Blood Vessel Support and Prevention Package for Macular Degeneration Support

amd-4g2-email.gifA 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 eyes. The AMD Package 4G2 contains nutrients to help strengthen the retina, and blood vessels, and reduce the risk of new unwanted blood vessel growth.

Contents of the ARMD Package

Advanced Eye and Vision Support Formula provides antioxidants for both eyes and total body health. Eye-specific nutrients include lutein, bilberry, special Chinese herbs, carrot root, and more.

Krill Oil Complex is an important source of omega-3 fatty acids.  Additionally, krill provides a treasured antioxidant for heart and vision health called “astaxanthin.” (LINK)

Vitamin D3 is for retinal and overall body support. Research has indicated this vitamin could reduce ARMD risk.1 Many Americans have low vitamin D due to indoor activities and less sunlight exposure in the winter. Vitamin D supports immunity, skeletal health, the heart, and cognition.

Dr. Grossman’s Blood Vessel Formula is designed to help prevent the growth of unwanted blood vessels. This wild-crafted herbal formula is based on a National Institutes of Health study.2 Includes ginkgo biloba, grape extract, cinnamon, ginseng and more. Click for ingredients.

See the AMD Package 4G2 in the Natural Eye Care Store.

https://www.naturaleyecare.com/blog/blood-vessel-growth-prevention-package-macular-degeneration/

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Limbal stem cell transplantation appears suited for severe ocular surface disorders

This is the largest study to examine long-term outcomes following allogenic ocular surface stem cell transplantation (OSST) for limbal stem cell deficiency (LSCD).

Study design

Investigators reviewed 165 eyes of 110 patients with total LSCD who underwent ocular surface stem cell transplantation (OSST) by a single surgeon. Procedures included keratolimbal allograft, conjunctival-limbal autograft and others, with a follow-up of at least 5 years. The primary indications for the procedure were congenital aniridia, chemical/thermal burns, and Stevens Johnson Syndrome (SJS). The authors examined both ocular surface stability and BCVA.

Outcomes

Over 70% of all patients achieved ocular surface stability by the end of follow-up, defined as lack of diffuse staining, corneal conjunctivalization or persistent epithelial defects. When sorted by indication for OSST, eyes with aniridia showed the highest success rate (73.1%), followed by chemical/thermal injury (70.3%). BCVA improved by 2 or more lines in 62% of patients.

Of note, about 65% of eyes underwent concurrent keratoplasty, and over half of these grafts failed. All eyes underwent systemic immunosuppression, with 32% of eyes having at least 1 acute episode of rejection.

Of the 51 eyes that required additional OSST surgery, 56.9% achieved a stable ocular surface.

Limitations

The study is limited by its retrospective nature that may have introduced potentially confounding variation in the underlying diagnoses and clinical presentations. The treatment modalities also differed greatly, making definitive conclusions difficult. Though all procedures were performed by a single surgeon, the technique implemented varied over the course of the study.

Clinical significance

This study uniquely demonstrates that good long-term results can be achieved with OSST for limbal cell deficiency, despite the rigors of systemic immunosuppression necessary for managing the chronic underlying conditions. Allograft OSST should be considered as a therapeutic option for certain severe ocular surface disorders.

https://www.aao.org/editors-choice/limbal-stem-cell-transplantation-appears-suited-se

Reproxalap on track to supplant steroids for patients with uveitis


DEC 08, 2017

By Anni Griswold

Uveitis

Physicians may soon have a steroid alternative in their uveitis treatment toolkit: A phase 2 trial finds that the new aldehyde trap drug reproxalap (Aldeyra Therapeutics) is noninferior to prednisolone acetate (Pred Forte) at reducing ocular inflammation in patients with noninfectious anterior uveitis.

“The use of corticosteroid therapy for the treatment of ocular inflammation is hampered by ophthalmic toxicity, including cataract formation, secondary infection, viral reactivation, delayed wound healing and elevated intraocular pressure that can cause irreversible glaucomatous optic atrophy,” says John D. Sheppard, MD, an expert in ocular inflammation and president of Virginia Eye Consultants.

