Lehigh Valley Center For Sight

APR 27, 2018 By Anni Griswold Comprehensive Ophthalmology, Cornea/External Disease, Neuro-Ophthalmology/Orbit, Retina/Vitreous A weekly roundup of ophthalmic news from around the web. Pinterest just rolled out a  new app, designed with visually impaired people in mind . The company spent more than a year reworking its app based on feedback from people with eye conditions ranging from macular degeneration to complete blindness. The new app boasts user-friendly colors and fonts, special markings around buttons and menus, and—most importantly—compatibility with Voice Over and Talk Back. Co. Design This isn’t another scleral tattoo mishap: When a 70-year-old man realized the whites of his eyes had taken on a blue hue , he turned to doctors for help. Eye exams revealed normal vision and no sign of disease. The culprit? An antibiotic called minocycline that he’d been taking for 15 years to treat inflammatory arthritis. His case appeared last week in the New England Journal of Med

APR 26, 2018 By Anni Griswold Novartis Comprehensive Ophthalmology A new smartphone app lets patients participate in ophthalmology trials without ever stepping foot in a clinic. Novartis’ FocalView app guides patients through self-assessments of visual function and disease activity, streaming large volumes of real-world data directly into researchers’ hands. The app, created using Apple’s ResearchKit platform, aims to dissolve barriers to patient participation by easing the enrollment process, improving compliance and reducing the time and expense of clinical exams. Data capture in traditional ophthalmic clinical trials tends to be “inflexible and infrequent,” Novartis says, so adapting a trial’s design to fit the daily routine of patients could spur participation. If proven effective, FocalView could help uncover key insights about disease manifestation or progression by providing researchers with real-time reports collected over a span of months or years. “Optimizing di

Patients with dry eye may not significantly benefit from supplementation with fish-derived omega-3 fatty acids, according to findings from a year-long randomized controlled trial. The results, reported earlier this month in The New England Journal of Medicine , are the most reliable and generalizable evidence thus far on omega-3 supplementation for dry eye disease, and goes against what previous trials have shown. These new observations were surprising to many eye care providers that routinely prescribe omega-3s for this condition. “This study is sure to stir up a lot of controversy,” commented Julie Schallhorn, MD, an assistant professor of clinical ophthalmology at the University of California, San Francisco. Both Dr. Schallhorn and Sumitra S. Khandelwal, MD, an associate professor of ophthalmology at Baylor College of Medicine, point out that though the DREAM (Dry Eye Assessment and Management) study was rigorous and well executed, the results should be taken in context. “It lo

In addition to funding sight-saving research, we at FFB work hard to tell the scientific world about it. That’s because knowledge sharing and collaboration are critical to accelerating the advancement of promising therapies. Progress in developing treatments and cures isn’t made in a vacuum. The best opportunity for us to showcase FFB-funded research is at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), which is being held April 29 – May 3 this year in Honolulu. More than 11,000 eye researchers from around the world — including five intrepid members from FFB’s science team — will gather to participate in what is essentially a massive “show and tell” of the latest scientific advancements. This year at ARVO, FFB will have its own, impressive show and tell, highlighting nearly 100 posters and presentations on a variety of topics including: MyRetinaTracker.org (our global patient registry), FFB patient genetic testing program, FFB ProgStar

APR 20, 2018 By Kanaga Rajan EBioMedicine Cataract/Anterior Segment, Comprehensive Ophthalmology, Retina/Vitreous, Uveitis Cataract surgery can be safely performed on Ebola survivors, according to a study from scientists at Emory University School of Medicine and their international colleagues. The team systematically assessed the persistence of the Ebola virus in the ocular fluid of survivors and report vision outcomes after cataract surgery. Their study appeared in the April 2018 issue of EBioMedicine. “These findings are truly exciting, as they improve our ability to impact vision care and quality of life for thousands of Ebola survivors at risk for eye disease,” says Steven Yeh, MD, the M. Louise Simpson Associate Professor of Ophthalmology, Uveitis and Vitreoretinal Surgery at Emory. Dr. Yeh treated the first known case of ocular Ebola in 2015. His 43-year-old patient, Ian Crozier, MD, an Ebola virus survivor, presented with rapidly declining vision approximately

