INCREASED RISK OF CATARACT WITH INCREASED IOP AND GLAUCOMA GTTS

ScienceDirect - Ophthalmology : Associations between Elevated Intraocular Pressure and Glaucoma, Use of Glaucoma Medications, and 5-Year Incident Cataract: The Blue Mountains Eye Study

This study concludes:

"Elevated IOP may increase the risk of nuclear cataract, but not that of other
types. The use of glaucoma medications could magnify this risk."

SILICONE OIL IN DRY EYE

EyeWorld Magazine: March 2006
This article discusses the successful use of silicone oil in severe dry eye that is recalcitrant to all current treatments.

SURGERY ON CONGENITAL CATARACT

ScienceDirect - Journal of American Association for Pediatric Ophthalmology and Strabismus : Is There a Latent Period for the Surgical Treatment of Children With Dense Bilateral Congenital Cataracts?

This paper concludes:

"Previous reports have proposed that cataract surgery during the first 5 to 8
weeks of life is associated with better visual outcomes in children with dense
bilateral congenital cataracts. Our results would suggest that good visual
outcomes can be achieved beyond this age, but the incidence of poor visual
outcomes increases if cataract surgery is delayed beyond 10 weeks of age. The
absence of preoperative nystagmus is a better predictor of a good visual outcome
than the age at surgery."

OPAQUE CONTACT LENS AS OCCLUSION IN AMBLYOPIA

Eye & Contact Lens: Science and Clinical Practice - Abstract: Volume 32(2) March 2006 p 84-87 Opaque Contact Lens Treatment for Older Children With Amblyopia.
This study concludes:

"Daily-wear opaque contact lens treatment is a useful occlusion method for
amblyopia treatment in older children with various practical and social
impediments to skin patching. Meaningful improvement in visual acuity can be
obtained, even in children older than 8 years of age."

SLT vs. ALT

EyeWorld Magazine: March�2006
This article discusses the advantages and disadvantages of selective laser trabeculoplasty vs. argon laser trabeculoplasty and gives recommendations for it's use.

ICL POST-OP

IOP- mild IOP rises you can treat with the usual topical medications orgive oral diamox. If the IOP is very high check for pupillary block- theyhave 2 PIs per eye but it's possible the PIs are blocked by residualoccucoat.Try to see the ICL through the pupil with the slit beam and try to see thedistance between the ICL and the cyrstalline lens. It should be about thesame width as the cornea thru the slit beam. If you can make a goodestimation, go ahead and write it in the chart under "vault"- the distancebetween the ICL and the lens.

Wavefront for Hyperopia and Hyperopic Astigmatism

"wavefront is now approved for hyperopia and hyperopic astigmatism (up to 3.00 of cylinder). So now just about everyone who can have lasik can have wavefront."

Uveitis Treatment May Aid Diabetic Patients

Review of Optometry, Vol. No: 143:4Issue: 4/15/2006

An intravitreal implant used to treat posterior uveitis also shows promise as a treatment for diabetic macular edema.

Retisert (fluocinolone acetonide intravitreal implant), releases a constant amount of fluocinolone, a corticosteroid, into the eye.

Preliminary follow-up data found that at 36 months after implantation, 58% of the implanted eyes showed no evidence of edema vs. 30% of eyes that received standard-of-care treatment. Also, 28% of the implant patients demonstrated a three or more line improvement in visual acuity vs. 15% of patients who received the standard of care.


The Retisert implant, shown here for size, is FDA approved for uveitis but also shows effectiveness in treating diabetic macular edema.

The most common adverse events included cataract requiring extraction in 95% of phakic implanted eyes and intraocular pressure rise in 35% of implanted eyes. Also, 36 eyes (28%) required a filtering procedure, and the device was explanted in six eyes (5%) to manage IOP.

BIOPTIC DRIVING IN ARIZONA

Arizona will soon grant a driver's license to individuals with VA of 20/200 or greater who do not have restricted visual fields who use no more than a 4X bioptic telescope.

OCULAR ALLERGY & PREGNANT WOMEN

EyeWorld Magazine: April�2006 This article teaches that pregnant women are at higher risk for ocular allergies. It states that mast cell stabilizers and antihistamines are safe in pregnant women, but that we should leave systemic therapy to the obstetrician. OTC allergy meds can cause birth defects.

