by Dan Roberts
This has been a year of watching and waiting, as many studies and clinical trials are bearing down on promising treatments and cures for retinal diseases. My ninth annual report will offer brief descriptions of the work done in pharmaceutical treatments, anti-VEGF and combination therapies for neovascularization, stem cell therapy, gene therapy, new technology, diet, nutrition, daily living, and self-management.
PHARMACEUTICAL THERAPY
Beginning with news about pharmaceutical therapies, clinical studies are continuing to test new drugs to treat both dry and wet forms of age-related macular degeneration (AMD). Trials are also ongoing to test combination therapies for AMD and diabetic macular edema (DME), and retinal vein occlusion (RVO).
One of the most promising new developments this past year was FDA approval of a drug called JETREA®.
JETREA®
Early treatment with JETREA® (formerly called ocriplasmin) has shown effectiveness in lessening the risk of macular pucker, macular hole, and vitreomacular traction. These conditions are caused by the tugging on the macula by the vitreous gel, which is attached to the retina at several points. As the vitreous shrinks with age, it puts tension on these “adhesions”. If the adhesion does not release spontaneously, the retinal tissue can be torn, and surgery is required to save vision.
Until recently, vitreomacular adhesion could not be prevented in its early stages. Now, however, the biopharmaceutical company, ThromboGenics, has announced that a large retrospective review of patients with vitreomacular traction and vitreomacular adhesion confirms that early treatment with JETREA® may stop disease progression and lead to better visual function outcome.
At least 11 after-market studies have found Jetrea to be effective in about half of patients, with recommendations that it be considered as a preventative treatment. They are listed here:
References:
Effect of Ocriplasmin on the Management of Macular Holes Assessment of the Clinical Relevance of Ocriplasmin. Joseph Moisseiev, MD, et al (JAMA Ophthalmol. Published online April 10, 2014.)
ARVO Program Number: 291 Poster Board Number: B0269
Ocriplasmin for Vitreomacular Adhesion (VMA) in the Clinical Setting: Rates of VMA Release, Development of Macular Holes, and Visual Outcomes. Andrew Coskey, et al
ARVO Program Number: 294 Poster Board Number: B0272
Resolution of Vitreomacular Traction Using Jetrea and its Potential Role in Diabetic Macular Edema. Bradley ONeill, et al
ARVO Program Number: 298 Poster Board Number: B0276
Predictors of Success with Intravitreal Ocriplasmin in the Treatment of Symptomatic Vitreomacular Adhesion. Daniel B. Roth, et al
ARVO Program Number: 299 Poster Board Number: B0277
Jetrea (ocriplasmin) as a treatment option for symptomatic vitreomacular traction with or without macular hole (<400 mm) – first clinical experience. Mathias M. Maier, et al
ARVO Program Number: 301 Poster Board Number: B0279
Ocriplasmin for Vitreomacular Adhesion: Aftermarket Experience and Findings. Eric Nudleman, et al
ARVO Program Number: 302 Poster Board Number: B0280
Analysis of Anatomic and Visual Acuity Outcomes Following Ocriplasmin Therapy in Symptomatic Vitreomacular Adhesion (VMA) Patients. Robert Park, et al
ARVO Program Number: 305 Poster Board Number: B0283
Long-term Clinical Outcomes with Ocriplasmin: The OASIS Study ‚ Baseline Demographics and Ocular Characteristics. Michael Tolentino, et al
ARVO Program Number: 308 Poster Board Number: B0286
Complications of Intravitreal Ocriplasmin in the Treatment of Symptomatic Vitreomacular Adhesion. Henry L. Feng, et al
ARVO Program Number: 319 Poster Board Number: B0297
Intravitreal Ocriplasmin for Symptomatic Vitreomacular Adhesion. David Warrow, et al
Dry AMD (Geographic Atrophy)
Pharmaceutical therapies for dry AMD also continue to advance in clinical trials. Most notable are ACU-4429 by Acucela and anti-factor D by Roche.
ACU-4429 slows the visual cycle and helps to decrease toxic by-products in the retina. Long-term phase 2b trials are still underway.
Anti-factor D is an injectable drug that has resulted in a 20.4 percent reduction in progression of advanced dry macular degeneration (geographic atrophy) at 18 months.