APR 24, 2018 Cataract/Anterior Segment, Refractive Mgmt/Intervention This prospective study examined the tilt and decentration of multifocal IOLs following implantation in myopic eyes. Study design The authors studied 28 myopic (axial length >24.5 D) and 56 emmetropic eyes that underwent phacoemulsification and Tecnis ZMB00 multifocal IOL (Abbott) implantation. Outcomes included tilt and decentration of the IOLs, high-order aberrations and modulation transfer function (MTF), measured using an OPD-Scan III aberrometer. Subjective symptoms were assessed using a questionnaire. Outcomes At 1 year postop, UDVA, CDVA and UNVA did not differ between groups, nor did horizontal decentration or IOL tilt. Vertical decentration, however, was statistically worse in the myopic group. The myopic group also had worse aberration data, poorer MTF and more subjective symptoms than controls. Axial length negatively correlated with vertical decentration. Limitations The study only used the

APR 20, 2018 By Anni Griswold Cornea/External Disease, Glaucoma, Retina/Vitreous A weekly roundup of ophthalmic news from around the web. An Instagram model paid the ultimate price to change her eye color from hazel to light grey. Nadinne Bruna, 32, shelled out $3,000 to have silicone plates implanted in front of her iris, but the procedure ended up costing her much more: 80% of vision in her right eye and 50% in her left eye. Daily Mail Glaucoma expert Thomas W. Samuelson, MD, took the reins this month as the 33 rd president of the American Society of Cataract and Refractive Surgery (ASCRS). Samuelson is an attending surgeon and founding partner of Minnesota Eye Consultants, and an adjunct professor of ophthalmology at the University of Minnesota. Healio Canadian engineer Marinko Sarunic says his shoebox-sized retinal scanner (shown above) can capture high-resolution, 3-D, cross-sectional images of the tissue in a level of detail that rivals images from much larger s

  Regenerative Patch Technologies , a company developing stem-cell-derived treatments for people with retinal diseases, has reported encouraging results for the first five patients with advanced, dry age-related macular degeneration (AMD) participating in a Phase 1/2a clinical trial for its therapy – a patch comprised of a layer of retinal pigment epithelial (RPE) cells on a synthetic scaffold. The treatment is known as the California Project to Cure Blindness–Retinal Pigment Epithelium 1 (CPCB-RPE1). One patient in the trial had visual acuity improvement of 17 letters (about 3 lines on an eye chart) in her treated eye. Three patients had vision maintained in their treated eyes. Two had improved fixation. One patient did not receive the patch due to debris underneath the retina. No evidence of safety issues with the treatment was observed. The study investigators also reported anatomic improvements in the treated eyes. Imaging showed that the transplanted RPE cells integrated with

Researchers from Japan treated bullous keratopathy with an injection of cultured human corneal endothelial cells (CECs) supplemented with a rho-associated protein kinase (ROCK) inhibitor. Study design This non-randomized prospective study enrolled 11 patients with corneal edema secondary to Fuchs endothelial dystrophy or pseudophakic bullous keratopathy. The patients had no detectable endothelial cells on specular microscopy, a central corneal thickness greater than 630 μm and frank epithelial edema. The CECs were cultured from a donor cornea and injected into the anterior chamber with a silicone cannula. Ten patients received approximately 1x10 6 cells, while the remaining patient received 5x10 6 cells. The injection medium contained the ROCK-selective inhibitor, Y-27632. After the procedure, patients were placed in a prone position for 3 hours and maintained on topical corticosteroids as an anti-rejection prophylaxis. Outcomes At 24 weeks post-injection, all patients had an en

