph node, dendritic cells present antigens to T cells to initiate an immune response. Metastatic uveal melanoma patients were vaccinated with autologous DCs loaded with tumor antigens (gp100 and tyrosinase), obtained by leukapheresis, according to a schedule of 3 biweekly vaccinations. One to 2 weeks after the last vaccination, a skin test was performed to analyse the induction of immunologic responses. We can conclude that dendritic cell vaccination is feasible and safe in metastatic uveal melanoma. Dendritic cell-based immunotherapy is potent to enhance the host’s antitumor immunity against uveal melanoma in approximately one third of patients. (more…)
Author Interviews, Exercise - Fitness, Karolinski Institute, Ophthalmology / 04.10.2014

MedicalResearch.com Interview with: Jinjin Zheng Selin, MSc Unit of Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden Medical Research: What are the main findings of the study? Response: Our results suggest that higher levels of total physical activity, especially in the long-term, as well as specific types of physical activity including walking/bicycling and work/occupational activity, may be associated with decreased risk of age-related cataract among middle-aged and elderly women and men. On the other side, high levels of leisure time inactivity may be associated with increased risk of cataract. (more…)
Author Interviews, Ophthalmology / 01.10.2014

Dr. Michael Kalloniatis School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia; Centre for Eye Health, Sydney, New South Wales, Australia;MedicalResearch.com Interview with: Dr. Michael Kalloniatis School of Optometry and Vision Science, UNSW Australia, Sydney, New South Wales, Australia; Centre for Eye Health, Sydney, New South Wales, Australia; Medical Research: What are the main findings of the study? What was most surprising about the results? Dr. Kalloniatis: Normal mice given a single sildenafil treatment had a transient loss of visual function which recovered in two days. Carrier mice (mice which carry a single copy of a mutation that commonly causes recessive Retintis Pigmentosa) showed a supernormal visual response (a response much larger than the norm) to sildenafil which took two weeks to recover to normal. Carrier mice also showed an increase in an early marker for apoptosis (a protein which suggest cells may be preparing to die) suggesting sildenafil may cause retinal degeneration in these mice. (more…)
Author Interviews, Ophthalmology / 22.09.2014

Dr. David O'Brart Keratoconus Research Institute, Department of Ophthalmology St. Thomas' Hospital, London, United KingdomMedicalResearch.com Interview with: Dr. David O'Brart Keratoconus Research Institute, Department of Ophthalmology St. Thomas' Hospital, London, United Kingdom   Medical Research: What are the main findings of the study? Dr. O'Brart: There was a slight but significant increase in myopic spherical equivalent refractive error after Photorefractive Keratectomy between 1 and 20 years, particularly in those under 40 at the time of treatment and female patients. Corneal curvature/power remained unchanged but axial length increased over two decades. The procedure was safe with no long-term sight-threatening complications and improvements in CDVA (corrected distance visual acuity) and corneal transparency with time. (more…)
JAMA, Ophthalmology / 20.09.2014

Szilárd Kiss, MD Director of Clinical Research Director of Compliance Associate Professor of Ophthalmology Weill Cornell Medical College NewYork-Presbyterian Hospital New York, New York 10021MedicalResearch.com Interview with: Szilárd Kiss, MD Director of Clinical Research Director of Compliance  Associate Professor of Ophthalmology Weill Cornell Medical College NewYork-Presbyterian Hospital New York, New York 10021 Medical Research: What is the background for your study? Dr. Kiss: There has been a good deal of publicity about bevacizumab (Avastin; a Genetech/Roche antibody originally developed for treatment of cancer but now used widely to treat macular degeneration and diabetic retinopathy) being prepared by (mostly unregulated) compounding pharmacies for injection into the eye, and being associated with pathogen contamination. (more…)
Author Interviews, JAMA, Ophthalmology, Telemedicine / 11.09.2014

Mary G. Lynch, MD Professor of Ophthalmology Atlanta Veterans Affairs Medical Center Decatur, Georgia. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GeorgiaMedicalResearch.com Interview with: Mary G. Lynch, MD Professor of Ophthalmology Atlanta Veterans Affairs Medical Center Decatur, Georgia. Department of Ophthalmology, Emory University School of Medicine,  Atlanta, Georgia Medical Research: What are the main findings of the study? Dr. Lynch:
  • Since 2006, the VA has been systematically using teleretinal screening of patients with diabetes to screen for retinopathy in the Primary Care Clinics. Under this program, 90% of veterans with diabetes are evaluated on a regular basis. A number of patients who are screened have findings that warrant a face-to-face ophthalmic exam. No information exists on the effect of such a program on medical center resources.
  • 1,935 patients  underwent teleretinal screening through the Atlanta VA over a 6 month period.  We reviewed the charts of the 465 (24%) of the patients who were referred for a face to face exam in the Eye Clinic.
  • Data was collected for these patients to determine the reasons for referral, the accuracy of the teleretinal interpretation, the resources needed in the Eye Clinic of the Medical Center to evaluate and care for the referred patients over a two year period and possible barriers to patient care.
  • Of the 465 patients referred for an exam, 260 (55.9%) actually came in for an exam. Community notes were available for an additional 66 patients. Information was available for 326 (70.1%) of the referred patients.
  • The most common referring diagnoses were nonmacular diabetic retinopathy (43.2% of referrals), nerve related issues (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%) and diabetic macular edema (5.6%).
  • 16.9% of the referred patients had 2 or more concurrent problems that put them at high risk for visual loss.
  • The percentage agreement between teleretinal screening and the ophthalmic exam was high: 90.4%. Overall sensitivity was 73.6%. The detection of diabetic macular edema had the lowest sensitivity.
  • A visually significant condition was detected for the first time through teleretinal screening for 142 of the patients examined (43.6%).
  • The resource burden to care for referred patients was substantial.
  • 36% of patients required 3 or more visits over the ensuing 2 year period.
  • The treatment of diabetic macular edema had the highest resource use involving on average 5 clinic visits, 6 diagnostic procedures and 2 surgical procedures
  • The most common non-refractive diagnostic procedures were visual fields and optical coherence tomography.
  • The average cost to care for the referred patients (in Medicare dollars) in work RVUs alone was approximately $1,000 per patient. The cost to care for a patient with diabetic macular edema was $2673.36.
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