Academy Research Committee to Meet in Canada July 16–18, 2010
The Academy of Optometry’s Research Committee, currently chaired by Lyndon Jones, OD, PhD, FAAO, will meet this month at the University of Waterloo. The committee appointed by the Academy Board and including the Editor-in-Chief of Optometry and Vision Science, is involved in a range of activities that impact the successful conduct of optometric research, particularly as it relates to the Academy. A substantial part of the workload involves reviewing all AOF applications for Fellowships, Residencies, Research Projects, and optometric education awards. It also includes reviewing the travel fellowships for the ARVO and annual meeting of the Academy.
2010 Invitational Clinical Research Institute Hosted by the Academy and AOA
The American Optometric Association Council on Research and the American Academy of Optometry Research Committee will conduct the 2010 Invitation Clinical Research Institute. This will be the 12th workshop co-sponsored by the AOA and AAO. It will take place July 19 to 23, 2010, on the campus of the Ohio State University in Columbus, Ohio.
About 40 invitees will participate in an intensive workshop with the summer faculty mentors. The “summer camp” is designed to facilitate funded collaborative research in optometry and has a remarkable history of success with the investment in the workshops representing only a tiny fraction of the total subsequent funded research. This results in substantial part from the workshop initiatives. This year, there will be four working groups, by topic area (pediatric vision, low vision and rehabilitation of vision, contact lens and cornea, and ocular disease).
Academy’s Optometry and Vision Science, Doubles Submissions in Early 2010
By the end of May, OVS had received almost exactly twice as many article submissions as it did in the same period in 2009. In fact, the number submitted in this calendar year by May 28, 2010, was not reached until September in 2009. The Editorial Board and Editors, despite being called on to carry the additional load with invited reviewers, view this as a healthy trend for the Journal.
ORGANIZATION & INSTITUTION NEWS
New Treatment for Diabetic Macular Edema: Dramatic Visual Improvement
On April 27, 2010, the National Eye Institute released a press statement that preceded an ARVO 2010 presentation a few days later. They announced, “Researchers have shown that ranibizumab (Lucentis) eye injections, often in combination with laser treatment, result in better vision than laser treatment alone for diabetes-associated swelling of the retina.”
Laser treatment alone has been the standard care for the last 25 years. But nearly 50 percent of patients who received this new treatment experienced substantial visual improvement after 1 year, compared with 28 percent who received the standard laser treatment. The study involved 52 clinical sites within the Diabetic Retinopathy Clinical Research Network (DRCR.net), supported by the National Eye Institute (NEI) and the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.
“These results indicate a treatment breakthrough for saving the vision of people with diabetic macular edema,” said Neil M. Bressler, MD, chair of the DRCR.net and chief of the Retina Division at the Wilmer Eye Institute, Johns Hopkins University, MD. “Eye injections of ranibizumab with prompt or deferred laser treatment should now be considered for patients with characteristics similar to those in this clinical trial.”
Laser treatment of the retina has been the standard care for diabetic macular edema since an NEI-supported study in 1985 showed it to be beneficial. However, recent small short-term studies have revealed the visual benefits of eye injections of medications that block a chemical signal that stimulates blood vessel growth, known as vascular endothelial growth factor (VEGF). These studies have indicated that repeated doses of anti-VEGF medications, such as ranibizumab, may prevent blood vessels from leaking fluid and causing macular edema. The DRCR.net study, published online April 27 in Ophthalmology, confirms preliminary results and provides evidence of the treatment’s effectiveness in combination with laser therapy through at least 1 year of follow-up.
“This comparative-effectiveness study demonstrated that a new treatment can protect and, in many cases, improve the vision of people with diabetic macular edema,” said NEI Director Paul A. Sieving, MD, PhD.
This study included a total of 854 eyes of 691 people, who had one or both eyes treated. Participants, who were on average in their early 60s, were diagnosed with type 1 or 2 diabetes and macular edema. They were randomly assigned to one of four study groups: sham injections plus prompt laser treatment within 1 week; ranibizumab injections plus prompt laser treatment; ranibizumab plus deferred laser treatment after 6 months or more; or injections of corticosteroid medication known as triamcinolone (Trivaris) plus prompt laser treatment.