Metabolic changes of the crystalline lens fibers in your eye can lead to opacification and loss of transparency of the lens in the eye over time. This could lead to vision impairment. During cataract surgery, the cloudy natural “cataract” lens in your eye is removed and replaced with a synthetic lens to restore clear vision. Laser cataract surgery Laser cataract surgery was first performed in the USA in 2010. Due to the precision, quick turnaround time, consistency and convenience offered by this procedure, it has gained the support of ophthalmic surgeons worldwide. Most laser cataract surgeries take just 15 minutes and since the procedure only requires local anesthesia you will be awake during this procedure. How a laser cataract surgery is performed: The laser-assisted cataract system’s camera analyses your eyes and feeds detailed visuals of your eye lens to a specialized computer. This allows your surgeon to map the eye-lens surfaces and identify the ideal location for incisi

APR 13, 2018 By Anni Griswold Comprehensive Ophthalmology, Cornea/External Disease, Glaucoma, Pediatric Ophth/Strabismus Above: The GonioPEN (Credit: Nanyang Technological University) A weekly roundup of ophthalmic news from around the web. Ophthalmologists earn more than the average physician , and their salaries are on the rise (+3% over the last year, to be precise). Eye docs will earn a mean $375,000 this year—more than the physician average of $299,000, but well below a typical plastic surgeon’s paycheck. See for yourself in Medscape’s 2018 Physician Compensation Report . Medscape A special supplement to USA Today will highlight the work of Von Miller , a 28-year-old linebacker for the Denver Broncos and former Super Bowl MVP. Through his foundation, Von’s Vision, Miller connects thousands of underprivileged children in Denver with affordable, high-quality eye care. His interview will appear in the “Vision Health” campaign during World Glaucoma Week, available in pr

APR 12, 2018 By Keng Jin Lee FDA Comprehensive Ophthalmology, Retina/Vitreous Iowa-based biotech firm IDx, LLC has gained regulatory approval for the first artificial intelligence (AI) device capable of screening for diabetic retinopathy (DR). The IDx-DR software is designed for use by primary care physicians and other health providers who treat patients with diabetes. The goal, IDx says, is for these providers to screen adult patients without requiring an eye specialist to scan images for signs of DR. Images of the patient’s retina are captured by a Topcon NW400 camera and uploaded to a cloud server, where the IDx-DR software resides. The software autonomously interprets the images and returns one of two possible results: ‘More than mild diabetic retinopathy detected: refer to an eye care professional’ or ‘negative for more than mild diabetic retinopathy; rescreen in 12 months.’ A multi-center trial of the device in more than 900 adults with diabetes revealed a sensitivi

This single-arm clinical trial assessed the ability of the Retina Implant Alpha AMS (Retina Implant AG) to restore vision in 6 patients with end-stage retinitis pigmentosa. Study design The prospective, investigator-sponsored, interventional trial compared vision with the implant turned on versus with the implant turned off in the same eye. Each of the 6 patients received the Alpha AMS implant in their worse-seeing eye, which had bare light perception or no light perception at study entry. The main outcome measures were vision assessments, which included object recognition tasks, patient self-assessment of their mobility, as well as screen-based visual acuity testing including Basic Light and Motion testing as well as grating visual acuity. Outcomes During a 24-month follow-up period, the implant restored light perception and temporal resolution to all 6 participants. The ability to locate high-contrast tabletop objects was reestablished in all but 1 participant, whose implant

APR 09, 2018 Pediatric Ophth/Strabismus, Retina/Vitreous Findings from this case-control study support the hypothesis that vitamin A can slow loss of cone function in children with common forms of retinitis pigmentosa (RP). Study design The study included 55 patients with RP who took oral vitamin A palmitate supplements (5,000 IU to 15,000 IU daily, depending on age). Twenty-five untreated patients served as controls. The main outcome was the annual rate of change in full-field cone electroretinography amplitude to 30-Hz white flashes. Outcomes Patients were followed for a mean of 4 to 5 years. After adjusting for covariates, vitamin A supplementation was associated with almost 50% slowing of the mean exponential rate of decline of full-field cone electroretinogram amplitude compared with controls. The difference between groups was 0.0771 log e -unit per year (P=0.009). The incidences of falling to a visual field diameter of 20° or less or a visual acuity of 20/200 or less i

