Lasers have been used in the past, starting in 2000, to help remove Cataracts via the Laser Photolysis method. Dr. Jacobs was the first surgeon in New Jersey to have performed this technique and our surgical center in Springfield was only one of 22 sites in the United States to have utilized this technology. However, due to limitation in the technology it has been replaced by more advanced techniques, such as torsional phacoemulsification (ultrasonic fragmentation of cataracts). Of great importance, there is now improved technology on the horizon to improve Cataract Surgery by phacoemulsification. The Cataract Surgeons of the Eye Care and Surgery Center in New Jersey will be offering this new procedure, called FLAP™ (Femtosecond Laser Assisted Phacoemulsification) utilizing the femtosecond laser, presently used in "bladeless" LASIK Eye Surgery. The femtosecond laser has been specifically modified to help create precise corneal incisions, anterior capsulotomies (removing the front part of the Cataract), and nuclear fragmentation (dividing the Cataract into small pieces), prior to completing the operation with phacoemulsification. By using the accuracy of the laser, Cataract Surgery, Lens Replacement Surgery and Intraocular Lens Implantation (IOL) promises to be even more predictable and to have better outcomes than presently possible.
Cataract News
Women's Hormone Replacement Therapy Linked to Cataracts-Ophthalmology: March 2010
Swedish researchers conducted an 8 year prospective study of more that 30,000 postmeopausal women and found that those who were using or had used HRT had significantly higher rates of Cataract removal, compared with women who had never used HRT. Alcohol consumption seemed to increase HRT's harmful effect. The HRT study was led by Birgitta E. Lindblad, MD, Sundsvall Hospital, Sweden as part of the Swedish Mammography Cohort (SMC), established to study lifestyle factors and chronic diseases. More than 4,300 Cataract Surgeries were performed in participants between 1997 and 2005. The risk for Cataract removal was increased by 14 percent in women who had ever used HRT and by 18 percent in current HRT users, compared with women who never used HRT. Longer duration of HRT use correlated with increased risk. Current HRT users who also reported having more than one alcoholic drink per day had 42 percent increased risk, compared with women who used neither HRT nor alcohol. Smoking status did not significantly affect risk. "Cataract is more prevalent in postmenopausal women than in men at similar ages; this implies that hormonal differences are involved and suggests a possible role for estrogen," Dr. Lindblad explained. She described how HRT may act to promote Cataracts and also compared her project's findings with earlier studies.
Estrogen receptors have been detected in the eye's lens, the area that becomes cloudy and inflexible when a Cataract develops. Naturally occurring (endogenous) estrogen appears to protect the eye from Cataract, along with guarding cardiovascular and other body systems before menopause. Exogenous estrogens like those used in HRT do not function the same way. For example, HRT increases C-reactive protein levels, associated with cataract development in other studies. Dr. Lindblad's study also describes how alcohol and HRT may interact to raise estradiol levels, which appears to affect cataract risk.
In contrast to the SMC, earlier large HRT and Cataract risk studies in the United States, Australia and Europe reported mixed results. Importantly, some of these studies included women who were premenopausal and so possibly protected by endogenous estrogen. Results of the Swedish study may have been impacted by factors unique to this population, for example, nearly all participating women shared the same ethnicity, and all had equal access to care. The study did not identify type of HRT, type of cataract, or measure exposure to excess sunlight, a risk factor for cataract, although unlikely to impact residents of northern Europe.
Statins Reduce Cataract Risk in Patients Under 75 Years Old-Annals of Epidemiology: February 2010
Statins are widely used by patients to reduce cholesterol. There is evidence to suggest that Statins also have anti-inflammatory and anti-oxidative effects and thus may prevent the formation of Cataracts. Researchers examined the charts of 180,291 patients who initiated Statin use and were examined between 1998 and 2007 and the incidence of Cataract and Cataract Extraction was evaluated. The study results showed the development of 27,301 cataracts and 6,976 cataract extractions performed in this group. The data demonstrated that the consistent use of Statins had a statistically significant association with diminished risk of cataract in male and female patients aged 45 to 74 years (P < .001) with men ages 45 to 54 years having a 38% lower risk of developing cataracts and women of the same approximate age reduced their risk by about 18%. However, the data showed no significant association between consistent Statin use and risk of Cataract in elderly patients above 74 years of age. Thus, the consistent use of Statins appears to lower the risk of Cataract formation in patients 45-75 years of age.
Vision Problems & Dementia in the Elderly- American Journal of Epidemiology: February 2010
Elderly people with untreated poor vision are significantly more likely to suffer from Alzheimer’s disease and other forms of Dementia than their clear-sighted counterparts, according to a study published online by the American Journal of Epidemiology. The study suggests that vision problems may be a contributing factor in the development of dementia, rather than a symptom of it.
The study found that when elderly people with poor vision went to an Ophthalmologist even once, their risk of Dementia was reduced by 64 percent and that people who had undergone eye procedures such as to treat Glaucoma and remove Cataracts they were also less likely to develop Dementia.
