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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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

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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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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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Cataract Surgery Linked To Improved Health and Survival, As Well As Sight

MedicalResearch.com Interview with:

Anne L. Coleman, MD, PhD Center for Community Outreach and Policy, Stein Eye Institute David Geffen School of Medicine Director, UCLA Mobile Eye Clinic Department of Epidemiology, Fielding School of Public Health UCLA

Dr. Coleman

Anne L. Coleman, MD, PhD
Center for Community Outreach and Policy, Stein Eye Institute
David Geffen School of Medicine
Director, UCLA Mobile Eye Clinic
Department of Epidemiology, Fielding School of Public Health
UCLA

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

Response: Cataracts are a leading cause of vision loss worldwide, and cataract surgery is an intervention that is known to be extremely effective to address the vision loss related to cataract. However, it is unclear if there are benefits of cataract surgery beyond vision improvement in people with cataracts. Previous studies have suggested that in addition to improving vision, cataract surgery may decrease the risk of fractures and accidents, improve mental health, and improve overall quality of life. The purpose of the present study was to further investigate the potential benefits of cataract surgery and to determine if cataract surgery was associated with increased survival in people with cataracts.

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Vascular Safety of Ranibizumab in Patients With Diabetic Macular Edema

MedicalResearch.com Interview with:

Marco A Zarbin, MD, PhD, FACS Alfonse Cinotti, MD/Lions Eye Research Professor and Chair Institute of Ophthalmology & Visual Science Rutgers-New Jersey Medical School Rutgers University Newark, NJ 0710

Dr. Zarbin

Marco A Zarbin, MD, PhD, FACS
Alfonse Cinotti, MD/Lions Eye Research
Professor and Chair
Institute of Ophthalmology & Visual Science
Rutgers-New Jersey Medical School
Rutgers University Newark, NJ 0710 

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

  1. Most large, randomized clinical trials are powered to assess the efficacy of drugs or interventions, but they usually do not enroll enough patients to accurately assess the frequency of uncommon, undesirable side effects.
  2. In order to compensate for this deficiency in trial design, investigators aggregate the results of numerous studies all of which address the same clinical question with the same (or similar) drugs/interventions to increase the power to detect uncommon side effects. These aggregate studies can be meta-analyses.
  3. Unfortunately, most meta-analyses do not have the ability to answer some critical questions such as the timing of an adverse event relative to the last exposure to the drug, nor can they compensate fully for differences among the aggregated studies in trial design, length of patient follow-up, or presence pre-existing risk factors for the side effects in question.
  4. A pooled analysis of combined clinical trials using patient level data, however, allows a more in depth analysis of side effects than study level data, which are usually used for most published meta-analyses, because patient level data allow one to incorporate the per-patient duration of exposure to treatment, adjust for imbalances in predefined baseline risk factors, and adjust for the effect of results of single studies on the overall result.

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Study Identifies Risk Groups For Keratoconus

Maria A. Woodward, MD Department of Ophthalmology and Visual Sciences University of Michigan Ann Arbor, MI 48105

Dr. Woodward

MedicalResearch.com Interview with:
Maria A. Woodward, MD

Department of Ophthalmology and Visual Sciences
University of Michigan
Ann Arbor, MI 48105 

Medical Research: What is the background for this study? What are the main findings?

Dr. Woodward: The research was sparked by questions whether changes to the eye with keratoconus affect other parts of the body.  There is conflicting information from past research about connections between systemic diseases and keratoconus.  This creates confusion for patients and for doctors treating these patients.
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LUCAS: Lucentis Compared to Avastin Treat and Extend Study For Macular Degeneration

Karina Birgitta Berg MD Department of Ophthalmology Oslo University Hospital Oslo, Norway

Dr. Berg

MedicalResearch.com Interview with:
Karina Birgitta Berg MD
Department of Ophthalmology
Oslo University Hospital
Oslo, Norway 

Medical Research: What is the background for this study? What are the main findings?