LASIK, short for Laser-Assisted In Situ Keratomileusis, is a type of refractive surgery that reshapes the cornea of the eye in order to correct myopia, hyperopia, and astigmatism. It is an outpatient procedure that is performed by a refractive surgeon. LASIK costs vary widely depending on the area of the country in which LASIK is performed and the degree of the patient’s refractive error. The cost of LASIK can range anywhere from $499 per eye to $2,500 per eye. But you should not base your choice of a LASIK surgeon solely on the cost of the surgery; a less skilled ophthalmologist may charge less for LASIK, but he may not have the same experience, training, or precise equipment as a more expensive doctor. Many experts recommend avoiding discount laser eye surgery centers that rely on aggressive marketing campaigns. Although paying more does not necessarily mean that you will get the best surgeon. To ensure that you find a skilled refractive surgeon to perform your LASIK eye surgery,

APR 06, 2018 By Keng Jin Lee Science Translational Medicine , University of Southern California Comprehensive Ophthalmology, Retina/Vitreous Researchers from University of Southern California (USC) are the first to show the feasibility of a stem cell-based implant in people with advanced dry AMD , with no adverse events noted through 1 year. “Our study shows that this unique stem cell-based retinal implant thus far is well tolerated, and preliminary results suggest it may help people with advanced dry age-related macular degeneration,” said co-author and lead inventor of the implant Mark S. Humayun, MD, director of the USC Institute for Biomedical Therapeutics and co-director of the Roski Eye Institute. Results from the phase 1/2a study, funded in part by the California Institute for Regenerative Medicine, appeared March 4 in  Science Translational Medicine . Stem cell researchers from the University of California at Santa Barbara also contributed to the high-profile study.

APR 06, 2018 Cornea/External Disease This study retrospectively analyzed data from the German Keratoplasty Registry to delineate trends in corneal transplantation. Study design The authors distributed questionnaires to 111 ophthalmologic departments in Germany to ascertain the number of corneal transplants performed between 2001 and 2016, as well as the indications for each procedure. Outcomes Analysis of responses from 94 of the 111 departments revealed that keratoplasties increased by 1.5-fold over the study period, from 4,730 in 2001 to 7,325 in 2016. By 2014, lamellar keratoplasties were performed more often than penetrating keratoplasties. In 2016, German surgeons performed 12 times more Descemet's membrane endothelial keratoplasties (DMEKs) than Descemet's stripping endothelial keratoplasties (DSEKs). Throughout the study period, Fuchs endothelial corneal dystrophy remained the most common indication for surgery. The proportion of deep anterior lamellar keratop

APR 06, 2018 By Anni Griswold Cataract/Anterior Segment, Comprehensive Ophthalmology, Glaucoma, Uveitis A weekly roundup of ophthalmic news from around the web. Ophthalmologists in Illinois are contesting legislation that could expand the scope of practice for the state’s optometrists. Illinois General Assembly’s Joint Committee on Administrative Rules is expected to decide within the next few months if optometrists can perform 8 surgical procedures —including biopsies, corneal debridement and subconjunctival injections—after completing 32 hours of training. State Journal-Register During a Holy Thursday visit to Rome's Regina Coeli prison, Pope Francis encouraged inmates to practice “cataract surgery for the soul” by shedding the cloud of disillusionment and cleansing their view on life. The Pope, age 81, revealed that he has cataracts (real ones!) and plans to undergo surgery next year. Reuters AbbVie’s blockbuster drug, Humira, will face a rival in European marke

APR 05, 2018 By Keng Jin Lee Nasdaq Retina/Vitreous ThromboGenics announced positive data from a phase 1/2 trial assessing the safety and tolerability of THR-317 , an experimental treatment for diabetic macular edema (DME). THR-317 is a recombinant humanized monoclonal antibody directed against human placental growth factor (PIGF), a member of the VEGF subfamily. Preclinical models have demonstrated that anti-PIGF has anti-angiogenic, anti-edema and anti-inflammatory properties. Conducted in Czechia, Hungary and Slovakia, the trial ( NCT03071068 ) enrolled 49 patients with diabetes, of which 40 were treatment naïve and 9 had previously demonstrated suboptimal response to anti-VEGF therapy. Patients were randomized to 3 monthly injections of 4-mg or 8-mg THR-317. The Belgium-based biotech reported initial improvements in best-corrected visual acuity for the treatment-naïve group. Thirty days after the last intravitreal anti-PIGF administration, 30% of patients in the 8 mg gr