JUSTIFICATION FOR REFERRING CSR

Review of Optometry This article points out that CNVM can look like CSR. Therefore we ought not hesitate to refer to retina when we see a CSR, even though treatment for CSR is not indicated.

DIFFERENTIAL OF "SANDY FEELING" IN EYE

The Non-Dry �Dry Eye� Complex - Karger Publishers We always think dry eye when someone says they have a sensation of sandy or foreign body feeling in their eyes. This article suggested:

"A perception of dryness may be caused by non-dry conditions of which four are presented here: (1) lid margin touch, (2) conjunctival laxity, (3) cilia touch, and (4) fibrin accumulation in conjunctival inflammation".

Under lid margin touch I've seen inspissated meibomian glands where the hardened dome/s were probably the cause. Another cause may be anterior basement membrane dystropy.

OCT AFTER A SINGLE ACUTE ANGLE CLOSURE ATTACK

ScienceDirect - American Journal of Ophthalmology : Optical Coherence Tomography Measurement of Retinal Nerve Fiber Layer After Acute Primary Angle Closure With Normal Visual Field We all wonder how much damage is done from a single acute angle closure attack. This study concluded:

"Inferior region RNFL thickness was significantly decreased in the attacked eyes after an APAC episode associated with normal visual field."

TOPICAL DORZOLAMIDE IN PATIENTS WITH CME AND RP

ScienceDirect - American Journal of Ophthalmology : Topical Dorzolamide for the Treatment of Cystoid Macular Edema in Patients With Retinitis Pigmentosa This study's purpose was to determine if topical dorzolamide would be effective in treating CME in patients with RP. Of 15 patients with CME and RP, who were treated with w/ topical dorzolamide TID, 87% showed significant decrease in retinal thickness in at least one eye after at least four weeks, 33% showed significant improvement in both eyes, and 31% of those who showed improvment showed worsening with continued treatment. The study concluded:

"The present study documents the potential efficacy of topical dorzolamide for treating CME in patients with RP. We observed that some patients may show a “rebound phenomenon” with continued use of the medication; hence, there is a need for careful follow-up in patients being treated."

Retinal Vessel Diameters and Risk of Stroke

"Larger retinal venular diameters are associated with an increased risk of stroke and cerebral infarction. The role of venules in cerebrovascular disease warrants further exploration."

SOURCE: Ikram MK, de Jong FJ, Bos MJ, et al. Retinal vessel diameters and risk of stroke: the Rotterdam Study. Neurol 2006;66(9):1339-43.

RENU WITH MOISTURE-LOC REMOVED FROM MARKET

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 news release:

"there is no evidence of product contamination, tampering, counterfeiting or sterility failure. That leads us to conclude that some aspect of the MoistureLoc formula may be increasing the relative risk of Fusarium infection in unusual circumstances."

Another troubling note is that there were three cases of patients developing fusarium keratitis who used Alcon's Optifree ReFResh.

SYSTEMIC SIMVASTATIN & RETINAL BLOOD FLOW

Arch Ophthalmol -- Abstract: Effect of Systemic Administration of Simvastatin on Retinal Circulation, May 2006, Nagaoka et al. 124 (5): 665 This is a very interesting study that may have implications for RVO, RAO, and glaucoma. The study was done to investigate the effect of systemic administration of simvastatin on the retinal circulation. It may have implications for vein and retinal occlusions and glaucoma. It states:

"The effects of systemic administration of simvastatin on the retinal circulation after 90 minutes and after 7 days were studied in a placebo-controlled, double-masked, clinical trial among 12 healthy men.

"There were no significant changes in any retinal circulatory parameters at 90 minutes after administration of simvastatin. Daily administration of simvastatin for 7 days significantly increased blood velocity and blood flow in retinal arteries and veins but did not significantly change vessel diameter. The intraocular pressure significantly decreased at 90 minutes and at 7 days after administration of simvastatin.

Conclusion: Simvastatin induced an increase in blood velocity and blood flow in retinal arteries and veins, and decreased the intraocular pressure, probably through the increase in nitric oxide."