Dr. Berg: Neovascular age-related macular degeneration (nAMD) has been the leading cause of vision loss in the elderly population of Western countries. Inhibition of vascular endothelial growth factor (VEGF) with medications such as bevacizumab and ranibizumab injected into the eye, has dramatically reduced the incidence of social blindness from this disease. Bevacizumab was marketed for intravenous cancer treatment, while ranibizumab was later developed and approved for intraocular treatment of nAMD. Due to similar clinical effects and a strikingly low cost compared to ranibizumab, bevacizumab has remained widely used as an off-label treatment for the treatment of nAMD. In order to preserve vision results over time, most patients need injections repeatedly. Treatment on a monthly basis has shown good vision improvement, while monitoring monthly and treating only when signs of recurrences appear, is less successful. The aim of a treat-and-extend protocol is to gradually increase the treatment intervals, while avoiding potentially harmful recurrences. This treatment modality has become commonly used, entailing fewer patient visits and less burden upon health care systems.

The multicenter prospective randomized Lucentis Compared to Avastin Study (LUCAS) was aimed at comparing the efficacy and safety of bevacizumab versus ranibizumab when following a treat-and-extend protocol. The patients received monthly injection treatment until inactive disease was achieved. The treatment interval was then increased by two weeks at a time up to a maximum of 12 weeks. In the event of a recurrence, the treatment interval was reduced by two weeks at a time. The study demonstrated equivalent results in vision improvement with bevacizumab and ranibizumab after two years of treatment. Treatment according to a treat-and-extend protocol was safe with good visual results when extending up to 10 weeks, while recurrences at 12-week intervals had a negative impact on the final results on vision.

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Gene Therapy May Stop Blindness From Retinitis Pigmentosa

Professor Robert E MacLaren MB ChB DPhil FRCOphth FRCS Nuffield Laboratory of Ophthalmology Nuffield Department of Clinical Neurosciences, University of Oxford Oxford Biomedical Research Centre, University of Oxford, Oxford, UK Moorfields Eye Hospital & UCL NIHR Biomedical Research Centre for Ophthalmology London, UK.MedicalResearch.com Interview with:
Professor Robert E MacLaren MB ChB DPhil FRCOphth FRCS
Nuffield Laboratory of Ophthalmology
Nuffield Department of Clinical Neurosciences
Oxford Biomedical Research Centre, University of Oxford,
Moorfields Eye Hospital & UCL NIHR Biomedical Research Centre for Ophthalmology
London, UK.


Medical Research: What is the background for this study? What are the main findings?

Prof. MacLaren: The study shows that gene therapy can be used to release a protein in the eye that arrests the development of retinitis pigmentosa, a blinding disease caused by degeneration of the retina. The study was performed in mice which had a similar genetic defect to that found in humans with the disease. The mice also had fluorescent green “glow in the dark” light sensing cells known as cones, which we could see and count by looking into the eye – like counting stars in the night sky. By counting the green fluorescent cones we were able to work out the exact dose of gene therapy needed to keep these cells alive indefinitely. The study was funded by Fight for Sight, a UK charity that supports finding cures for eye diseases.

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Novel Therapeutic Target Identified For Treatment Of Proliferative Diabetic Retinopathy Identified

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.

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Retinal Artery Occlusion Linked To Increased Risk Of Acute Coronary Syndrome

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. Continue reading

Binocular iPad Games Effectively Treated Childhood Amblyopia

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.

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Risk of Endophthalmitis from Aflibercept-Related Sterile Intraocular Inflammation

Pravin U. Dugel MD Managing Partner, Retinal Consultants of Arizona Phoenix AZ Clinical Professor  USC Eye Institute Keck School of Medicine  Los Angeles CAMedicalResearch.com Interview with:
Pravin U. Dugel MD

Managing Partner, Retinal Consultants of Arizona Phoenix AZ
Clinical Professor  USC Eye Institute
Keck School of Medicine  Los Angeles CA

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Dugel: Endophthalmitis is one of the most feared complications in ophthalmology. It is potentially blinding. All retina specialists should be aware of any data involving this complication. This is valuable information that has direct patient care implications. However, it is equally important to distinguish definitive data from hypothesis building data. This is the latter, not the former. Further investigations will either confirm or refute this … But such investigations are warranted.