The new treatment, previously known as ADX-102, is a first-in-class drug that reduces inflammation by sequestering aldehydes in the anterior chamber. The drug does not cause steroid-related side effects, such as increased IOP.

“Reproxalap could represent a welcome addition to the topical therapeutic options available to practitioners who treat noninfectious anterior uveitis,” Sheppard says.

The randomized, controlled trial showed that reproxalap (0.5% ophthalmic solution) is statistically noninferior to the coticosteroid at reducing anterior chamber inflammatory cell count after 2 weeks or 1 month of monotherapy (both P<0.05). The study further reveals that a twice-daily Pred Forte-reprozalap combination therapy is statistically noninferior to 4-times-daily Pred Forte monotherapy.

A phase 3 clinical trial of reproxalap for uveitis is underway, with topline results expected in the second half of 2018. A separate phase 2 trial of reproxalap has shown that it also has the potential to relieve signs and symptoms of dry eye disease.

https://www.aao.org/headline/reproxalap-on-track-to-supplant-steroids-patients-

Early steroid response predicts long-term vision gains in DME


DEC 11, 2017

Retina/Vitreous

Findings from this retrospective study suggest that patients with initial suboptimal response to an intravitreal corticosteroid implant may continue to have a suboptimal response on long-term follow-up.

Study design

Researchers reviewed medical charts from 102 eyes with diabetic macular edema that received a 0.7-mg dexamethasone intravitreal implant. Eyes were subdivided into 3 groups based on change in BCVA at 3 months. The investigators followed the patients for at least 18 months to assess the long-term outcomes of each group.

Outcomes

The analysis uncovered a significant positive correlation between response at 3 months and long-term improvement in BCVA. Of the eyes with a >10 letter improvement in BCVA at 3 months, 29% maintained that improvement at final follow-up. By contrast, only 7% of eyes with a <5 letter improvement in BCVA gained more than 10 letters by final follow-up.

Limitations

Retrospective chart reviews are inherently limited. Given the dexamethasone implant’s durability, excluding eyes with a history of vitrectomy may inadvertently exclude a large portion of the potential study population. Interestingly, the majority of eyes demonstrated either a >10 letter improvement or a <5 letter improvement (with few outliers), suggesting an alternative interpretation of the study’s findings: that diabetic macular edema may respond to intravitreal dexamethasone in an almost binary fashion.

Clinical significance

This study suggests that a patient’s early response to the intravitreal corticosteroid implant may predict their long-term gains in BCVA. In clinical practice, these findings could indicate that eyes with poor initial response to intravitreal corticosteroids may be better served with alternative treatment modalities such as anti-VEGF therapy or early pars plana vitrectomy, although further study is warranted before making this conclusion.

https://www.aao.org/editors-choice/early-steroid-response-predicts-long-term-vision-g

Zika vaccine advances to phase 2 testing


DEC 08, 2017

By Aliyah Kovner

The Lancet

Comprehensive Ophthalmology

A new Zika vaccine shows promising safety and immunogenicity, according to a phase 1 trial by the Vaccine Research Center at the NIH.  

The speedy development of a Zika vaccine candidate was enabled by recent success in creating a vaccine for West Nile Virus—a closely related virus of the same genus—using the emerging DNA vaccine platform. Rather than introducing viral antigens or attenuated live virus, DNA vaccines consist of a plasmid containing genes for virus-specific proteins, allowing the host to produce antigen targets in situ.

The study, published online in The Lancet, evaluated the safety and immunogenicity of 2 DNA vaccine candidates (VRC5288 and VRC5283) in 125 healthy adult volunteers.

Subjects in the VRC5288 arm were randomized to 1 of 4 injection schedules, receiving a total of 2 or 3 intramuscular injections. Those in the VRC5283 arm received single (4 mg) or split doses (2 mg in each deltoid) given intramuscularly by syringe or needle-free device. All participants were followed for 24 months.  

