Week in review: Pinterest redesign, scleral mystery, stroke predictors

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 Medicine. LiveScience

Retinal imaging could potentially stave off stroke, according to new evidence that abnormalities in the retinal microvasculature — due to arteriovenous nicking, focal arteriolar narrowing, retinal micro-aneurysms or retinal hemorrhage—increase the risk of ischemic or lacunar stroke. The findings, presented last week at the American Academy of Neurology annual meeting, came from an analysis of 10,468 individuals who were enrolled in a large NIH-funded study. MedPage Today

A new vlog highlights the daily lives of legally blind people. The Low Vision Specialists of Maryland and Virginia launched the series to show how a local man with retinopathy and legal blindness navigates the workforce. PR Web

Skiers and snowboarders need a lesson in UV protection, warn vision scientists from the University of Liverpool. They asked participants to apply sunscreen to their faces, then used a UV-sensitive camera to snap before and after photos. Areas covered with sunscreen appeared black—and the delicate skin around the eyelids and the inner corner of the eye often remained unprotected. Researchers stress the importance of wearing UV protective eye gear on the slopes.  EurekAlert!
*Image credit: University of Liverpool

https://www.lvcenter4sight.com/week-in-review-pinterest-redesign-scleral-mystery-stroke-predictors/

Novartis launches app for remote participation in clinical trials

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 digital technology in research and development, particularly in ophthalmic disease, could have a marked impact on the quality of the data we capture,” said Bertrand Bodson, chief digital officer at Novartis. “We believe apps like FocalView, which we’ve made freely available to the research community on an open-source platform, can help accelerate the development of treatments and bring them to the patients who need them most.”

Researchers will soon take the app for a test run in a prospective, non-interventional trial to determine how well it captures visual acuity and contrast sensitivity compared with traditional assessments in a clinical setting. During the study, scientists will rate the app’s ease of use, track enrollment numbers and report any challenges related to gathering documentation, such as informed consent, from participants.

FocalView is available for download from the App Store in the US and will be offered in additional markets in the future, Novartis says.

https://www.lvcenter4sight.com/novartis-launches-app-for-remote-participation-in-clinical-trials/

Omega-3s no better than placebo for treating dry eye

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 looked at one type of omega-3 formulation. Its placebo was olive oil, which could have its own anti-inflammatory properties,” explained Dr. Khandelwal. “In addition, it was a real-world study, which has pros and cons, one of which being that additional treatment was not controlled. All that being said, it is the first study of its kind and opens the door to discussion of management of dry eye.”

Conducted at 27 centers across the United States, the NEI-funded DREAM trial was a double-masked study that enrolled 535 individuals with moderate to severe dry eye disease. The treatment arm consisted of 349 patients who took 3000 mg of omega-3 (2000-mg eicosapentaenoic acid and 1000-mg docosahexaenoic acid) daily—the highest dose ever tested for treating dry eye disease. The 186 individuals who were randomly assigned the control arm took 5000 mg of olive oil. Unlike in most industry-sponsored trials, all participants were free to continue taking their previous dry eye medications.

After 1 year, both the active supplement and placebo groups reported significantly improved Ocular Surface Disease Index (OSDI) scores from baseline (13.9 vs. 12.5 points, respectively). However, the 1.4-point difference did not reach statistical significance (P=0.21). Other ocular surface parameters—including conjunctival staining, corneal staining, tear break-up time and Schirmer’s test scores—were also comparable between groups.

“I think this study really highlights how much we don’t understand about the complex interplay between patient-reported symptoms and clinical dry eye disease,” concluded Dr. Schallhorn. “Moving forward, it may make sense to start investigating psychometric factors in future dry eye trials to try to help us better understand the treatment of dry eye disease.”

https://www.lvcenter4sight.com/omega-3s-no-better-than-placebo-for-treating-dry-eye/

ARVO 2018: World’s Largest Show and Tell for Innovations in Eye Research

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 natural history study for Stargardt disease,
• and dozens of FFB-funded research efforts for treatments and cures.

In addition, we’ll be hosting our 5th Retinal Innovation Summit, which convenes more than 200 researchers and industry leaders for 37 presentations on the latest developments in clinical trials and translational research for inherited retinal diseases. This pre-ARVO, one-day summit is co-hosted by Casey Eye Institute at Oregon Health & Science University, and sponsored by: Spark Therapeutics, AGTC, REGENXBIO and NightStar Therapeutics.

Other examples of FFB-related sessions at ARVO include:

How Foundations Can Enhance Clinical Trial Enrollment and Advance Patients as Partners

Saturday, April 28, 3:45-4:00 p.m. HST, Room 316A

Stephen Rose, PhD, FFB’s chief research officer will discuss how FFB has engaged patients to boost clinical trial enrollment, and opportunities to educate patients on how trials for specific treatments benefit the entire community of people with retinal diseases.