Sources:
www.fiercebiotech.com
A Phase 2 Double-masked, Placebo-controlled, Dose Ranging Study of Emixustat Hydrochloride (ACU-4429) in Subjects with GA Associated with Dry AMD (Pravin U. Dugel1, et al)
Copaxone for Dry AMD
Another drug, Copaxone, has been previously shown to reduce drusen in patients with dry AMD. 9 out of 10 eyes of patients treated with Copaxone demonstrated a mean 46.9% improvement in retinal sensitivity, in comparison with patients treated with placebo, who had a mean 6.2% decrease in light sensitivity during the 6 week study.
Source: ARVO Program Number: 1127 Poster Board Number: C0001
Improvement in microperimetry in patients receiving Copaxone for dry age-related macular degeneration (Danielle Strauss, et al)
Geographic Atrophy From Anti-VEGF Injections
Last year, I described a concern in the eye care field about the potential risk of chronic use of anti-VEGF agents for treatment wet AMD, While of obvious net benefit to patients, researchers were beginning to worry that inhibition of blood vessel growth in the retina may lead to progression of geographic atrophy and dry AMD in treated eyes.
After putting the theory to test, experimental studies on mice have shown that, at standard clinical doses, neither Lucentis nor Eylea produced evidence of cell damage. After 24 hours exposure to two times the normal clinical dosage, Lucentis was the only drug to not significantly change the cell structures. At 10 times normal doses, all three drugs showed toxicity.
This seems to confirm the concern, but much more research needs to be done before practical conclusions can be drawn.
Source: ARVO Program Number: 599 Poster Board Number: B0126
Mitochondrial Membrane Potential Response of Retinal Pigment Epithelium Cells In Vitro to Anti-VEGF Agents: Ranibizumab, Bevacizumab, Aflibercept and Ziv-aflibercept (Deepika Malik, et al)
Aspirin
The association of aspirin use with wet AMD continues to make the news. As reported in my 2013 summary, most doctors have been weighing the benefits with the risks and recommending continued use of aspirin by people with cardiovascular problems. At least three studies this past year have further supported that aspirin has no
statistically significant association with AMD progression, either wet or dry.
Sources:
ARVO Program Number: 2993
Effect of Aspirin Use on Progression of Age-Related Macular Degeneration
in the Age-Related Eye Disease Study 2 (AREDS2) Participants (Mary E. Aronow, et al)
ARVO Program Number: 5211 Poster Board Number: B0260
Lack of an Association Between Aspirin Use and Progression to Exudative Age Related Macular Degeneration in the Unaffected Eye of Patients Currently Being Treated with anti-VEGF agents (David Alter, et al)
ARVO Program Number: 5218 Poster Board Number: B0267
Effect of Aspirin on Polyethylene Glycol (PEG) induced Mouse Model of Dry Age Related Macular Degeneration and Human ARPE-19 cells in vitro (Sunali Goyal, et al)
ANTI-VEGF THERAPY FOR WET (NEOVASCULAR) AMD
Difference in Treatment Scheduling
Anti-VEGF drug injections have been common practice since 2006 for treatment of unwanted blood vessel growth and leakage in the retina. Three drugs are now being used regularly: Lucentis, Eylea, and off-label Avastin.
The principal difference between the two leading FDA-approved anti-VEGF drugs, Eylea and Lucentis has been accepted as the difference in length of time between injections. A new study, however, found no significant difference in injection scheduling between the drugs. The overall groups of patients. The 6 months analyses included 319 Eylea patients and 1,054 Lucentis patients, and the 12 month analyses included 57 Eylea patients and 374 Lucentis patients. The study was sponsored by Genentech Pharmaceuticals, makers of Lucentis. If these results continue to hold true in clinical use, this would effectively negate the main factor in deciding which drug to use, since the cost differs by only about $100 per treatment.
Source: Retrospective Analysis of First-Line Anti-Vascular Endothelial Growth Factor Treatment Patterns in Wet Age-Related Macular Degeneration Stephen S. Johnston, et al (Advances in Therapy, Volume 30, Issue 12)
Second Treated Eye
Clinical research has shown that second eyes with wet AMD begin treatment with, and maintain better visual acuity than, the first treated eye for at least three years. This makes them the more important eye functionally, and highlights the importance of diligent monitoring and treatment of the fellow eye for best visual outcomes.