Poor vision often prevents people from participating in the types of activities thought to reduce Alzheimer’s risk, such as socializing, reading and physical activity. Early treatment of vision disorders, the authors suggest, could delay the onset of Dementia, and of Alzheimer’s disease in particular.
Thirteen million Americans are expected to have Alzheimer’s disease by 2050, according to the U.S. Centers for Disease Control and Prevention. Treating vision problems early may make that number less daunting. “If we can delay the onset of dementia, we can save individuals and their families from the stress, cost and burden that are associated with Alzheimer’s disease,” the authors relayed.
Bausch & Lomb Introduces Crystalens® Aspheric Optic (AO) Accommodating Lens Implant (IOL): January 2010
Bausch & Lomb has received Food and Drug Administration (FDA) approval for and has released the Crystalens® AO, the first aberration-free accommodating intraocular lens (IOL) with aspheric optics, to Cataract Surgeons worldwide. Aspheric Intraocular Lens Implants (IOL)s are widely used during Cataract Surgery as patients report that they are able to achieve a better overall quality of vision and especially in dim or low light conditions. The Crystalens® AO has prolate aspheric surfaces and is designed to be free of spherical aberration. This design feature is intended to improve retinal image quality without compromising depth of field and therefore provides greater quality of distance and intermediate vision as well.
Cataract Surgery and Progression of Macular Degeneration- Archives of Ophthalmology: November 2009
There has been some concern among Cataract Surgeons and Retina Specialists that Cataract Surgery may predispose patients to a quicker progression of Age Related macular Degeneration (ARMD). Researchers enrolled 108 patients in a study who were awaiting Cataract Surgery to see if over time they were more likely to develop wet macular degeneration. They were studied with Fluorescein Angiography before their Cataract Surgery and were followed carefully for up to one year after their eye surgery. They concluded that there was a very low incidence of neovascular of wet macular degeneration and that Cataract Surgery did not hasten the progression of Age Related Macular Degeneration.
Adaptation to the Tecnis® Multifocal Intraocular Lens (IOL) Implant - European Journal of Ophthalmology: September/October 2009
Researchers reported on a clinical study of 250 eyes having the Technis® Multifocal Intraocular Lens (IOL) implanted. As part of the study they examined and reported on patients who were examined for as long as 7 months after surgery. The researchers found that 96.8 percent of eyes could read at 20/20 without eyeglass correction or reading glasses correction and that more than 90 percent of the participants ranked their near, distance and overall vision as good or excellent, with 88.4 percent not needing eyewear for seeing well at any distance. However, they did find that in order to obtain the best overall vision it required an adaptation period of about 6 months for most patients. This "neuroadaptation" period is common and has been reported previously with other types of near vision presbyopia correcting multifocal intraocular lens (IOL) implants as well as accommodating and diffractive lens implants for the correction of near vision and presbyopia after cataract Surgery.
Patients With Age-Related Macular Degeneration Benefit From Cataract Surgery - Ophthalmology : November 2009
Emily Chew, M.D. of the National Eye Institute reported on data from the Age-Related Eye Disease Study (AREDS), which was organized primarily to evaluate the effects of high-dose vitamin and mineral supplements on Cataract and AMD. She reported on the results of 1,939 eyes of 1,244 patients with AMD and evaluated their visual acuity after Cataract Surgery. The results showed that on average, patients with AMD, ranging from mild to advanced, gained visual acuity after cataract surgery; with the best gains were in patients with vision worse than 20/40 before surgery. There was no difference in improvement between patients with Wet Macular Degeneration as compared to Dry Macular Degeneration. The results remained significant at one year after their surgery as well.
Prior Cataract Surgery Affects Results of VEGF Injections for Wet Macular Degeneration - Retina Congress : 2009
Ayala Pollack M.D., Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel reported on a review of patients who had prior Cataract Surgery and found that those patients who have new blood vessel growth secondary to age-related macular degeneration (AMD) and are treated with VEGF injections do not respond as well to treatment if they have had prior Cataract Surgery. The analysis found that patients who had not had prior cataract surgery fared slightly better than those who had had their cataracts removed and had intraocular lenses implanted. Dr. Pollack said further prospective studies are needed to confirm these results. When initiating patients on VEGF injections, consideration should be given to whether these patients have intact crystalline lenses. A more aggressive therapeutic regimen may be warranted if patients have had prior Cataract Surgery, and in particular, if they had their surgery within the 2 years immediately preceding the diagnosis of wet AMD.
FDA Approves Aspheric AcrySof IQ Toric Intraocular Lens: March 2009
Alcon announced that the FDA has approved the AcrySof IQ Toric Intraocular Lens Implant for the correction of astigmatsim during Cataract Surgery.This new lens offers an enhanced aspheric optic that improves image quality and increases contrast sensitivity in cataract surgery patients with astigmatism. The innovative lens design offers these patients the best opportunity for quality distance vision without glasses. According to company officials, the first AcrySof Toric lens was introduced in 2005 and quickly became the leading toric lens on the market, due to its predictable power outcomes and excellent rotational stability. These benefits are largely realized due to the strengths of the AcrySof IOL material and proprietary single-piece design. As the first acrylic single-piece lens, AcrySof provides unequalled stability in the eye. This is especially important when correcting astigmatism, which occurs due to an irregular shape of the eye.
