Academies of Optometry and Ophthalmology Collaboration
On December 4, 2013 the American Academy of Optometry and the American Academy of Ophthalmology announced “a joint initiative to work together to better prepare and support their members in delivering the highest quality eye care. The organizations will collaborate in support of joint educational initiatives that will be developed over the next 12 to 18 months, with a formal launch in 2015.”
Academy 2013 Seattle
Academy 2013 Seattle was the 92nd annual meeting of the American Academy of Optometry and the largest meeting in Academy history, with 6006 total registrants. This included 3801 optometrists and vision scientists and 805 students, marking a 20% overall increase in attendance over 2012. Attendees engaged in high-quality learning, experienced new products and technologies in a packed and sold-out Exhibit Hall, and met the optometrists and vision scientists who are not only conducting the research but also bringing the results to their clinics and practices.
Translating research into clinical application is a featured topic of several events including the Plenary Session, “Today’s Research, Tomorrow’s Practice®: Stem Cells and Ocular Regenerative Therapies.” Amander Clark, PhD, Jeffrey Goldberg, MD, PhD, and Victor Perez, MD, spoke to approximately 1800 attendees on the current status of stem cell use in the treatment of previously intractable ocular diseases.
A highlight of the meeting was the President’s Banquet on Saturday, where 244 new Fellows were inducted into the American Academy of Optometry, making it the largest class of new Fellows in Academy history. Fellows of the Academy must complete a candidacy process that includes submitting written work demonstrating their skills as an optometrist or vision scientist and sitting for an oral examination at the annual meeting of the Academy. About 10% of practicing optometrists in the United States are Fellows of the American Academy of Optometry (FAAO). Optometrists, scientists, educators, librarians, administrators, and editors are eligible to become Fellows of the Academy and earn the right to use “FAAO” after their names.
In addition, five individuals were awarded Diplomate status by Sections of the American Academy of Optometry. Diplomates are Fellows of the Academy who wish to demonstrate their skill in a specific area.
Currently, eight Sections offer Diplomate programs: Anterior Segment; Binocular Vision, Perception, and Pediatric Optometry; Cornea, Contact Lenses, and Refractive Technologies; Low Vision; Optometric Education; Primary Care; Public Health and Environmental Vision; and Vision Science. The American Optometric Foundation, the Academy’s foundation supporting research, would like to thank sponsors, donors, awardees, and volunteers for making Academy 2013 Seattle another huge success. The meeting resulted in more than $150,000 in generous donations and new pledges. Approximately 260 supporters attended the Foundation’s Celebration Luncheon and the silent auction resulting in more than $20,000 in donations. In addition, nine new individuals and couples joined the Presidents Circle by making pledges or donations of $10,000. The Presidents Circle now has more than 100 total members.
Fry Awardees Celebrate the Newest Awardee David Elliott
As it has become an annual tradition, all prior Glenn A. Fry Awardees toast the most recent Awardee at the Academy’s banquet. This year, it was David Elliott who won the Award and gave the Glenn A. Fry Lecture. David is seen here thoroughly enjoying the occasion. The American Optometric Foundation (AOF) of the AAO gives this prestigious award annually. The award is given annually to a distinguished scientist or clinician scientist in recognition of the quality, significance, impact, and relevance to optometry of his or her current research contributions. . . . and that current accomplishments are worthy of the award and the nominee is highly likely to continue to make significant contributions to his or her field.
The 12th Annual Meeting of the OGS at Academy Seattle
Since its founding in 2002, the Optometric Glaucoma Society (OGS) has presented a scientific meeting before the annual AAO meeting. From humble beginnings, with fewer than 30, this year’s meeting attracted nearly 130. Topics included extrapolations from experimental glaucoma, new ideas and techniques in diagnosis and treatment, evidence from research on ganglion cell rescue and regeneration, and the Honoree’s lecture. Claude Burgoyne, MD, summarized decades of research on anatomic changes and designations of the lamina cribrosa and surrounding structures. By emphasizing the significance of SD-OCT imaging, he also sounded the death knell for the C/D ratio as a keystone optic nerve descriptor.