Source: ARVO Program Number: 1307
The Neovascular Age-related Macular Degeneration Database: Report 2. Incidence, management and visual outcomes of Second treated eyes
Javier Zarranz-Ventura, et al)
Lifetime Treatment Outcomes
Researchers have assessed the lifetime treatment outcomes of anti-VEGF treatment for wet AMD in routine medical practice by modeling 200 patients over ten years–10 years being the average expected life expectancy after beginning treatment.
They reported that the average treatment duration was about 37 months, and the mean number of injections was 21. On average, visual acuity in the treated eye improved by about 7 letters on the eye chart and remained stable in the better eye.
40% of patients were treated in both eyes. Persons with a beginning visual acuity of better than 20/40 in both eyes had a 16% chance at 5 years to remain at that level of vision, and an 11% chance at 10 years.
On the other hand, those same patients had a 29% chance at 5 years of losing vision in one eye and a 21% chance of losing vision in both eyes. At 10 years, they had a 20% chance of losing vision in one eye and a 14% chance of losing vision in both eyes.
No matter what their original acuity, all patients had a 30-35% chance at 5 years of stopping treatment and a 50-55% chance at 10 years.
So, based on these results, most patients will eventually be able to stop treatment, but will experience deterioration of vision in both eyes despite treatment over ten years. A proportion of patients, however, will maintain good vision of better than 20/40 in both eyes, and a number of patients who begin with already limited vision, will retain vision better than 20/60.
Source: ARVO Program Number: 3957 Poster Board Number: C0259
A model of 10-year outcomes of anti-VEGF treatment for neovascular age-related macular degeneration (Robert P. Finger, et al)
COMBINATION THERAPY FOR NEOVASCULARIZATION
Injection into the eye of anti-VEGF drugs to treat blood vessel leakage has had enormous success. Now the trend is to achieve even better results by combining these drugs with others.
Fovista, Ozurdex, and Iluvien
Fovista, reported in last year’s summary, appears to be the most promising of those drugs. Clinical trials are continuing, and we hope to see good results by this time next year.
Two steroid drugs are also being looked at as combination treatments for diabetic macular edema and retinal vein occlusion. They are Ozurdex by Allergan and Iluvien by Alimera Sciences.
STEM CELL THERAPY
High Dose Stem Cell Transplant
While several trials are currently studying the safety and effectiveness of stem cell therapy, Stem Cells, Inc. announced the first of 16 patients to receive a high dose of one million purified human neural stem cells in their Phase 1/2 clinical trial. And now they are enrolling more patients for the second cohort of the trial, which is designed to evaluate the safety and efficacy of human neural stem cells as a treatment for dry AMD. Complete information may be found on the company’s website at www.stemcellsinc.com
GENE THERAPY
Gene Expression in the Retina
Identifying the genetics of retinal degeneration has become especially important with progress of trials in gene therapy. Investigators have identified more than 200 retinal degeneration disease genes, but still haven’t been able to find the cause of disease in up to half of cases.
Researchers have identified almost 30,000 novel exons and over 100 potential novel genes not identified previously. Exons are the portions of the genome that are used to encode proteins or other genetic elements.
The investigators validated almost 15,000 of these novel transcript features and found that more than 99 percent of them could be reproducibly detected. Several thousand of the novel exons appear to be used specifically in the retina. In total, the newly detected mRNA sequence increased the number of exons identified in the human genome by 3 percent.
This new data provides an unprecedented opportunity to translate research progress into sight preservation and restoration in patients with retinal degenerative disorders.
Source: Ocular Genomics Institute (Drs. Michael Farkas, Eric Pierce, and colleagues,
Ocular Genomics Institute, Massachusetts Eye and Ear. July 2013)
C3 Gene Variant and Macular Degeneration
Researchers report that a change in the C3 gene, which plays a role in inflammation and in the body’s immune response, also contributes to macular degeneration.
After sequencing DNA from 10 regions of the genome that had been previously linked to AMD in previous genetic studies, the researchers turned up two gene variants: one in the C3 complement gene, and an alteration that had been identified in previous studies of macular degeneration. The two gene variants together contribute to a three-fold increased risk for macular degeneration by interfering with inactivation of inflammation in the retina.
Source: The Genome Institute at Washington University School of Medicine (St. Louis and the University of Michigan School of Public Health in Ann Arbor.) Results published online Sept. 15 in Nature Genetics.