Cataracts & Age Related Macular Degeneration (ARMD) Ophthalmology: February 2009
There has been concern that having Cataract Surgery might accelerate ARMD and increase the potential for vision loss in aging patients. As reported in the publication of the American Academy of Ophthalmology, Ophthalmology, in February 2009, researchers from the National Eye Institute reviewed 5 years of data on the progression of AMD after Cataract Surgery as part of the Age Related Eye Diseases Study (AREDS) which a large scale clinical study. Their conclusion was that having Cataract Surgery did not increase the risk for the onset of advanced ARMD and that patients should be reassured by this.
Exercise & Cataracts February 2009
Researchers from the U.S. Department of Energy’s Lawrence Berkeley National Laboratory tracked approximately 41,000 runners for more than seven years, and found that running reduced the risk of both cataracts and age-related macular degeneration. Their study suggests that vigorous exercise may help prevent vision loss and offers hope for people seeking to fend off the onset of certain age related eye diseases.“In addition to obtaining regular eye exams, people can take a more active role in preserving their vision,” says Paul Williams, an epidemiologist in Berkeley Lab’s Life Sciences Division who conducted the research. “The studies suggest that people can perhaps lessen their risk for these diseases by taking part in a fitness regimen that includes vigorous exercise.”
New Technique for Early Detection of Cataracts: National Institute of Health January 2009
Researchers from the National Eye Institute (NEI), part of the National Institutes of Health, and the National Aeronautics and Space Administration (NASA) collaborated to develop a simple, safe eye test for measuring a protein related to cataract formation. If subtle protein changes can be detected before a cataract develops, people may be able to reduce their cataract risk by making simple lifestyle changes, such as decreasing sun exposure, quitting smoking, stopping certain medications and controlling diabetes. The new device is based on a laser light technique called dynamic light scattering (DLS). It was initially developed to analyze the growth of protein crystals in a zero-gravity space environment. NASA’s Rafat R. Ansari, Ph.D., senior scientist at the John H. Glenn Research Center brought the technology’s possible clinical applications to the attention of NEI vision researchers when he learned that his father’s cataracts were caused by changes in lens proteins.
Cataract Gene Located by Swiss Researchers: February 2008
Swiss Researchers from the University of Zurich will report information in the American Journal of Human Genetics regarding the location of a gene that is responsible for the formation of juvenile Cataracts. The researchers have identified the chromosomal location and exact molecular defect in the coding region of the gene responsible for a juvenile Cataracts. They were able to accomplish this through the detailed study of a large Swiss family wherein the members had autosomal dominant juvenile Cataracts.It is believed that a transporter protein may exist that moves small molecules acoss cell membranes and damages the Crystalline Lens causing a Cataract . Age-related cataract patients are now being screened to find mutations in this gene. Understanding the exact function of this transporter may open new approaches for preventiona and non-surgical treatment of Cataracts.
FDA Approves Crystalens HD (TM) 4th Generation Accommodating Lens Implant-June 2008
Bausch & Lomb received approval from the Food and Drug Administration (FDA) to market the Crystalens HD™ in the United States. Crystalens accommodating intraocular lens (IOL) was first approved by the FDA in November 2003. The Crystalens HD is the fourth generation of the only FDA approved accommodating lens.The surface of the Crystalens HD (TM) has been shaped to enhance the depth of focus with a proprietary optical modification. The enhanced optic provides an increased depth of focus which is designed to improve near vision without compromising intermediate or distance vision. The HD lens does this without inducing increased undesirable dysphotopsia or night vision symptoms.
Aspheric Lens Implants & Contrast Sensitivity
Journal of Cataract & Refractive Surgery: August 2007-A Canadian researcher reported that by carefully measuring and targeting the amount of spherical aberration to be corrected through an Aspheric Intraocular Lens Implants after cataract surgery, it is possible to improve the overall contrast sensivity achieved. Contrast sensitivity improvements are generally regarded as a way to improve vision in dim illumination and poor lighting conditions such as for night driving.
Delaying Cataract Surgery
Canadian Medical Association Journal: April 2007-People who undergo cataract surgery within six weeks of booking their procedure have better visual outcomes, as well as increased quality of life and fewer adverse events such as falling, says research reported in the April 24 issue of the Canadian Medical Association Journal. People who waited six months or longer for their cataract surgery experienced more adverse events.
Cholesterol Drugs Decrease Risk of Cataracts and Macular Degeneration
American Journal of Ophthalmology: April 2007-The class of cholesterol lowering medications called “statins” have been found to reduce risks of developing both cataracts and advanced age-related macular degeneration. Researchers found that statins slowed the development of cataracts by 50%.