Ranibizumab injections could be given as often as every 4 weeks, and triamcinolone injections or laser treatments could be given as often as every 16 weeks. In general, treatment was continued until a participant’s vision or retinal thickness returned to normal, or additional treatment did not improve vision or retinal swelling.
After 1 year, nearly 50% of eyes treated with ranibizumab and prompt or deferred laser treatment showed a substantial visual improvement. People could read at least two additional lines on an eye chart with the treated eye, or letters that were at least one third smaller than they could read before the study treatment. Fewer than 5% of eyes in these groups experienced a visual loss of two or more lines. The results were similar whether patients received prompt or deferred laser treatment with the ranibizumab injections. In contrast, about 30% of eyes that received laser treatment alone or triamcinolone plus laser showed a visual improvement of two or more lines on an eye chart, whereas 13 to 14% of eyes in these groups had a visual loss of two or more lines.
Although participants in all three injection groups had a greater decrease in retinal thickness after 1 year than with laser treatment alone, patients who received triamcinolone injections had greater complication rates. About 30% of people in the triamcinolone group developed high eye pressure that required medications, and about 60% developed cataracts that required surgery.
Few participants who received eye injections of ranibizumab had eye-related complications, such as an infection inside the eye likely caused by the injections, or worsening of a retinal detachment that existed before beginning treatment. The study found that eye injections of ranibizumab were not associated with any serious risks such as heart attack or stroke. DRCR.net researchers will continue to monitor the study participants for at least 3 years to obtain additional information about the safety and effectiveness of these macular edema treatments. Find more information about this clinical trial (NCT00444600) at www.clinicaltrials.gov.
See also Elman MJ et al. “Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema” Ophthalmology 2010; DOI: 10.1016/j.ophtha.2010.02.031.
Web Site for Color Defective “Would-be” Practitioners
Professor Barry Cole, Emeritus Professor of Optometry at the University of Melbourne in Australia, and two UK physician colleagues, have recently developed a web site “Colour Blindness and Medicine,” which is an excellent resource for students considering to study medicine, optometry, nursing, or any health profession where color vision is important in diagnosis and management of patients. It is also an excellent site for health care practitioners already engaged in clinical care. See: http//www.colourmed.com.
The site has nine different sections:
1. Tests of color vision deficiency.
2. More about color vision deficiency.
3. Common color vision problems.
4. Picture gallery of common problems.
5. Should I study medicine?
6. Is there treatment for color vision deficiency?
7. Tips and advice for the color-blind doctor.
8. Overview of color vision deficiency.
9. Published articles on color vision deficiency.
The site also includes a detailed overview of the evidence for believing that abnormal color vision can affect the practice of medicine, and a comprehensive bibliography of some 62 publications.
This is a great resource for practitioners who are counseling their patients interested in a career in medicine, optometry, or health care professions that use color as part of their decision making in practice.
Gene Therapy Successfully Treats Achromatopsia in Dogs
Researchers at the University of Pennsylvania have reported in the journal Human Molecular Genetics E-Pub in April that they have successfully used gene therapy to treat a form of achromatopsia found in dogs that leads to blindness at daylight light levels. A video filmed by the researchers shows dogs with the achromatopsia could easily make their way through a darkened obstacle course but had significant trouble navigating the same course in bright light. Dogs treated with the gene therapy then walked the course with the same speed as healthy dogs. Video can be seen at: http://www.eurekalert.org/multimedia/pub/21,820.php?from=158844.
The gene therapy was reported to be more effective in younger dogs but was promising even with dogs more than 1 year old. The gene therapy targets mutations of a gene known as CNGB3, the most common cause of achromatopsia in humans. The researchers report that dogs are the only large animal with CNGB3 achromatopsia. Although achromatopsia is quite rare, its treatment may be useful as a model for other, more common, retinal diseases altering the retinal cone photoreceptors.