Call for Courses for Academy Denver
The Lectures and Workshops Committee invites you to submit up to three course proposals for consideration for Academy 2014 Denver. The submission window will be open January 1 to February 1, 2014. To read the proposal guidelines and other resources, visit the Call for Courses at the Academy Web site.
Academy Fellow and Research Committee Chair Leadership
Recently (October 21, 2013), the Tear Film and Ocular Surface Group TFOS issued a workshop report, chaired by Academy Fellow and Research Committee chair Jason J. Nichols, OD, MPH, PhD, FAAO, on “Contact lens discomfort: what is it, why does it occur, and how can it be treated?” Contact lens discomfort (CLD) may be the leading cause of patient dissatisfaction with, and discontinuation of, contact lens wear throughout the world, but there is little agreement among vision researchers and eye care professionals about how to define and manage its causes.
“Up to half of all contact lens wearers experience CLD,” explained Nichols. “However, there is no global consensus concerning the definition, classification, epidemiology, pathophysiology, diagnosis, management, and the proper design of clinical studies for CLD.”
To lay the groundwork for defining and treating this widespread issue, the TFOS International Workshop on Contact Lens Discomfort issued the report that was chaired by Nichols. The workshop report offers a framework for getting answers. The CLD Workshop took 18 months to complete and involved 79 experts from around the world—many of the American Academy of Optometry fellows. “Workshop participants used an evidence-based approach and a process of open communication, dialog, and transparency to achieve a global consensus concerning multiple aspects of CLD,” noted Mark Willcox, PhD, FAAO, Vice Chair of the Workshop.
“This TFOS report will significantly increase awareness of factors that may, and may not, contribute to the generation of CLD. Ideally, this TFOS report will stimulate innovative research in this very important field,” commented David A. Sullivan, MS, PhD, Founder and recent past TFOS President. The TFOS International Workshop on Contact Lens Discomfort Report is freely available to scientists and clinicians worldwide (www.tearfilm.org).
ORGANIZATION AND INSTITUTION NEWS
A New Eye and Vision Resource Just for Women
According to Prevent Blindness America (October 15, 2013), women are at a significantly greater risk of blindness or visual impairment than men. In fact, according to the 2012 “Vision Problems in the US” study, 66% of those experiencing blindness are women, 61% of those with cataracts are women, and 65% of those with age-related macular degeneration are women.
“See Jane See—Women’s Healthy Eyes Now” is a Web-based educational campaign dedicated solely to women’s vision health. See Jane See and the dedicated Web site, SeeJaneSee.org, offer free information and downloadable tip sheets created specifically for women on a variety of issues across the age spectrum.
More on 3-D Printing: A Heart from Stanford
On October 3, 2013, the San Francisco Chronicle (Kristen V. Brown) had an article that takes the previous OVS News on the understandable excitement about 3-D printing a step further. This time into direct application for human hearts. In the article, Brown reports, “the mode of work is deceptively low tech in appearance. Boxy and gray in a 1980s throwback sort of way, in reality, the uPrint 3-D printer is technology representative of medicine’s almost unbelievable future—a future in which, instead of waiting months or years for a donor, a necessary new organ might simply be printed in a laboratory. That future is a ways off but, in smaller ways, the 3-D printer has already begun to reshape medicine and medical research.”
She continues, Wang, a Stanford cardiologist, devotes his days to developing new methods of treating arrhythmias, irregular heartbeat patterns that are usually harmless but sometimes deadly. He is constantly tinkering and inventing new devices to make treatment more precise and less invasive. For example, in the works is one device he describes as a ‘little moon rover’ that ‘walks inside the heart.’ A rover that could theoretically crawl between the chambers of the heart—zapping cell clusters responsible for an arrhythmia—could replace typical procedures like catheter ablations, in which thin flexible wires guided through blood vessels in the arm, leg, or neck into the heart perform the same cell-busting duty. His robot could conceivably be ready for human trial in a couple of years. He estimates that 3-D printing has sliced years off of development time for the device.