ReStor® Aspheric Lens Implant FDA Approved: February 2007
The U.S. Food and Drug Administration recently approved a new aspheric version of Alcon's AcrySof ReStor Intraocular Lens (IOL) for cataract surgery. The lens, known as the AcrySof ReStor apodized diffractive aspheric IOL, addresses presbyopia by providing different zones enabling vision correction at near to far distances. An Alcon Laboratories statement says the newly approved aspheric optics design is the only one currently available in the U.S. in a presbyopia correcting lens implant.
Researchers previously have produced evidence that aspheric lenses, which are somewhat flattened at the periphery, may help offset aberrations in the eye that can cause vision problems such as reduced night vision and contrast sensitivity.
Medicare Allows Astigmatism Correcting Lens Implants for Cataract Surgery
Centers for Medicare and Medicaid Services: February 2007 Medicare recipients are now able to choose an astigmatism-correcting Intraocular Lens for cataract surgery. While the ruling allows Medicare coverage for basic cataract surgery, patients must pay out-of-pocket for any extra features such as for astigmatism correction. In the past, astigmatism-correcting lens implants were not covered at all.
Common Prostate Drug Can Cause Problems With Cataract Surgery
American Academy of Ophthalmology: August 2006 – A number of medical associations including the American Academy of Ophthalmology, the American Society of Cataract & Refractive and the American Urological Association have warned patients that the common prostrate drug, Flomax, and similar medications known as alpha-blockers may cause problems during cataract surgery. If you are taking Flomax and plan on having cataract surgery it is important that you alert your cataract surgeon before you have your surgery.
Flomax, commonly used to treat an enlarged prostate, and other alpha-blockers such as Hytrin, Cardura and Uroxatral can cause abnormal movement of muscles controlling the opening and closing of the iris and thus can interfere with pupil dilation, creating a condition known as intraoperative floppy iris syndrome.Your cataract surgeon will take extra precautions including additional eye drops if you are taking these medications in order to prevent unexpected complications during cataract surgery.
Asthma Drugs May Be Linked to Cataracts
European Respiratory Journal: July 2006 - Researchers at McGill University Health Centre found that people older than 65 using daily doses of inhaled corticosteroids to reduce risk of attacks of asthma or chronic obstructive pulmonary disease (COPD) increase their risk of developing cataracts by 24%. For that reason older people with asthma who use cortisone-based medications in their inhalers might consider asking their physicians about reducing dosages to avoid cataracts or their progression.
"New Technology" Designation Awarded to Tecnis Intraocular Lens
Centers for Medicare and Medicaid Services: March 2006 -The Centers for Medicare and Medicaid Services (CMS) announced that the "new technology" designation for the Tecnis Intraocular Lens, used to replace the eye's natural lens during cataract surgery, was effective in late February 2006. Because the lens incorporates an aspheric design, it corrections higher order aberrations and thus is helpful in increasing glare under certain lighting conditions by enhancing contrast especially at night and low light conditions.
Fruits and Vegetables May Protect Against Cataracts
American Journal of Clinical Nutrition: July 2005- Researcher William Christen of Harvard Medical School and Brigham and Women's Hospital investigated the effects of dietary intake of fruits and vegetables on the occurrence of cataracts. When the study began, none of the patients had cataracts. By the end of the study, those who had eaten the most fruit and vegetables were 10% to 15% less likely to have cataracts than the other patients.
Medicare Allows Presbyopia Correcting Lens Implants for Cataract Surgery
Centers for Medicare and Medicaid Services: May 2005-The Centers for Medicare and Medicaid Services (CMS) have ruled that Medicare beneficiaries may choose Intraocular Lenses (IOLs) that correct presbyopia for an additional fee as part of their Medicare-covered cataract surgery. These newer IOLs correct vision at more than one distance and offer the possibility of little or no dependency on reading glasses. Before the ruling, Medicare patients were limited to receiving the traditional monofocal distance-vision IOLs that don't correct near vision.
ReZoom™ Multifocal Lens Implant FDA Approved: April 2005
The ReZoom Multifocal Intraocular Lens is designed to distribute light over five optical zones to provide distance, intermediate, and near vision for cataract patients. The idea is to reduce the need for spectacles, including reading glasses, after cataract surgery.
AcrySof ReSTOR® Lens Implant FDA: March 2005
The AcrySof Lens Implant, a type of artificial lens or intraocular lens implant that can restore vision at near, intermediate, and distance ranges following cataract surgery received U.S. Food and Drug Administration approval. The clinical studies supporting the approval showed that 80 percent of patients who received the AcrySof ReSTOR lens did not use glasses for any activities after cataract surgery. The AcrySof ReSTOR lens provides different ranges of vision based on a lens configuration that enables specific distribution of light in response to how wide or small the eye's pupil might be. Most current intraocular lenses used for cataract surgery are able to restore vision only in limited distance ranges, which means patients often must use eyeglasses or other corrective lenses following surgery.