DOD Announces $10 Million in Vision Research: Optometric Researcher Among Awardees
At a Monday, May 3, standing room only session held by NAEVR at the 2010 ARVO Annual Meeting, representatives from the Department of Defense’s (DOD) Telemedicine and Advanced Technology Research Center (TATRC) announced $10 million in grant awards to vision researchers from its Vision Research Program. The net total of these awards reflects Fiscal Year (FY) 2009 and FY 2010 Congressional appropriations of $4 million and $3.75 million from the Peer-Reviewed Medical Research-Vision (PRMR-Vision) program line item in defense funding plus $3.2 million provided by TATRC’s “sister” agency within the U.S Army’s Medical Research and Materiel Command (MRMC), the Clinical and Rehabilitative Medicine Research Program (CRMRP), minus administrative costs.
Stacey Choi, OD, PhD, was one of the nine awardees announced at ARVO 2010. Her research, as an Associate Professor at the New England College of Optometry (NECO), is titled “Ultrahigh Resolution Imaging with Adaptive Optics for Early Diagnosis of Traumatic Brain Injury.”
In announcing the awards, TATRC Vision Portfolio Manager Robert Read commented that it was the quality of the proposals and their emphasis on research that fills “knowledge gaps” in understanding the impact of traumatic eye injury that have made Research Area Directors in other DOD programs, such as the CRMRP, interested in funding such projects. Vision Center of Excellence Director Donald Gagliano, MD, who serves as the co-chair of the TATRC Programmatic Panel, echoed Mr. Read’s remarks, noting that “vision researchers have certainly raised awareness among DOD agencies for both the quality and responsiveness of their grant submissions to the current needs of our military.” Dr. Gagliano also gave a Powerpoint presentation about how the VCE, which is a joint DOD and Department of Veterans Affairs (VA) program, is coordinating military vision care from diagnosis through rehabilitation, including development of a Congressionally mandated Defense and Veterans Eye Injury Vision Registry (DVEIVR). The latter may identify the most significant future research needs.
Vision CRC Breakthrough Technology Reports Control of Myopia in Children
In late March 2010, scientists from the Vision Cooperative Research Centre (Vision CRC) in Australia announced what they describe as a “vision CRC breakthrough technology (that) controls myopia in children.” The technology is based on the publications pointing to “successful basic research on the nature and cause of myopia has led to the discovery that the peripheral retinal image plays a major part in stimulating eye growth and myopia.” They report “large scale clinical trials testing both spectacles and contact lenses, designed to control the position of the peripheral image and involving over 500 children in China and Australia, have produced promising results.” The technology has been licensed to Carl Zeiss Vision (CZV) and developed into “the first spectacle lens of its kind” through a joint project with CZV lens designers. This new spectacle lens was scheduled to be launched under the ZEISS brand name throughout Asia in April 2010. The Vision CRC has also licensed its myopia control technology to CIBA VISION for contact lens applications.
Professor Brien Holden, CEO of the Vision CRC, explained, “The beauty of this new technology is that it addresses this problem by bringing the peripheral image forward, onto or even in front of the retina, and at the same time independently positioning the central image on the retina giving clear vision.”
Dr Padmaja Sankaridurg, Head of the Myopia Program at Vision CRC, said, “We are continuing testing in Chinese and Australian children and young adults. So far, the trials have found that the first spectacle lens prototypes based on this new technology slow the rate of progress of myopia by 30% in children 6 to 12 years of age, where the child has a history of parental myopia.” A published article, soon to be available as an E-Pub on line, is scheduled for the September Optometry and Vision Science issue (Vol. 87, Number 9).
The Vision CRC highlights the potential impact of successful myopia management by pointing to the numbers of myopes and their prevalence worldwide.
* India—177 million myopes (15% of the population).
* China—628 million myopes (47% of the population).
* United Kingdom—16 million myopes (27% of the population).
* United States—127 million myopes (42% of the population). The estimated prevalence of myopia has increased from 25.0% in 1971–1972 to 41.6% in 1994–2004.
* Singapore—2.8 million myopes (60% of the population). Studies have shown a dramatic increase in rates of myopia among young adults in Singapore. The prevalence in males aged 15 to 25 years went from 26% in the late 1970s to 83% by the late 1990s.
* Taiwan—12.9 million myopes (56% of the population). In Taiwan, the prevalence rate of myopia is 84% for teenagers between 16 and 18 years.