For the uninitiated, 3-D printing is pretty much exactly as it sounds. “Using a digital model, a 3-D printer can print a three-dimensional solid object of nearly any shape or size.”
Brown continues, “In 2012, the 3-D printing market grew by nearly 30% to $2.2 billion. It is expected to double by 2015. What began as a niche novel technology in the 1980s has ballooned into a market where companies like MakerBot make relatively cheap 3-D printers for commercial sale.”
Blood-Brain Barrier Mysteries Revealed?
For those working in eye and vision, especially clinicians, the blood-brain barrier (BBB) has particular significance. Early in November, The Scientist (Megan Scudellari, November 1, 2013) recounts the recent history of research related to the BBB by noting, “When neuroscientist Ryan Watts talks about receptor-mediated transcytosis, he sounds like an orchestra conductor describing his favorite piece of music. To him, the passage of a molecule through a cell membrane via a receptor-assisted vesicle is an art form and, more importantly, a way into the brain. In 2004, Watts formed the neuroscience unit at pharmaceutical company Genentech. Right away, he organized a program to develop antibodies against the protein fragment amyloid beta, a component of brain plaques associated with Alzheimer disease. But as soon as he began, Watts, like many before him, ran into a wall—literally. His antibodies were being trapped at the BBB, a mesh of tight junctions between specialized endothelial cells lining brain capillaries that prevent foreign particles from entering the brain.” Scudellari continues, “Antibodies actually can get into the brain, just not very efficiently. Some small lipid-soluble drugs do cross the BBB simply by diffusion through the cell membrane, and others, like caffeine, enter successfully via specialized transporter proteins. So, Watts, along with Genentech biochemist Mark Dennis, devised a far more subtle solution to get antibodies to cross the BBB—receptor-mediated transcytosis. Their success surprised neuroscientists and caught the attention of the rest of the pharma industry, which has become eager to identify new ways to breach the BBB.” Apparently, there have been some quite dramatic breakthroughs in the last 2 years, and Sculldellari notes, “Genentech’s early achievements breaching the BBB have opened the floodgates. These days, crossing the barrier is in vogue, with numerous companies and academics devising diverse, creative, and sometimes downright wacky ways to pry open a window into the brain. In doing so, they hope to deliver drugs that will treat Alzheimer disease, multiple sclerosis, Parkinson disease, and many more brain illnesses that are currently intractable.”
The complete report can be found at:
Are We Close to Statins for Everyone?
Certainly a recent study and report suggests that, although there is unlikely to be a call for all of us to take statins, a highly regarded committee recently announced changes in guidelines for statin use that will hugely increase the use of statins in the United States. Moreover, the guidelines are different in a number of important ways from those of the past and current practice. The NY Times (Megan Bearder) reported on the study on November 13, 2013. She notes, “The new approach divides people needing treatment into two broad risk categories. Those at high risk because, for example, they have diabetes or have had a heart attack should take a statin except in rare cases. People with extremely high levels of the harmful cholesterol known as LDL—190 or higher—should also be prescribed statins. In the past, people in these categories would also have been told to get their LDL down to 70, something no longer required. Everyone else should be considered for a statin if his or her risk of a heart attack or stroke in the next 10 years is at least 7.5%. Doctors are advised to use a new risk calculator that factors in blood pressure, age, and total cholesterol levels, among other things.