I'd like to see more studies done on this.

INTRAVITREAL TRIAMCINOLONE NOT EFFECTIVE IN DIABETIC MACULAR EDEMA?

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 This report stated: "Patients treated with intravitreal triamcinolone or a laser for persistent diabetic macular edema showed “no statistically significant improvement from baseline” at the 1–year follow-up, said Zdenek Gregor, MD, at the French Society of Ophthalmology meeting.

"Patients experienced an initial improvement in best corrected visual acuity and a reduction of macular thickness. However, by 1 year, results returned to near baseline and there was no statistically significant improvement in either group, he said.

"'The results were inconclusive or rather negative. Intravitreal triamcinolone up to 1 year did not improve BCVA, did not reduce macular thickness or volume' Dr. Gregor said. 'Intravitreal triamcinolone is unlikely to improve visual acuity in any lasting fashion.'"

AMIODARONE & OPTIC NEUROPATHY

Arch Ophthalmol -- Abstract: Optic Neuropathy in Patients Using Amiodarone, May 2006, Purvin et al. 124 (5): 696. This article in Archives of Ophthalmology recommends further research evaluating the link between amiodarone and optic neuropathy, and how to differentiate it from ischemic optic neuropathy.

BETTER NOT TO PATCH SMALL CORNEAL ABRASIONS

Patching for corneal abrasion (Cochrane Review) This review concluded:

"Treating simple corneal abrasions with a patch does not improve healing rates on the first day post-injury and does not reduce pain. In addition, use of patches results in a loss of binocular vision. Therefore it is recommended that patches should not be used for simple corneal abrasions. Further research should focus on large (greater than 10 mm2) abrasions."

MARX LINE: QUICK SCREENING FOR MEIBOMIAN GLAND DYSFUNCTION

ScienceDirect - American Journal of Ophthalmology : Marx Line: Fluorescein Staining Line on the Inner Lid as Indicator of Meibomian Gland Function

The Marx line is a flurescein-stained line which runs along the inner eyelid and is correlated with meibomian gland dysfrunction.

BETTER RESULTS IN RETREATED LASIK PATIENTS WITH CONVENTIONAL VS. WAVEFRONT

ScienceDirect - American Journal of Ophthalmology : Conventional and Wavefront-Guided Myopic LASIK Retreatment: "In the study period with the current equipment, our results showed that conventional LASIK retreatment was superior to wavefront-guided LASIK retreatment in both efficacy and safety.

This study concluded:

"In the study period with the current equipment, our results showed that conventional LASIK retreatment was superior to wavefront-guided LASIK retreatment in both efficacy and safety."

NOVEL PROCEDURE FOR KERATOCONUS

EyeWorld Magazine: March�2006

This article summarizes a novel procedure for keratoconus using intracornal rings and femtosecond laser.

YAG CAPSULOTOMY AND MACULAR HOLES

ScienceDirect - Journal of Cataract & Refractive Surgery : Reopening of 2 macular holes after neodymium:YAG capsulotomy

This paper reported 2 cases of reopening of macular holes afer successful YAG capsulotomy.

RESISTANCE TO 4TH GENERATION FLUOROQUINILONES

ScienceDirect - Journal of Cataract & Refractive Surgery : Fourth-generation fluoroquinolone-resistant bacterial keratitis after refractive surgery

The first two cases of resistant bacterial keratitis were reported in the literature. The first had Pseudomonas aeruginosa keratitis afer PRK despite treatment with moxifloxacin. The second was a methicilin-resistant Staphylococcus aureus keratitis resistant to gatifloxacin.

This is not comfortable news.

AOA LEGISLATIVE UPDATE

Senate Bill 1955 is an effort to make health insurance available to small businesses, but may harm optometry because it allows insurance discrimination against optometry. AOA is trying to kill the bill, but if it passes, AOA is trying to make sure that non-discrimination language gets included in the bill.

Senate Bill 2480 supported by 1-800-CONTACTS would limit optometrists ability to sell contact lenses that 1-800-CONTACTS does not have access to.

House Bill 2238 would provide federal grants for children's vision initiatives.

