INTERESTING EYE NEWS & CLINICAL PEARLS

Conjunctival epithelium improvement after systemic pilocarpine in patients with Sjogren's syndrome -- Aragona et al. 90 (2): 166 -- British Journal of Ophthalmology This study concludes: "Oral pilocarpine induced an increase in goblet cells number and an amelioration of conjunctival epithelium not dependent on tear secretion." Yea, but how 'bout those side effects! I can't imagine using oral pilocarpine in anyone but the more desperate dry eye patients.

Journal of Glaucoma - Abstract: Volume 15(2) April 2006 p 120-123 Relationship Between Central Corneal Thickness and Localized Retinal Nerve Fiber Layer Defect in Normal-tension Glaucoma. According to this study: "CCT is a significant factor in predicting the extent of localized RNFL defect at the initial examination of NTG patients." In some ways this study spurs more questions rather than answers. Again, thin corneas are higher risk for glaucoma, but I can't imaine that this study suggests the correlation is anything more than missed diagnoses due to clinician assumptions of "normal" intraocular pressure. For me, anyone with moderate to extensive cupping deserves a pachymetry and if the corneas are thin, further evaluation is warranted.

Journal of Glaucoma - Abstract: Volume 15(2) April 2006 p 124-130 Selective Laser Trabeculoplasty as Initial and Adjunctive Treatment for Open-Angle Glaucoma. This study indicates that: "Selective laser trabeculoplasty was found to be equally efficacious as latanoprost in reducing intraocular pressure in newly diagnosed open-angle glaucoma and ocular hypertension over 12 months, independent of angle pigmentation. These findings support the consideration of selective laser trabeculoplasty as a first-line treatment for newly diagnosed open-angle glaucoma or ocular hypertension."

Clinical Management of fungal keratitis | AOA News This article discusses management of the fusarium keratitis. Additional resources and constant updates are found at the AOA website .

CDC issues snapshot of cases | AOA News This article provides a summary of the demographics of the recent "outbreak" of fusarium keratitis.

Fungal Keratitis Management: A Clinical Perspective | AOA News This is an article by Dr. Art Epstein about the recent fungal (fusarium) keratitis "epidemic" and how to manage it. He suggests we become suspicious of a corneal ulcer being fungal in origin when it has a fluffy, white or grey appearance, or satellite lesions, or if it does not respond to typical antibiotic therapy. He suggests scraping the lesion and plating it on Sabouraud agar (yea, I don't have that in my office either).

ScienceDirect - Ophthalmology : Prophylactic Treatment of Age-Related Macular Degeneration Report Number 1: 810-Nanometer Laser to Eyes with Drusen. Unilaterally Eligible Patients This abstract discusses the prophylactic treatment of drusen with diode laser in the attempt to prevent choroidal neovascularization. It concludes: "Prophylactic diode laser treatment to an eye with multiple large drusen in a patient whose fellow eye has already suffered a neovascular event places the treated eye at higher risk of developing choroidal neovascularization. We advise against using prophylactic subthreshold diode laser treatment in these eyes."

Corneal calcification following intensified treatment with sodium hyaluronate artificial tears -- Bernauer et al. 90 (3): 285 -- British Journal of Ophthalmology This abstract discusses 5 cases of deep calcium deposition in the corea due to frequent use of hyaluronic acid artificial tears. All five required PKP! The abstract says: "This is because of its high phosphate concentration and typically frequent instillation. Manufacturers and prescribers should be aware that topical preparations may contain considerable amounts of phosphate which may lead to sight threatening corneal complications." The only drop I know with sodium hyaluronate is Aquify. The abstract does not define "frequent" but the full-text probably does.

OSN SuperSite - The Voice of Ophthalmology - latest news and articles from Ocular Surgery News; Ophthalmic Surgery, Lasers and Imaging; Journal of Refractive Surgery; and Pediatric Ophthalmology and Strabismus According to this abstract: "Women on hormone replacement therapy are at an increased risk of refractive regression after LASIK."

There's a new trend to give Acular to every cataract patient prophylactically to avoid post-operative cystoid macular edema. But it may be irresponsible to indiscriminately write for an NSAID without considering patients with aspirin sensitivity as Acular is absolutely contraindicated in patients with aspirin sensitivity. 5% of individuals allergic to aspirin are also allergic to NSAIDS and may experience reactions as severe as anaphylactic shock. There have even been fatalities reported in the literature. There's a reason only doctors can prescribe certain drugs.