The new guidelines, formulated by the American Heart Association and the American College of Cardiology and based on a 4-year review of the evidence, simplify the current complex five-step process for evaluating who needs to take statins. In a significant departure, the new method also counts strokes as well as heart attacks in its risk calculations, a step that will probably make some additional people candidates for the drugs. The previous guidelines put such a strong emphasis on lowering cholesterol levels by specific amounts that patients who did not hit their target levels just by taking statins often were prescribed additional drugs like Zetia, made by Merck. But the new guidelines say doctors should no longer prescribe those extra medicines because they have never been shown to prevent heart attacks or strokes.”
Pig Implants Delivering Insulin to People with Diabetes
According to a report from researchers in from Glasgow Caledonian Scotland, pig cells could be used to deliver insulin to type 1 diabetes patients using an under-the-skin implant. This would potentially obviate the need to have regular insulin injections. Insulin, a hormone from the pancreas, is needed to regulate blood sugar levels. People with type 1 diabetes are unable to produce insulin so that they constantly need to inject their insulin to sustain life.
With islet transplantation cells from the pancreas of a dead human donor, which are implanted into the liver of a type 1 patient, they begin to produce insulin. The treatment is quite complex and involves the need to suppress the immune system with drugs to stop cell rejection. However, now, pig cells are possible cells from living tissue. Instead of implanting cells from the pancreas, the researchers want to deliver it through the skin. Unfortunately, pig cell insulin implants are not close—funding for preclinical (nonhuman trials) has only recently begun to allow production of genetically modified pigs that do not have viruses or health problems. So there is a way to go, mostly resting on a sense of hope and optimism.
Do We Primates Have Reptilian Predator Detectors?
Some primates do. Apparently, a study published October 28, 2013, in the Proceedings of the National Academy of Sciences (PNAS, doi:10.1073/pnas.1312648110, 2013) provides the first neuroscientific evidence to support this idea.
In another very interesting article in The Scientist (Tracy Vence, October 28, 2013) based on this PNAS study, we learn that “Humans and other primates have a remarkable ability to detect snakes, even in a chaotic visual environment. Primate socioecologist Lynne Isbell has long theorized that snakes played a significant role in the evolutionary history of primates, and a study published in the Proceedings of the National Academy of Sciences today (October 28) provides the first neuroscientific evidence to support her hypothesis. Specifically, Isbell and her colleagues identify neurons in the Japanese macaque (Macaca fuscata) brain that respond selectively to images of snakes.
Isbell, a professor of Anthropology at the University of California, Davis, first proposed her snake detection theory of primate evolution in 2006. In 2009, she published a book on the subject. In The Fruit, the Tree, and the Serpent, Isbell argued that predation pressure from snakes shaped primates’ brains and vision. Because the medial and the dorsal parts of the pulvinar are distinctive to primates and because previous work implicates the brain region in the rapid processing of threatening visuals, Isbell suspected that it might contain snake-sensitive neurons. And so, teaming up with neuroscientists from Japan and Brazil, she sought to test that notion.”
Smart Phones Expand Application in Medical Diagnosis
An article in Science Daily refers to a publication in ophthalmology that advocates consideration of use of smart phones for fundus images. The article may be questioned as overly optimistic, but OVS readers may find it of interest. The application appears, at present, to be of most interest “in the emergency department setting, in-patient consultations, and during examinations under anesthesia.”
A Double Whammy for Diabetes Treatment
On October 3, 2013, we learned of a dual-action drug that shows promise against diabetes. The drug was used in a relatively small clinical trial and is said to “pack the action of two natural hormones into a single injectable agent” and is reported to lower blood sugar in humans, monkeys, and rodents. Lead researcher Richard DiMarchi, a biomolecular scientist at Indiana University in Bloomington, is a member of the international team that published the results in Science Translational Medicine.
The molecule was developed in DiMarchi’s laboratory; it targets receptors for two hormones: glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1). The Swiss pharmaceutical company Roche supported the research and has licensed the agent. The report of the study can be found at:
Google Glass for Optometrists and Ophthalmologists?