Investigators evaluated the effectiveness of curative and preventative surgical strategies for negative dysphotopsia. Study design The therapeutic group comprised patients with self-reported chronic negative dysphotopsia who underwent corrective surgery. The preventative group included symptomatic patients requiring cataract surgery in a contralateral eye. The primary outcome measure was improvement of negative dysphotopsia by 3 months after surgery. Outcomes Of the 40 eyes in the therapeutic group, 76.6% had acrylic IOLs, 23.4% were silicone and all were bag-fixated. Negative dysphotopsia was associated with acrylic or silicone IOLs of either square- or round-edge design. Anterior capsule overlap on the IOL surface was the key factor inducing negative dysphotopsia. Successful outcomes for each surgical strategy were as follows: bag-to-bag IOL exchange (0/5), a reduction in posterior chamber depth with iris suture fixation of the bag–haptic complex (0/1), piggyback secondary IOL (8

The post Lasik period is just as important as the surgery itself. The cornea has to completely heal. Upon completion of your LASIK surgery , your surgeon will have you rest for a bit. After a brief post-operative exam, someone can drive you home. (You cannot drive after LASIK until your eye doctor sees you the following day and confirms your uncorrected vision meets the legal standard for driving). You should expect some blurry vision and haziness immediately after surgery; however, clarity should improve by the very next morning. Your eyesight should stabilize and continue to improve within a few days, although in rare cases it may take several weeks or longer. For most people vision improves immediately. You may be able to go to work the next day, but many doctors advise a couple of days of rest instead. Also, it is usually recommended that you refrain from any strenuous exercise for at least a week, since this can traumatize the eye and affect healing. Generally, you will re

APR 03, 2018 Refractive Mgmt/Intervention This study examines long-term changes in endothelial cell density (ECD) in eyes implanted with Artisan (Ophtec BV) iris-fixated phakic intraocular lens (pIOL). Study design The authors measured ECD at baseline and 5 and 10 years in 127 eyes implanted with the Artisan Myopia pIOL and in 20 eyes implanted with the Artisan Toric pIOL. Noncontact specular microscopy was performed using the same microscope for the entire 10-year period. Outcomes The mean ECD decreased by an average of 48 to 61 cells/mm 2 every year in a linear fashion, without any signs of plateau. After correcting for estimated physiologic EC loss, total ECD decreased between 5% to 7.5% at 5 years, and by 11% to 16% at 10 years. At 10 years, between 6.3% to 7.9% of eyes endured an endothelial cell loss of greater than 25% and approximately 4% had endothelial cell count of less than 1500 cells/mm 2 . Criteria for suggested removal of an Artisan vary depending on the rec

Basketball, Baseball and Air/Paintball Guns  Top the List of Leading Cau ses of Eye Injur ies More than 40 percent of eye injuries that occur every year are related to sports or recreational activities. A recent study found that about 30,000 people in the U.S. went to an emergency department with a sports-related eye injury, a substantially higher estimate than previously reported. Three sports accounted for almost half of all injuries: basketball, baseball and air/paintball guns. Basketball was the leading cause of injury in males, followed by baseball/softball, and air/paintball guns. Baseball or softball was the leading cause among females, followed by cycling and soccer. In support of Sports Eye Safety Month in April, we are offering athletes of all ages guidance on how to protect their eyes. Sports-related injuries can range from corneal abrasions and bruises on the lids to more serious, vision-threatening internal injuries, such as a retinal detachment and internal bleeding.