LASIK Surgery & Laser Vision Correction News
FDA LASIK Quality of Life Study - FDA Press Release: October 2009
The U.S. Food and Drug Administration plans to conduct a collaborative study with the National Eye Institute and the U.S. Department of Defense to examine the potential impact on quality of life from Laser-Assisted In Situ Keratomileusis (LASIK). The goal of the LASIK Quality of Life Collaboration Project is to determine the percentage of patients with significant quality of life problems after LASIK surgery and identify predictors of any problems. Funded by the government agencies, the project is composed of three phases. The objective of Phase 1, which began in July 2009, is to design and implement a Web-based questionnaire to assess patient-reported outcomes and evaluate quality of life issues post-LASIK. Phase 2 will evaluate the quality of life and satisfaction following LASIK as reported by patients in a select, active duty population treated at the Navy Refractive Surgery Center. Phase 3 will be a national, multi-center clinical trial and will study the impact of the procedure on quality of life following LASIK in the general population. Patient enrollment in Phases 2 and 3 have yet to begin but plans are underway. Phase 3 is expected to end in 2012. The results of the project will help identify factors that can affect quality of life following LASIK and potentially reduce the risk of adverse effects that can impact the surgical outcome. If any of these factors are related to the safety or effectiveness of the lasers used in LASIK surgery, the FDA will evaluate whether any action is necessary. The project is part of the FDA’s ongoing effort to better monitor and improve the safety and effectiveness of the lasers used in LASIK surgery.
Use of Refractive Surgery in Pediatric Patients OSNSupersite: September 2009
At presentation by Laurence Lasueur, M.D. at the French Society of Ophthalmology in Paris, information on the appropriateness and results of Laser Eye Surgery and vision correcting Intraocular Lens Implants (IOL)s was reported. Dr. Lasueur shared favorable clinical results in the use of Excimer Laser Vision Correction and Phakic Lens Implants such as the Visian ICL for the correction of significant unequal refractive errors and prescriptions between eyes that were causing amblyopia or "lazy eye" as well as high degrees of nearsightedness in both eyes. "Refractive surgery such as Laser Vision Correction and phakic lens implants (IOL)s has become a reasonable option in the treatment of selected options in the pediatric age groups, remarked Paolo Nucci, M.D. of the Milan University School of Medicine."
Wavefront Guided LASIK Produces Excellent Vision and Contrast
Journal of Cataract and Refractive Surgery: July 2009-Clinical researchers at the University of Waterloo School of Optometry reported on a study of Wavefront LASIK evaluating visual acuity and contrast sensitivity. The researchers found that 84% of patients achieved 20/20 vision or better with Wavefront LASIK vision correction and reported statistically significant improvement of contrast sensitivity. The improvement in contrast sensitivity is thought to translate into better overall vision performance in dim illumination and under poor lighting conditions.
Monovision LASIK Success
Current Opinions in Ophthalmology: June 2009-Researchers reported on factors that can effect the success and patient satisfaction with monovision LASIK including age, sex, ocular dominance, amount of monovision correction and degree of myopia, hyperopia and astigmatism and concluded that overall the most successful group are nearsighted women however the study concluded that monovision LASIK is quite suitable for farsighted patients as well.
LASEK Safe with Controlled Diabetes
European Society of Cataract & Refractive Surgery Meeting: Stockholm September 2007-According to data presented at the ESCRS in Stockholm Sweden, Diabetic patients who wish to have Laser Eye Surgery for Laser Vision Correction of nearsightedness can have LASEK safely, although they should expect to have longer epithelial healing times. Refractive results were good for myopic patients, however a significant number experienced epithelial healing times of greater than 4 days possibly increasing discomfort and slowing overall visual revcovery. Patients with evidence of Diabetic Retinopathy should not be treated.
Same Visual Outcome from Blade Free All Laser LASIK & Conventional LASIK
Ophthalmology: August 2007-In a recent prospective LASIK study to compare the results of using a conventional microkeratome vs. a femptosecond laser (Intralase), researchers found that there was no clinically significant difference in high-contrast visual acuity, manifest refractive error, contrast sensitivity or Intraocular forward light scatter throughout the six-month followup.
Femptosecond Laser Flap Does Not Improve Dry Eye After LASIK
Journal of Cataract and Refractive Surgery: July 2007-Manufacturers of femtosecond lasers used to create flaps for LASIK surgery have made numerous claims regarding the clinical benefits of laser flaps. The most common LASIK side effect is temporary dry eye. Researchers reported on the use of the femptosecond laser to create flaps in various hinge positions in order to evaluate whether dry eye was reduced after LASIK. The results demonstrated a significant increase in dry eye, consistent with LASIK surgery regardless of using the femptosecond laser and regardless of hinge position.
LASIK and Air Force Vision Requirements
Associated Press: June 2007-Up until recently, the Air Force and other United States military services did not permit the use of LASIK for Laser Vision Correction for those involved in certain high contact or specialized positions such as pilots due to environmental condition concerns or safety concerns during combat. This policy will soon change at the Air Force Academy in Colorado Springs where cadets will not only be permitted to have LASIK prior to their enrollment and still be able to meet the vision requirements, but will actually be able to have LASIK at the Air Force Academy eye clinic.