Although most of our readers have heard something about “Google Glass” and its potential applications, it is fair to say that it is new enough that it can be described as a marvelous device “looking for the most appropriate and innovative problem-solving applications.” Because of its potential wide-ranging and potentially mischievous and privacy-invading applications, it also has some wariness expressed by a number of commentators.
Some of our readers may have noted our colleague Eli Peli, OD, MS, FAAO, wandering around the Seattle Academy halls wearing his Google Glasses. He is imaged here. Recognize him?
On November 5, 2013, the San Francisco Chronicle had a story on the Google Glass. In it, Kristen Brown notes, “Glass is essentially a hands-free head-mounted computer, tricked-out with amenities including Wi-Fi, Bluetooth, a camera, and voice activation . . . as having the potential to make doctors’ lives easier while improving efficiency and accuracy in medicine. What if, for example, a doctor could easily videotape an entire patient visit and then have the information automatically transferred to medical records? A doctor would spend minimal time shuffling medical information from one place to another, and a more accurate record would be created to help with diagnoses and treatment down the line.” Apparently, Peli is far from being the only health care professional exploring applications. Brown notes efforts to reduce office time paperwork tasks, exploration by a cardiothoracic surgeon, efforts to consult on patients remotely by streaming real-time video to physicians who are not immediately present, as a teaching tool in training and even an internist who has begun using Glass on occasion for patient visits, snapping photos of a patient’s lesion or recording other relevant office visit information.
Vision Care Institute Launches Clinical Grading Scales App
The Vision Care Institute, a Johnson & Johnson Company, recently announced that eye care professionals in the United States can now have easy access to comprehensive grading scales used in clinical practice to help practitioners assess the severity and evaluate the progression of complications associated with contact lens wear. The “Clinical Grading Scales” is a free app, compatible with the iPhone, and can be downloaded via the Apple App Store.
Vision Risks from Antiseizure Medication
Bloomberg News (November 1, Kitamura) reports “GlaxoSmithKline Plc’s antiseizure treatment Potiga (ezogabine) now carries a boxed warning in the US on risks including potential vision loss. The new warning ‘underscores risks of abnormalities in the eye, vision loss, and skin discoloration, all of which may become permanent,’ the FDA said in a statement. ‘In light of these reported adverse events, we have worked closely with regulators to update the medicine’s labeling to restrict its use to those patients where other appropriate medicine combinations have proved inadequate or have not been tolerated,’ Glaxo said in an e-mailed statement.”
Alimera’s ILUVIEN Continues Focus on EU
On October 18, 2013, Alimera Sciences announced that it had received notification from the FDA that the New Drug Application for ILUVIEN, its sustained-release microinsert for the treatment of diabetic macular edema, will be reviewed by an Advisory Committee in January 2014. This communication, along with a Complete Response Letter, came in response to a resubmission of the New Drug Application that was filed in May 2013.
As Alimera prepares to present data to the advisory committee, efforts to accelerate European market growth for ILUVIEN are underway. Currently, the product is commercially available in the United Kingdom and Germany, approved for marketing in Austria, France, Portugal, and Spain, and pending approval in Italy. In addition, Alimera has filed with the Medicines and Healthcare Products Regulatory Agency in the United Kingdom the Reference Member State for 10 additional European country approvals through the Mutual Recognition Procedure.
Optovue Launches Widefield En Face OCT
On November 15, 2013, Optovue announced the worldwide launch and availability of Avanti Widefield En Face OCT. Avanti made its US debut at the annual American Academy of Ophthalmology meeting, November 16 to 19, 2013, in New Orleans. The company states that Avanti is a next-generation diagnostic device providing an all-in-one solution for posterior and anterior high-speed, high-resolution OCT imaging offering 70,000 A-scans per second, Widefield 3-D motion correction and 3-μm digital resolution (sampling). With the next wave of OCT technology innovation in mind, Avanti is designed as a scalable platform to take eye care professionals to the next level in clinical OCT.