* Malaysia—12.6 million myopes (48% of the population).
* Australia—3.5 million myopes.
Plan to Boost Indian Optometry Endorsed
A recent decision by a delegation of Indian and international optometry representatives has led to firm support for the development of eye care services throughout India. The New Delhi meeting concluded with the signing of a Delhi Declaration that heralds a significant step toward the sustainable development of optometry in the country.
The delegation met to discuss the development of blindness prevention and to agree on a pathway for the further development of optometry as an independent profession and to substantially upgrade and increase optometric human resources.
An estimated 456 million of India’s 1.12 billion people require vision correction. The staggering cost in lost productivity from uncorrected refractive error (the need for an eye examination and pair of glasses) is estimated at $23 billion per annum.
Professor Holden, CEO of the International Centre for Eyecare Education (ICEE) and a delegate, commented, “The reality is that to provide the necessary vision care to the population, India needs 115,000 optometrists. But the fact remains that currently the country has approximately 9000 (4-year trained optometrists) and 40,000 (2-year trained) eye care personnel.” He continued, “If it is to further develop into a regulated profession in India, it is estimated that the country will need at least 100 schools of optometry over the next few decades to meet the demand for fully qualified optometrists. Ensuring that quality education is delivered in all these undergraduate programs would require the development of a minimum of 1000 optometric educators who are capable of facing the challenges ahead to help produce around 5000 optometry graduates per year.”
The Delhi Declaration was endorsed by the Indian Optometric Association, the Association of Schools and Colleges of Optometry (ASCO), World Council of Optometry, LV Prasad Eye Institute (LVPEI), Brien Holden Vision Institute and ICEE. The initiative was supported by the Australia-India Council.
Visual Impairment a Massive Burden on Health Care Systems and Economies Worldwide
In mid April 2010, coincident with their Global Congress in Vienna, the AMD Alliance International (AMDAI) released what they describe as “the first-ever estimates of global cost of vision loss—nearly $3 trillion dollars for the 733 million people living with low vision and blindness worldwide in 2010.” Even more importantly, they note that these costs are set to rise dramatically through to 2020 unless effective prevention and treatment strategies are adopted worldwide. Current costs include direct health care expenditure, informal caregiver time, lost productivity, and inefficiencies in raising tax revenue to fund health care. In North America alone, the direct cost was $512.8 billion, and the indirect costs were $179 billion, according to the AMDAI study.
Latino Americans High Rates of Blindness, Diabetic Eye Disease, Cataracts
The May issue of the American Journal of Ophthalmology, reminds us that Latino Americans having higher rates of visual impairment, blindness, diabetic eye disease, and cataracts than whites in the United States. In analyzing data reported from more than 4,600 participants in the Los Angeles Latino Eye Study (LALES), researchers suggest that the Latinos’ rates of visual impairment and blindness are the highest of any ethnic group in the country.
VSP Launches Diabetes Campaign
In mid May, VSP Vision Care announced the launch of VSP Eye on Diabetes, a campaign in five states focused on increasing awareness and understanding of the connection between eyecare and a person’s general health. The campaign highlights the important role eye doctors play in the detection and treatment of diabetes.
A free continuing education course, approved by the Council on Optometric Practitioner Education (COPE), will be offered in each city for all licensed optometrists. Leading the courses are nationally recognized speakers in the areas of diabetes, ocular disease and systemic disease, Jeffry Gerson, OD, FAAO, and A. Paul Chous, MA, OD, FAAO.
“The first of its kind, the VSP Eye on Diabetes campaign is designed to increase consumer awareness around the importance of comprehensive eyecare in detecting and managing diabetes, as well as support our doctors with continuing education in providing this essential care,” stated Cheryl Johnson, VSP’s Vice President of Provider Services.
Crystalens AO Receives Quarter Diopter Approval
In mid May, Bausch and Lomb announced that it had received approval from the U.S. Food and Drug Administration (FDA) to market the Crystalens AO in quarter diopter steps in the United States. The Crystalens accommodating intraocular lens (IOL) was first approved by the FDA in November 2003. Bausch and Lomb notes that the Crystalens AO is the fifth generation of the only FDA-approved accommodating lens.