Proteomic analysis of human meibomian gland secretions -- Tsai et al. 90 (3): 372 -- British Journal of Ophthalmology I don't think it's news that meibomian gland dysfunction contributes to dry eye. This study concludes: "that the meibomian gland secretes a number of proteins into the tear film. It is quite possible that these proteins contribute to the dynamics of the tear film in both health and disease." This underscores the importance of addressing meibomian gland dysfunction in the treatment of dry eyes. I've been using flaxseed oil for this purpose lately with success, in addition to our other resources such as Restasis and plugs.

Non-arteritic anterior ischaemic optic neuropathy and the treatment of erectile dysfunction -- McGwin et al. 90 (2): 154 -- British Journal of Ophthalmology According to this article: "For men with a history of myocardial infarction or hypertension the use of Viagra or Cialis may increase the risk of NAION. Physicians prescribing these medications to patients with these conditions should warn them about the potential risk of NAION." For many men, the benefits probably outweight the benefits. "I don't care if I go blind! Give me my Viagra!"

Prediction of future scotoma on conventional automated static perimetry using frequency doubling technology perimetry -- Kogure et al. 90 (3): 347 -- British Journal of Ophthalmology According to this study: "An abnormal result in FDT shows a high risk of future scotoma on HFA after 3 years even if the original HFA perimetry showed normal results." I think FDT is a great screening test that is so fast and easy to use that it ought to be part of the standard tech work-up.

Effect of systemic hypertension on foveolar choroidal blood flow in age related macular degeneration -- Metelitsina et al. 90 (3): 342 -- British Journal of Ophthalmology According to this article: "AMD patients with systemic hypertension have lower choroidal blood flow than those without systemic hypertension. This decrease in choroidal blood circulation may help explain the mechanism by which systemic hypertension may contribute to the progression of AMD and the development of choroidal neovascularisation."

ScienceDirect - Ophthalmology : Prevalence and Risk Factors for Cornea Guttata in the Reykjavik Eye Study According to this study: "Smoking for more than 20 pack-years increases the risk of developing CG more than 2-fold."

Bausch & Lomb Asks Stores to Pull ReNu - Yahoo! News There was a report on Good Morning America last week about a new corneal fungal infection epidemic in the US that is baffling clinicians. B&L is pulling Renu with MoistureLoc from shelves which suggests something about it may be the cause. This article says: "ReNu with MoistureLoc was being pulled from U.S. store shelves at the request of Bausch & Lomb amid concern the contact lens solution may be linked to a fungal eye infection that can cause blindness." It goes on to say: "Federal health officials have made no direct link between MoistureLoc and the infections, but a high incidence of affected patients interviewed had used the cleaner." Many of the cases of fusarium keratitis were using Renu with Moisture-Loc, but there were some patients using Alcon and AMO products, although it is possible they were also using the B&L product.

Here's a really good article in EyeWorld Magazine that discusses two new anterior chamber goggles for dry eyes.

This article in OSN SuperSite concludes: “AMD is associated with immune, inflammatory and other cardiovascular mechanisms, and these results emphasize the need to adhere to healthy lifestyles for your eyes and your body overall,” Dr. Seddon and colleagues said in the release. Higher levels of serum antioxidants vitamin C and lutein/zeaxanthin and higher fish intake were associated with lower serum C-reactive protein levels, the researchers found. Serum vitamin E, smoking and increased body mass index were associated with an increased C-reactive protein level. Hypertension was associated with an increased homocysteine level, while vitamin E, beta carotene and dietary intake of antioxidants and vitamin B6 were associated with lower levels of the plasma, Dr. Seddon and colleagues said. “Factors reported to be related to AMD, namely antioxidants, smoking, body mass and fish intake, are also associated with inflammatory, immune or other cardiovascular mechanisms,” the study said. “Overall,...

According to this article in OSN Supersite , researchers found...: "...that AMD prevalence was 2.4% for blacks, 4.2% for Hispanics, 4.6% for Chinese and 5.4% for whites."