Choroideremia Gene Therapy
Researchers at Oxford University reported successful findings from their Phase 1/2 clinical testing of the CHM gene for treatment of choroideremia. Choroideremia is a rare disease affecting mostly males that leads to blindness.
In the multicenter clinical trial, six male patients (aged 35—63 years) all showed improvement after replacement of the malfunctioning gene. The mean gain in acuity was 3.8 letters on the chart. The researchers concluded that their findings lend support to further assessment of gene therapy in the treatment of choroideremia and other diseases, such as age-related macular degeneration.
Source: www.eye.ox.ac.uk/research/clinical-ophthalmology-research-group/press-releases-1/first-results-of-choroideremia-gene-therapy-trial-2014
TECHNOLOGY
The field of technology always gives us exciting things to talk about, and this year has been particularly notable, introducing three ground-breaking devices that bring sight to the blind.
Argus® II Retinal Prosthesis System
In August, Second Sight Medical Products, Inc. announced that The Argus® II Retinal Prosthesis System was approved for Medicare and Medicaid payments.
The Argus II System works by converting video images captured by a miniature camera housed in the patient’s glasses into a series of small electrical pulses that are transmitted wirelessly to an array of electrodes on the surface of the retina. These pulses are intended to stimulate the retina’s remaining cells, resulting in the corresponding perception of patterns of light in the brain. The patient then learns to interpret these visual patterns, thereby regaining some visual function. The Argus II is intended to help the most severely affected RP patients with bare light perception or worse vision.
Source: www.2-sight.eu/en/product-en
A Newer Retinal Prosthesis
A type of retinal implant for people with central vision loss may also be available soon from the Boston Retinal Implant Project. The device is similar to the Argus II prosthesis for people with more severe blindness.
Like the Argus II, a tiny video camera mounted on special glasses captures the image, and a pocket controller relays the signal to the implant. The implant then sends the signal to the brain, bypassing lost retinal cells. However, unlike the Argus II, which contains 60 electrodes, the new device has more than 256 electrodes, allowing for images with a larger number of pixels. This is expected to give patients a more refined visual image. Users of the retinal implant will also be able to adjust the implant according to their needs.
Source: www.bostonretinalimplant.org
OrCam
Another headline-grabbing new device this year was the OrCam, a camera-based system which allows the visually impaired to both read and identify objects with a point of a finger.
The OrCam device is a small camera connected by a thin cable to a portable computer in the wearer’s pocket. The system clips on to the wearer’s glasses with a small magnet and uses a bone-conduction speaker to read aloud words or identification of objects pointed to by the user.
According to MD Support medical advisor Dr. Janet Sunness, “The device is easy to use, with little practice required. Basically, you point with your finger at what you want the machine to read or detect, and the Orcam begins to read the newspaper, or food package, or sign to you. It can also learn what you want it to identify by waving an item in front of it and supplying the name of the item. It will eventually be able to recognize specific people and identify traffic light colors in the same way. It is currently priced at $2,500, less than a standard desktop CCTV.
“I did not have a chance to take one outside and try it extensively. When I used it, some things were read well, but with some things the Orcam had difficulty. Hopefully, this will be rectified by the time the commercial model is shipped.”
More information: www.orcam.com
Talking Prescription Labels
CVS pharmacy now provides ScripTalk talking prescription labels for prescriptions ordered for home delivery through its online pharmacy. The ScripTalk labels provide a safe and convenient way to access information on prescription labels for individuals who cannot read standard print.
The ScripTalk labels are free to CVS.com pharmacy customers who are blind or visually impaired. Customers can also obtain a free ScripTalk reader from Envision America that will enable them to listen to the information on the ScripTalk label. To order, call 1-855-SpeakRx (1-855-773-2579)
DIET & NUTRITION
AREDS2
In the field of diet and nutrition, results from the second Age-Related Eye Disease Study (AREDS2) found that the newly researched supplement formulation was not superior to the previous AREDS1 formulation.
However, the investigators did find that removing beta-carotene and adding lutein and zeaxanthin resulted in an additional 18% decrease in the risk of progression to advanced AMD. Not as dramatic as the original study, but still good news for people in the early stage of AMD.
Source: National Eye Institute
AREDS Formula and AMD Prevention
And a related report revealed that a recently completed study showed long-term daily intake of vitamins C and E, beta-carotene, and multivitamin supplements to have no significant effect on prevention of AMD. The same study did, however, reveal a significant decrease in the risk of cataract.