Medical Research: What should clinicians and patients take away from your report?

Dr. Dugel: It is important to remember that this is a summary of a voluntarily reported database. Therefore, it is not a definitive study. Nonetheless, the relative number of cases, the cluster of patients and the existence of other supportive  Medicare data-based studies, suggests that this issue warrants further investigation.

Citation:

 

 

New Biomarker Measures Sun Exposure To the Eye

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.
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Telemedicine Convenient and Cost-Effective For Diabetic Retinopathy Screening

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.
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Vitamin Deficiency After Bariatric Surgery Can Lead To Eye Complications

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%.

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Bacteria Causing Eye Infections Increasingly Resistant To Common Antibiotics

Ronald C Gentile, MD, FACS, FASRS Professor of Ophthalmology Chief, Ocular Trauma Service (Posterior Segment) Surgeon Director The New York Eye and Ear Infirmary of Mount Sinai New York, NY 10003 President: operationrestorevision.orgMedicalResearch.com Interview with
Ronald C Gentile, MD, FACS, FASRS
Professor of Ophthalmology
Chief, Ocular Trauma Service (Posterior Segment)
Surgeon Director
The New York Eye and Ear Infirmary of Mount Sinai
New York, NY 10003
President: operationrestorevision.org

Medical Research: What are the main findings of the study?

Dr. Gentile: We had three main findings in our study on the microbiological spectrum and antibiotic sensitivity in endophthalmitis over the past twenty- five years at the New York Eye and Ear Infirmary of Mount Sinai.

First Finding: The first main finding of the study was that there has not been any major change in the types of organisms causing endophthalmitis over the past 25 years. The most common cause of endophthalmitis in the study was bacteria, 95%, with most, 85%, being Gram-positive bacteria. The most prevalent organisms isolated were coagulase-negative staphylococcus, making up about 40% of the cases. This was followed by Streptococcus viridans species in about 12% and Staphylococcus aureus in about 11%. Gram-negative organisms accounted for about 10% and fungi for about 5%.

Second Finding: The second main finding of the study was that the current empiric intravitreal antibiotics used for treating endophthalmitis, vancomycin and ceftazidime, continue to be an excellent choice. The overwhelming majority of microorganisms causing endophthalmitis are susceptible to this combination. Over 99% of the Gram-positive isolates were susceptible to the vancomycin and about 92 percent of the Gram-negative isolates were susceptible to ceftazidime.

Third Finding: The third main finding of the study was that there was increasing microbial resistance to eight antibiotics including cefazolin, cefotetan, cephalothin, clindamycin, erythromycin, methicillin/oxacillin, ampicillin, ceftriaxone and decreasing microbial resistance to three antibiotics including gentamicin, tobramycin, and imipenem. For example, Staph Aureus isolates resistant to methicillin increased from 18% in the late 1980s to just over 50% this past decade while gentamicin-resistance endophthalmitis isolates decreased during the same time period from 42% to 6%.

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Ophthalmology: Using Claims Data to Assess Eye Research

Dr. Flora Lum, MD Executive Director, The H. Dunbar Hoskins Jr., M.D. Center for Quality Eye Care, American Academy of Ophthalmology San Francisco, CA 94109-1336MedicalResearch.com Interview with:
Dr. Flora Lum, MD
Executive Director, The H. Dunbar Hoskins Jr., M.D. Center for Quality Eye Care,
American Academy of Ophthalmology
San Francisco, CA 94109-1336

MedicalResearch.com: What are the main findings of the study? 

Dr. Lum: This study anticipates the increased use of claims data for research.

The study recommends a checklist for authors to use in reporting claims data analyses, and discusses the advantages  and limitations of using claims data.

MedicalResearch.com: Were any of the findings unexpected? 

Dr. Lum: There is variability in the methods and descriptions of claims data analyses, and as these increase in number and importance, its encouraged that researchers use rigorous methods.
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