Epi-LASIK Safety and Efficacy
Ophthalmology: June 2007-According to a study published is the June 2007 issue of Ophthalmology, Epi-LASIK can provide a safe and effective alternative to LASIK. Epi-LASIK is a type of Corneal Laser Eye Surgery in which rather than creating flap of tissue through the corneal stroma-which is a thicker flap-one is created by simply delaminating the corneal epithelium into a flap and replacing it after the application of the laser to achieve the desired correction. This is one potentially useful procedure option for those who have thinner corneas.
Visual Symptoms and Aberrations After LASIK
Journal of Refractive Surgery: March 2007- Investigators reported that LASIK patients who experience unusual symptoms such as halos, glare, double vision and blurry vision are typically found to have high order aberrations when evaluated with wavefront analysis. In addition these patients are likely to have reduced overall visual acuity and contrast sensitivity.
Keratitis Eye Inflammation and LASIK
Journal of Cataract and Refractive Surgery: March 2007-Researchers at the Moran Eye Center of the University of Utah reported that the overall incidence of corneal inflammation after LASIK surgery approximates 3% of all LASIK Eye Surgery performed at their institution. The actual eye surface inflammation, called non infectious keratitis or diffuse lamellar keratitis is a well known LASIK complication that is a risk of LASIK surgery believed to be related to sterilization procedures for instruments. Diffuse Lamellar Keratitis is easily managed clinically with steroid eye drops and sometimes lifting the flap and rinsing the surface of the cornea so it is free of debris.
LASIK and Acne Medication Accutane
Journal of the American Academy of Dermatology: January 2006- LASIK patients should avoid the widely prescribed acne medication Accutane as it induces dry eye and may cause difficulties with healing and vision. Those patients with acne patients should stop using Accutane at least six months before undergoing LASIK surgery and for six months after the LASIK procedure, to give the front surface of the eye sufficient time to heal and establish a normal and healthy tear film.
Macular Degeneration News
Radiation & Anti-VEGF Injections for Wet Macular Degeneration Therapy
American Academy of Ophthalmology-November 2007-Jeffrey Heier, M.D. reported on one year results of a multicenter clinical trial to evaluate the safety and efficacy of using beta radiation combined with Avastin Injections to treat wet macular Degeneration. At one year it appears that the combined therapy may provide more sustainable resultsfor certain patients. Additional followup and data collection are required to evaluate the long term results on visual acuity.
Smoking and Macular Degeneration
Archives of Ophthalmology: August 2007-Current and past smokers appear to be a considerably higher risk for developing Age Related Macular Degeneration according to a study published in the August 2007 Archives of Ophthalmology. Researchers presented the results of a study that demonstrated that curretn smokers were four times as likely to develop ARMD and past smokers were three times as likely to develop geographic atrophy than patients who had never smoked.
Primary Avastin Treatment Superior vs. Secondary Therapy:
Retina July/August 2007-Researchers presented the results of a study to compare the results of using Avastin alone as primary treatment for Macular Degeneration as compared to using Avastin injections after patients had been had first treated with Macugen. The patients treated with Avastin as a primary treatment demonstrated significantly better results after their treatment.
Vitamin Therapy for Age Related Macular Degeneration Improves Quality of Life
Ophthalmology: July 2007-Many studies have suggested that vitamins and supplements may offer a benefit to those suffering from ARMD. A recent study reported in the July 2007 journal Ophthalmology evaluated the cost effectiveness of vitamin therapy for ARMD and found that the overall quality of life was improved and the development of visual impairment was reduced in the better seeing eye.
Statin Cholesterol Medication and Macular Degeneration
American Journal of Ophthalmology: July 2007-While it was hoped that the use of statin medications, commonly prescribed to lower cholesterol, would provide some benefit in the progression of Age Related Macular Degeneration, the Beaver Dam Study has found that statins are not associated with either a slowing or progression of ARMD which is in agreement with other early studies including the Rotterdam Study and the Blue Mountains Study. The researchers did conclude that larger, long-term studies are needed to examine the association of statin use and the incidence of late ARMD.
Cost Effectivity of Lucentis Injections vs. Avastin Injections
British Journal of Ophthalmology: May 2007-Lucentis and Avastin are anti-VEGF drugs used to inhibit the formation of neovascularization. Both are used as intravitreal injections to treat macular degeneration. The San Francisco based firm Genentech markets both drugs. However, British researchers have found that Lucentis costs 50 times more than Avastin without producing even a 2.5 times improvement in effect which researchers say would justify the cost. There is some controversy among Ophthalmologists because Lucentis has undergone specific clinical studies and received FDA approval to treat Macular Degeneration whereas Avastin is being used “off label” to treat Macular Degeneration.