Both vaccine candidates were well-tolerated, showing mild-to-moderate local and systemic symptoms common to vaccination. Blood cell analysis, however, indicated that the VRC5283 vaccine induced higher antibody titres and greater CD4 and CD8 T-cell responses.

The findings also highlight the significant impact that delivery method can have on patient response: The group that received a split-dose of VRC5283 showed a significantly greater magnitude of immune response compared with all other groups.

Based on these results, the VRC5283 formulation has been advanced into an international phase 2 efficacy trial. The trial aims to enroll at least 2,500 participants, and is expected to conclude in 2020.

Although the medical community is now closer to a possible Zika vaccine, which will prevent or reduce the severity of the infection’s ocular manifestations in adults, it remains unknown whether or not inoculation will be protective against the viruses’ teratogenic effects. Recent investigations have shown that congenital Zika syndrome causes severe brain and eye abnormalities, including microcephaly as well as macular and optic nerve defects.

https://www.aao.org/headline/zika-vaccine-advances-to-phase-2-testing

Glaucoma drug Rhopressa snags early FDA approval


DEC 19, 2017

By Keng Jin Lee

Aerie Pharmaceuticals

Glaucoma

Aerie Pharmaceuticals announced that the FDA has approved their once-daily glaucoma drop, Rhopressa, for lowering IOP in patients with open-angle glaucoma or ocular hypertension.

The approval, which has been anticipated ever since an FDA advisory panel voted 9-1 in Rhopressa’s favor, comes 2 months ahead of the expected date.

Rhopressa (netarsudil ophthalmic solution 0.02%) is a first-in-class therapy that lowers pressure by targeting the trabecular meshwork.

“The approval of once-daily Rhopressa represents the single greatest achievement in Aerie’s history to date, and represents exciting news for patients with open-angle glaucoma or ocular hypertension, and physicians,” said Vicente Anido, Jr., PhD, chairman and CEO at Aerie. “We will hire our sales force of 100 sales representatives early in the first quarter of 2018, and plan to launch by mid-second quarter of 2018.”

Aerie also announced that a new drug application for their follow-up drug, Roclatan—a combination latanaprost and Rhopressa—will be filed in the second quarter of 2018.

https://www.aao.org/headline/glaucoma-drug-rhopressa-snags-early-fda-approval

Vitreous seed classification is predictive of response to intravitreal chemotherapy


DEC 19, 2017

Pediatric Ophth/Strabismus

This retrospective study evaluated outcomes of retinoblastoma treated with intravitreal melphalan as salvage for vitreous seeding.

Study design

The retrospective review included 28 eyes of 25 patients who were treated at Children’s Hospital Los Angeles over a 5-year period. All patients received systemic intravenous chemotherapy followed by intravitreal melphalan as salvage treatment for persistent or recurrent vitreous seeding.

Outcomes

Overall, intravitreal chemotherapy was very successful at treating all types of vitreous seeds (dust, spheres, cloud). Clouds required the most injections and took more time to regress than dust or spheres. However, spheres were more likely to recur. There was 100% regression of vitreous seeds after intravitreal melphalan, and no eye was treated with radiation or enucleated for seeding.

Of the 28 treated eyes, the overall globe salvage rate was 68%. Nine eyes were eventually enucleated: 6 eyes because of massive recurrences or recurrences near the optic nerve that were not amenable to local therapy; and 3 from development persistent retinal detachment or neovascular glaucoma with very poor visual prognosis.

Limitations

This study excludes patients who received intra-arterial chemotherapy, yet included those who received intravenous chemotherapy. Therefore, the size of the study is very low for a 5-year period. Also, follow-up data was limited to a small cohort, as a third of these eyes were enucleated.

Clinical significance

This study found that the number of injections and required dose of intravitreal melphalan is dependent on the class of retinoblastoma seed, regardless of primary therapy. Anticipating that patients with clouds may require more injections allows for better counseling of families with children who are undergoing intravitreal chemotherapy.

https://www.aao.org/editors-choice/vitreous-seed-classification-is-predictive-of-resp