Proctor Award: From Observations in the Retina Clinic to Insights into Pathophysiology

Sunday, April 29, 10:45-11:30 a.m. HST, Ballrooms BC

Sam Jacobson, MD, PhD, and Artur Cideciyan, PhD, FFB-funded researchers at the Scheie Eye Institute, University of Pennsylvania, are world leaders in clinical research for inherited retinal diseases. Among their many groundbreaking efforts, they played a key role in advancing RPE65 gene therapy into and through human studies. In addition to receiving the prestigious Proctor Award, they will deliver what is sure to be an insightful lecture on clinical diagnosis and the new era of vision-saving therapeutics.

Optogenetics for Vision Restoration — Translation

Sunday, April 29, 3:37-3:54 p.m. HST, Room 314

Optogenetics is an innovative approach for restoring vision to people who are completely blind from diseases like retinitis pigmentosa, regardless of the gene causing their vision loss. Deniz Dalkara, PhD, at the Institut de la Vision in Paris, will present FFB-funded research to move this approach into a clinical trial sponsored by GenSight.

Genetic Testing Adds Research and Clinical Value to a Retinal Degeneration Registry

Wednesday, May 2, 12:45-1:00 p.m. HST, Room 316C (paper session 4472)

Kari Branham, genetic counselor at the University of Michigan’s Kellogg Eye Institute, will discuss how FFB’s genetic testing program and global patient registry (www.MyRetinaTracker.org) are boosting retinal-disease research and patient access to clinical trials and studies.

Stay tuned to Eye on the Cure for updates from Honolulu on some of the outstanding research underway to save and restore vision.

ALOHA for now!

 

 

https://www.lvcenter4sight.com/arvo-2018-worlds-largest-show-and-tell-for-innovations-in-eye-research/

Cataract surgery on Ebola survivors appears safe for patients and physicians

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 9 weeks after being declared Ebola-free. Upon further investigation, the clinicians discovered that it stemmed from a lingering Ebola infection in the eyes. The safety of invasive ophthalmic procedures for Ebola survivors and their physicians has been unclear ever since.

Trying to resolve this uncertainty, this cross-sectional study screened 137 Ebola survivors from Sierra Leone and enrolled 50 with visually significant cataracts. The team tested aqueous humor and conjunctival fluid, sampled at a median of 19 and 34 months after Ebola diagnosis, and found no evidence of Ebola RNA. Thirty-four of the patients consented for manual small-incision cataract surgery with IOL implantation at the Lowell and Ruth Gess Eye Hospital in Freetown, Sierra Leone.

Following surgery, all patients showed better vision. Median visual acuity improved from hand motions at baseline to 20/70 by the end of 1 month postop and further improved to 20/30 at 3 to 4 months.

Their step-wise protocol, which features high-level safety precautions for preventing virus exposure, was designed to protect eye care providers and offers a step towards safe and efficient Ebola treatment and prevention. However, the study was small and not designed to determine if the eye harbored Ebola RNA at earlier time points, limitations that the authors say require further investigation before eye care providers can be assured about the safety of invasive ocular procedures.

https://www.lvcenter4sight.com/cataract-surgery-on-ebola-survivors-appears-safe-for-patients-and-physicians/

Multifocal IOLs susceptible to decentration in myopic eyes

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 ZMBOO IOL, which is high add and sensitive to centration. Newer lenses, such as the extended-depth of focus IOLs and low add, may not have this issue. One confounding factor is that higher axial length patients have poorer vision—whether it be from the retina or another sources—and are prone to worse aberration, poorer MTF and subjective symptoms even without a multifocal IOL.

Clinical significance

In general, patients with myopia are satisfied after cataract surgery, especially those with high axial lengths. This study suggests opthalmologists should counsel patients with high axial lengths about the risk of decentration of the lens and worse aberration data. These patients may be better off with a monofocal IOL that is less sensitive to centration but keeps them slightly myopic. However, further studies looking at newer lenses may help to adjust practice patterns.

View Abstract American Journal of Ophthalmology, April 2018

https://www.lvcenter4sight.com/multifocal-iols-susceptible-to-decentration-in-myopic-eyes/

Week in review: Insta-fail, shoebox-sized scanner, President Samuelson

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^rdpresident 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 scanners. Dr. Eduardo Navajas, a vitreoretinal specialist who tested the device for 8 months, says the scanner eliminates the need for—and the complications from—the injected dye used with fluorescein angiography, the current gold-standard imaging technique. EurekAlert!

A genetically modified cornea could help prevent graft rejection, according to a report in the journal Human Gene Therapy. Researchers say a donor cornea engineered to express 2 genes that prevent new blood vessel formation can reduce the risk of tissue rejection in a high-risk rabbit model. The therapy is called OXB-202. EurekAlert!

An Indianapolis retirement community recently honored the work of a color-blind artist with late-stage AMD. Ralph Rancourt, 95, began drawing black and white portraits of pets, family members and 20th-century presidents around the time that he was declared legally blind in his left eye. Seven years later, he lost vision in his right eye (also from AMD) and had to pack up his pencils, but his art lives on. Current

 

https://www.lvcenter4sight.com/week-in-review-insta-fail-shoebox-sized-scanner-president-samuelson/

Retinal Patch Performs Promisingly in Clinical Trial for Dry AMD Patients

 

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 photoreceptors, the cells that make vision possible.