Macular Degeneration Prevention with Beta Carotene Diet Supplements
Archives of Ophthalmology: March 2007-A specific formulation of dietary supplement has been reported in the AREDS Study to help moderate the onset and severity of Macular Degeneration. A 12-year long term Harvard study published in the Archives of Ophthalmology indicated that another formulation of dietary supplement containing only Beta Carotene was not effective in preventing Macular Degeneration.
OXiGENE, Waltham, Massachusetts Press Release: February 2007-OXiGENE reported that early results of clinical trials involving an experimental drug called Combretastatin A4 Phosphate (CA4P) administered through intravenous injection for patients with myopic macular degeneration demonstrated a halt in the progression of vision loss.
Genetic and Lifestyle Risk Factors for Macular Degeneration
Archives of Ophthalmology: March 2007-Harvard Medical School researchers at Brigham and Women’s Hospital has shown that individuals with certain common genetic mutations are 50 times more likely to develop Age Related Macular Degeneration than people who have normal copies of the same genes. Further, the chance of developing Age Related Macular Degeneration increase incrementally when lifestyle-related factors of smoking and obesity were added into the genetic equation. The genetic mutations associated with macular degeneration are common in Caucasian populations. The genetic risk factors were not affected in either a negative or positive way by other lifestyle choices including regular aspirin use, fruit consumption, fatty acid ratios, or use of alcohol.
Diabetic Retinopathy News
Diabetic Retinopathy May Predict Stroke Risk
Stroke: March 2007-Researchers at the University of Melbourne in Australia reported in the journal Stroke, that patients with diabetic retinopathy appear to have an increased risk of developing a stroke. They identified that the same factors causing damage to blood vessels in the Retina and causing diabetic retinopathy, also can be associated with an increased risk of stroke suggesting that patients with diabetic retinopathy also should be carefully monitored for the possibility of developing strokes.
Nepafenac Eye Drops Could Reduce Diabetic Eye Damage
Diabetes: February 2007-A non steroidal anti-inflammatory eye drop commonly used after cataract surgery called Nepafenac has been reported in the journal Diabetes to reduce microvascular damage in the retina of rats that is similar to the damage found in diabetic retinopathy. Researchers are hopeful that this could offer a benefit to patients with diabetes.
Lucentis and Diabetic Retinopathy
American Journal of Ophthalmology: December 2006-Researchers from the Johns Hopkins University-Wilmer Eye Institute reported results indicating the Lucentis Injections are useful as a treatment for diabetic retinopathy based on the findings in a small clinical trial in which there was significant visual improvement in people with early stages of the diabetic retinopathy that received Lucentis Injections. In particular, those patients with thickening of their Macula experienced dramatic improvement within a week after treatment, which actually continued to improve with repeated therapeutic injections. Similar results have been reported with Avastin Injections.
Avastin and Diabetic Retinopathy
American Journal of Ophthalmology: October 2006-Research reported in the American Journal of Ophthalmology, indicates that Avastin Injections eliminated neovascularization, or abnormal blood vessel growth, that was associated with vision loss in patients with proliferative diabetic retinopathy. Proliferative diabetic retinopathy can lead to vitreous hemorrhage and retinal detachment so achieving regression of the new blood vessel growth is a highly positive finding.
Avandia, Avandamet & Avandaryl May Cause Diabetic Macular Edema
U.S. Food and Drug Administration Warning Letter-January 2006-The FDA warned patients, physicians and GlaxoSmithKline the manufacturer of the compound rosiglitazone, contained in Avandia, Avandamet and Avandaryl, that these drugs used to treat diabetes could cause or worsen swelling of the retina in the Macula or diabetic macular edema. additional labeling about the risk of potential development of internal eye swelling known as diabetic macular edema. Symptoms of diabetic macular edema include blurry vision, decreased ability to adapt to the dark, and decreased color sensitivity.
Diabetes and Dry Eyes
American Journal of Ophthalmology: March 2005-A study reported in the American Journal of Ophthalmology indicated that patients with diabetes are more likely to have dry eye symptoms suggesting that inadequate blood sugar control in diabetic patients appears to be associated with development of dry eye. The study found that 20.6 percent of diabetic patients needed lubricating eye drops, compared with 13.8 percent of non-diabetic patients. This increased even further among those patients with poor blood sugar control.
Corticosteroid Injections for Diabetic Retinopathy
British Journal of Ophthalmology: March 2005-Researchers at the University of Heidelberg reported that the intravitreal injection of the corticosteroid Triamcinolone Acetonide effected significant improvement in patients with retinal swelling or diabetic macular edema. More than two thirds of those patients treated achieved an improvement of two or more lines of Snellin Visual Acuity and the effects lasted for as long as seven months after treatment. This suggests an important role of therapeutic injections of the anti-inflammatory drug Triamcinolone Acetonide in treating diabetic retinopathy.
Glaucoma News
Availability of Glaucoma Treatment for Older Americans
Association for Research in Vision and Ophthalmology: May 2007-Glaucoma researcher Joshua D. Stein, M.D, of Duke University School of Medicine reported that almost one third of older Americans diagnosed with glaucoma do not receive treatment, predisposing them to serious progressive vision loss and ultimately blindness. This issue needs to become part of the agenda for health care policy agencies and insurance companies in order to reverse the trend of glaucoma continuing to be a leading cause of blindness in older populations.