Our present provider discrimination law is not strong enough and requires a 4-6 year process to fix.

Optometry is the fastest, most progressive profession in health care.

EYE PAIN

From AZOA conference:

- Tylenol 3 q4h. Sedation and gastrointestinal problems.

- Lortab q4-6h, less sedation and gastrointestinal problems than Tylenol #3.

- Suspect abuse if patient demands a certain drug vs. another.

ANGLE CLOSURE GLAUCOMA

From AZOA conference. Things I didn't know about angle closure glaucoma:

- Topamax, a medication used for epilepsy, migraine, and weight loss can induce bilateral angle closure glaucoma.

- Don't forget glaucomacyclitic crisis (check for cells).

- Consider gonio in fellow eye if it's contraindicated in involved eye.

- Don't forget pilo 2% if IOP is < 40mmHg

.

- Don't allow patient to leave office if IOP is more than 30mmHg.

TEMPORAL ARTERITIS

From AZOA conference.
Thngs I didn't know about temporal arteritis:

-Higher prevalence in females with Scandinavian descent.

-2/3 develop bilateral ocular disease.

PSEUDOEXFOLIATION AND CORONARY ARTERY DISEASE

Optometric Physician

SOURCE: Citirik M, Acaroglu G, Batman C, et al. A possible link between the pseudoexfoliation syndrome and coronary artery disease. Eye 2006; Mar 24 [Epub ahead of print].

This study demonstrated a strong association between PXF and coronary artery disease.

GOLDMANN TONOMETRY CHECKS.

Optometric Physician
SOURCE: Kumar N, Jivan S. Goldmann applanation tonometer calibration error checks: current practice in the UK. Eye 2006; Mar 31 [Epub ahead of print].

Ophthalmology residents in England were surveyed and it was determined that:

"Only seven percent said they perform checks at the start of each clinical session, and eight percent check the tonometer for calibration errors if they had suspicious or unexpected measurements."

The summary in Optometric Physician concludes:

"Tonometers should be checked for calibration errors at least monthly."

We have biomed staff that maintains our equipment, but I don't know how often they calibrate our tonometers. I know it's not once a month. I honestly don't know how to calibrate the tonometer.

NERVE GROWTH FACTOR FOR CORNEAL HEALING

The Use of Nerve Growth Factor in Surgical Wound Healing of the Cornea - Karger Publishers

This study concluded:

"In the patients treated with NGF, on day 21, we found with OCT a complete wound healing, and the stromal incision was not visible. Conclusions: This clinical experience shows that the topical administration of NGF is effective in accelerating the healing of surgical corneal wounds."

Now I wonder if nerve growth factor might be useful in other applications, such as neurotrophic corneal ulcers or in diabetics whose corneal abrasions won't heal. I don't how how to obtain nerve growth factor, but I would be interested to see additional studies about nerve growht factor and non-healing corneal insults.

INTRACRANIAL PRESSURE AND INTRAOCULAR PRESSURE

SOURCE: Sajjadi SA, Harirchian MH, Sheikhbahaei N, et al. The relation between intracranial and intraocular pressures: study of 50 patients. Ann Neurol 2006;59(5):867-70.


The results of this study revealed a significant correlation between ICP and IOP.

BIMATOPROST MAY DECREASE HDL

SOURCE: Steinhauser SL. Decreased high-density lipoprotein serum levels associated with topical bimatoprost therapy. Optom 2006;77(4):177-9.

If prostaglandin analogues significantly decrease HDL, this is very bad news for glaucoma therapists and patients. Fortunately this is just a case study, but it does deserve further investigation.

MORE SUPPORT FOR FDT

Journal of Glaucoma - Abstract: Volume 15(2) April 2006 p 77-83 Frequency Doubling Technology Perimetry With the Humphrey Matrix 30-2 Test. Here's another study that demonstrates that:

"FDT perimetry appeared more sensitive than standard automated perimetry in detecting early glaucomatous fisual field loss. The FDT-N-30 test showed a slightly higher ability to detect early glaucomatous damage in patients at risk for the development of glaucoma, whereas the 30-2 test provided a more detailed characterization of the glaucomatous VF loss pattern, although it required 30% more time."