In people with advanced AMD, RPE cells degenerate leading to loss of photoreceptors. RPE cells provide critical support functions – including nutrition and waste management – for photoreceptors. The RPE cells used in Regenerative Patch’s emerging therapy are derived from human embryonic stem cells.

The treatment’s scaffold mimics Bruch’s membrane, which breaks down in people with AMD. Also known as the blood-retina barrier, Bruch’s membrane works like a sieve to transport waste debris to, and nutrients from, the retina’s vasculature.

“People with advanced dry AMD have very limited options for saving or restoring their vision,” says Stephen Rose, PhD, chief scientific officer at the Foundation Fighting Blindness. “These early results from the California Project to Cure Blindness are good news for these patients. We look forward to learning more about the therapy as the trial moves forward.”

Initial results of the clinical trial were published online in the journal Science Translational Medicine. Authors of the paper include Mark Humayun, MD, PhD, at the University of Southern California (USC), developer of the Argus bionic retina; Amir Kashani, MD, PhD, surgeon at USC; and Dennis Clegg, PhD, at the University of California, Santa Barbara, who has been funded by the Foundation Fighting Blindness to develop scaffolding for a therapeutic retinal patch in development at the University of Wisconsin-Madison.

 

https://www.lvcenter4sight.com/retinal-patch-performs-promisingly-in-clinical-trial-for-dry-amd-patients/

Novel treatment restores corneal clarity in patients with bullous keratopathy

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 1×10⁶ cells, while the remaining patient received 5×10⁶ 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 endothelial cell count (ECC) above 500 cells/mm², meeting the primary endpoint of the study. The mean ECC at 24 weeks was 1,924 cells/mm² (range 947–2,833 cells/mm²). Pachymetry decreased to less than 630 μm in 10 of 11 eyes, with a mean value of 549 μm.

Two years later, all 11 eyes showed clear corneas. The mean ECC was 1,534 cells/mm². Ten eyes had a pachymetry value lower than 600 μm.

No patients experienced anterior uveitis or rejection. One patient experienced elevated IOP (27 mm Hg) and underwent trabeculotomy.

Limitations

Though the outcomes are promising, this small study raises questions: Do the extra cells enter systemic circulation, potentially causing future harm? Are the injected cells responsible for the development of glaucoma? The glaucoma time-course is consistent with steroid-induced disease, and the authors note abnormal trabecular meshwork findings. Further evaluation and longer follow-up are needed to address these concerns.

Clinical significance

This is an exciting study with a promising new technique for treating endothelial cell loss and resulting bullous keratopathy. Though the idea is in its infancy, the cornea community will be following further developments with enthusiasm.

https://www.lvcenter4sight.com/novel-treatment-restores-corneal-clarity-in-patients-with-bullous-keratopathy/

Cataract Surgery

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 incision.
• A tiny incision in the eye surface is made via laser through which a small probe is inserted. This probe emits ultrasonic sound waves to break up the cataract-damaged lens.
• The probe is then substituted for another that removes the lens pieces via suction.
• A new synthetic intraocular lens (IOL) implant is rolled up inside the tip of another probe and inserted through the original incision.
• The lens is carefully unrolled and positioned for optimal vision.
• Since the incision is tiny, it doesn’t require stitches. After leaving the surgery room you’ll be asked rest in a recovery room for a few hours and then you’ll be discharged. Your eye-doctor will prescribe various eye drops for preventing infection and keeping your eye from getting dry.

LenSx Laser system

In traditional cataract surgery, the surgeon makes an incision in the eye using a blade. However, the LenSx laser system allows ophthalmic surgeons to use a bladeless, computer-controlled refractive cataract laser that uses an image-guided, high-repetition rate femtosecond laser to:

• Make all required incisions
• To break the old, cloudy lens and then replaced by a new lens.

This laser system is designed to improve precision during critical steps of cataract surgery that were earlier performed manually. This reduces human errors and increases reliability.

In the hands of an experienced ophthalmic surgeon, the LenSx system makes sure to produce extraordinary, precise and safe results every time.

A few advantages of the LenSx system are:

• Enhanced procedure automation.
• Precise and customizable incision architecture.
• Versatile fragmentation patterns.
• Simple and efficient one-piece patient interface. This uses an exclusive hydrogel lens technology that
  • Minimizes corneal distortion compared to solid interfaces
  • Reduces intraocular pressure to the cornea compared with solid interfaces
  • Fixates the eye, enhancing control of movement compared to liquid interface
• Innovative, high-definition OCT technology which delivers high-resolution cross-sectional images for every incision.

Complementary technology

A complementary digital marker can enhance the cataract refractive surgical experience as it automatically positions itself to the streamlined surgical plan. This reduces the time to program LenSx.

Houman Ahdieh, MD
Lehigh Valley Center for Sight
https://www.lvcenter4sight.com
eyedoc@lvcenter4sight.com

https://www.lvcenter4sight.com/cataract-surgery/