Risk of Auto Accidents and Falling with Glaucoma
Investigative Ophthalmology and Visual Sciences: March 2007-A study conducted at Dalhousie University found that patients with glaucoma were approximately six times more likely to have auto accidents than a control group-and they were likely to be at fault when involved in an accident. Further, they found that patients with glaucoma were three times more likely to experience a fall than a control group.
Glaucoma Risk from Weight Lifting
Archives of Ophthalmology: September 2006-Brazilian researchers reported that certain weight lifting maneuvers such as bench presses can temporarily boost intraocular pressure (IOP) and increase the risks associated with glaucoma. Further patients diagnosed with “normal tension” should be questioned and warned about possible involvement with exercises that involve weight lifting.
Glaucoma and Cataracts with On Line Steroid Purchase
The Lancet: August 2006-According to a report in the British medical journal The Lancet, a woman who illegally purchased oral steroids on-line now has serious vision problems as a side effect, including glaucoma and cataracts.
"The on-line availability of controlled and uncontrolled drug therapies needs to be carefully monitored," stated British ophthalmologists Philip Severn, M.D., and Scott Fraser, M.D. of Sunderland Eye Infirmary. In addition they warn of other risks with illegally purchasing drugs on-line, including risks that the substances are fake or could interact with other medications.
Glaucoma Screening and Diabetes
Ophthalmology: July 2006-Louis Pasquale, M.D., Co-Director of the Massachusetts Eye and Ear Infirmary Glaucoma Service reiterated the need for careful evaluation of Type 2 diabetic patients for glaucoma. Even after excluding lifestyle factors such as alcohol use and exercise, researchers still found a significant relationship between presence of Type 2 diabetes and development of glaucoma. "While obesity fuels the Type 2 diabetes epidemic, it appears that factors unrelated to obesity contribute to the positive association between Type 2 diabetes and glaucoma," reported Dr. Pasquale. This further reinforces the need for all Type 2 diabetics to be screened for glaucoma on a regular basis.
Selective Laser Trabeculoplasty (SLT) as Primary Treatment for Glaucoma
Journal of the American College of Surgeons: January 2005-Results of a large scale clinical study has identified that Selective Laser Trabeculoplasty, a type of laser treatment for glaucoma, is becoming useful as a primary treatment for glaucoma instead of eye drops. Eye drops for glaucoma are quite effective, however due to high costs, side effects and a lack of patient compliance SLT may offer a good alternative for initial treatment.
Other Eye Care News
Multiple Sclerosis Treatment Tysabri Reduces Vision Loss
Neurology: April 2007-Researchers at the University of Pennsylvania reported that vision loss related to multiple sclerosis is significantly reduced in people treated with the drug Tysabri. Multiple sclerosis or MS can cause Optic Neuritis, which is an inflammation and damages the fibers in the optic nerve, responsible for transmitting signals to the brain. In people diagnosed with MS and who took Tysabri, vision loss was reduced by as much as 47%.
Dry Eye and Quality of Life for Older Americans
American Journal of Ophthalmology: March 2007- Investigators from the Schepens Eye Research Institute of Harvard Medical School said about 4.8 million older U.S. residents have dry eye, which creates symptoms such as eye irritation and vision disturbances. Their investigation indicates that dry eye may be overlooked as a major health issue among older U.S. populations and found that the condition affects 7.8% of women and 4.7% of men aged 50 and older. Reading, computer use, and driving are among daily activities that can be significantly impacted by dry eye.
Interferon for Hepatitis C Patients May Cause Vision Problems
Investigative Ophthalmology and Visual Sciences: March 2007-Patients with Hepatitis undergoing treatment with Interferon (IFN) may retinopathy, which involves possible bleeding and other damage to the retina. Retinopathy was detected in some patients after only two weeks of Interferon treatments. Researchers reported that retinopathy symptoms subsided in all but nine patients after Interferon treatments were concluded.
Viagra, Cialis, Levitra and Vision
British Journal of Ophthalmology: January 2006 -Impotence drugs such as Viagra, Cialis, and Levitra could cause optic nerve damage and sudden blindness in older men with vascular problems such as high blood pressure or a history of heart attacks. Researchers recommend that patients using drugs such as Viagra should be warned of the risk of developing impaired blood flow to the optic nerve, which can cause sudden blindness.
Patients who previously had experienced heart attacks were 10 times more likely to develop a condition called non-arteritic anterior ischemic optic neuropathy (NAION), causing reduced blood flow damaging the eye's optic nerve, if they had taken drugs for impotence.
Other previous research indicated that older people generally are more likely to have NAION, particularly if they have high cholesterol, high blood pressure, a history of smoking, heart disease, and diabetes. This same group also is more likely to experience impotence, and therefore to take medication for it.