MAR 29, 2018 Uveitis This retrospective study assessed outcomes and relapse rates among patients with juvenile idiopathic arthritis (JIA)-associated uveitis upon discontinuation of immunomodulatory therapy (IMT). Study design The authors identified medical records from 66 patients with JIA-associated uveitis who were treated at 2 institutions. The main outcome was time to relapse after starting IMT taper or stopping IMT. Outcomes Of 66 patients, 51 patients (77%) received corticosteroid-sparing IMT, either with a single agent or as combination therapy. The most common medications used were methotrexate (86%), followed by adalimumab (25%) and infliximab (24%). Seven patients were also on oral prednisone; 35 patients were on topical steroids. During follow-up, 19 of 51 patients (37%) attempted IMT discontinuation. Approximately 68% relapsed at a median time of 288 days. Of note, 9 of 11 patients on TNF-alpha inhibitors relapsed after the medication was stopped. The time to rel

A major problem with advanced Macular Degeneration is the growth of blood vessels in the eye. These unwanted blood vessels develop in the late stages of Age-Related Macular Degeneration (ARMD), also known as “wet” ARMD. Dr. Marc Grossman at Natural Eye Care has developed a package of supplements aimed at strengthening the retina and reducing the risk of new blood vessel growth. New blood vessels obscure vision. Wet ARMD patients have few options. Doctors can sometimes zap the eye with lasers in an attempt to reduce the rate of future blood vessel growth. Oral drugs such as ranibizumab can help stop new blood vessels from developing. Injectable drugs are also aimed at stopping the extra blood vessel growth. All these options carry potential side effects and damage. In consultation with their eye doctors, some wet AMD patients have tried research-based targeted nutrition. Certain vitamins, nutrients, homeopathics, and Traditional Chinese Medicine remedies are aimed at supporting the e

MAR 27, 2018 Glaucoma In this prospective observational trial, investigators explored whether corneal hysteresis (CH) could be used as a biomarker for identifying patients at risk for developing glaucoma. Study design The cohort comprised 199 glaucoma suspects (287 eyes) who were followed for an average of 3.9 years. All eyes had normal visual fields and CH measurements taken at baseline. Development of glaucoma was defined as 3 consecutive abnormal standard automated perimetry tests during follow-up. Outcomes Repeatable visual field (VF) defects developed in 54 eyes (19%) eyes during follow-up. All eyes in this group had significantly lower CH measurement at baseline compared with those who did not develop VF defects (9.5 mm Hg vs 10.2 mm Hg, P=0.012). A multivariate analysis revealed that each 1-mm Hg drop in baseline CH was associated with a 21% increased risk of developing glaucoma during follow-up. Limitations This study failed to identify IOP as a risk factor f

MAR 29, 2018 Uveitis This retrospective study assessed outcomes and relapse rates among patients with juvenile idiopathic arthritis (JIA)-associated uveitis upon discontinuation of immunomodulatory therapy (IMT). Study design The authors identified medical records from 66 patients with JIA-associated uveitis who were treated at 2 institutions. The main outcome was time to relapse after starting IMT taper or stopping IMT. Outcomes Of 66 patients, 51 patients (77%) received corticosteroid-sparing IMT, either with a single agent or as combination therapy. The most common medications used were methotrexate (86%), followed by adalimumab (25%) and infliximab (24%). Seven patients were also on oral prednisone; 35 patients were on topical steroids. During follow-up, 19 of 51 patients (37%) attempted IMT discontinuation. Approximately 68% relapsed at a median time of 288 days. Of note, 9 of 11 patients on TNF-alpha inhibitors relapsed after the medication was stopped. The time

This observational, cross-sectional study examined how 3 reliability measures (false positives, false negatives and fixation losses) affect the global indices of visual field (VF) results in nonglaucomatous eyes. Study design Investigators included 830 adults (1,235 eyes) without visual impairment, glaucoma, significant cataract or major eye diseases from the population-based Singapore Chinese Eye Study. Participants underwent a comprehensive ocular exam and VF testing with the Humphrey Field Analyzer II using the SITA Standard 24-2 program. The effects of false-negatives (FN), false-positives (FP) and fixation losses (FL) on mean deviation (MD) and pattern standard deviation (PSD) were analyzed using multivariable regression models. Outcomes Both FN and FP responses were independently associated with the MD and PSD, but in a nonlinear fashion. An FN of greater than 15% had a larger effect on MD and PSD compared with lower FN frequencies (<15%). Likewise, a higher frequency of