Though this appears to conflict with the AREDS results, it is important to remember that the AREDS formula was shown to slow the progression of AMD to the advanced wet form. As this study confirms, it has never been intended for preventative use. The
recommended ways to prevent onset of AMD continue to be good diet, exercise,
avoidance of tobacco smoking, weight control, and protection of the eyes from direct sunlight.
Source: http://clinicaltrials.gov/ct2/show/NCT00270647?term=NCT00270647&rank=1
Prediction of AMD Advancement
A 10-year follow-up study of participants in the original AREDS trial revealed new statistics on the risk and rate of progression from early to advanced AMD.
Over 3500 participants in the AREDS trial with no AMD or AMD of varying severity were followed up. Over the 10-year period, the oldest participants with the most severe AMD at baseline had a 48.1% risk of developing wet AMD, and a 26.0% risk of developing loss of central vision.
The researchers also found that rates of progression to large drusen (cellular waste deposits in the retina) increased by 70.9% in participants who started with medium drusen in both eyes. 13.8% of that group progressed to advanced AMD (either neovascular AMD or central geographic atrophy).
Finally, median visual acuity at 10 years was 20/25 in eyes that originally had large drusen but never developed advanced AMD. Eyes that did develop advanced AMD had a median visual acuity of 20/200.
The study also re-confirmed that women and current smokers were at increased risk of neovascular AMD.
Source: “Prediction of Age-related Macular Degeneration in the General Population: The Three Continent AMD Consortium” by Gabrielle, H.S. et al (published online 11 October 2013 in Ophthalmology, Manuscript #2013-588.)
AREDS Supplements and Smoking
Canadian researchers recently conducted a telephone survey to evaluate patients’ understanding of the importance and adherence to various lifestyle and AREDS supplement recommendations. Tobacco smoking was one of the lifestyle choices looked at.
Of the 92 patients contacted, 98% knew about the AREDS formula, with 74% agreeing that high doses of antioxidants and zinc are important to eye health. 88% reported taking the AREDS supplementation. None, however, reported that they had ceased smoking.
Nearly everyone knew about and took an AREDS supplement, but none of those who smoked seemed to know that they were countering all of those good antioxidants. 96% of the patients responded that the benefits justified the extra expense of the AREDS formula, but virtually none of the smokers seemed to know or be acting upon the fact that they were also paying for cigarettes which are effectively destroying those benefits.
Source: www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-benefits
Statin Therapy and Cataracts
Statin therapy has been shown to reduce inflammation in the retina, but there has been some concern about cataract development for those who use the drugs.
Researchers announced in August that the risk of cataract formation was reduced by 20% among statin users versus non-statin users. The greatest benefit was seen in younger patients, and the duration of statin therapy influenced the benefit. People on statins for 14 years, for example, had a 55% reduced risk compared to a 10% risk for those on statins for 6 months.
The research leader said more study is needed, but the finding helps to “dispel worries about the safety of statins when it comes to cataracts, and lends additional support to long-term statin use”.
Source: Press conference: European Society of Cardiology meeting, Aug 30, 2013, John B. Kostis, MD (UMDNJ-Robert Wood Johnson Medical School, New Brunswick, N.J.)
DAILY LIVING
It is important and interesting to keep up-to-date on research. We still, however, have to live with our conditions while such research comes to fruition. This means taking advantage of support opportunities, technology, and ways to maintain our quality of life.
Support Groups
Researchers have found that facilitated patient support groups can significantly improve visual quality of life (VQoL) for visually impaired people. Twenty-nine groups of up to six patients each were recruited for participation in a “peer group emotional support service” facilitated by trained counselors for a period of six months.
For the group as a whole, VQoL significantly improved between the beginning of the service and the end, but six months later was no better than at the start. Those with poorer initial VQoL, however, showed significantly greater improvements after six months. The issues that became and remained easier were “feeling lonely or isolated due to eyesight”, “feeling sad or low due to eyesight”, and “feeling worried about general safety outside the home”.
Addressing the difference between people with initially higher and lower VQoL, the researchers concluded that “different interventions may be needed for those with initially good VQoL and to improve other aspects of quality of life not influenced by the service.”
As founding director of the International Low Vision Support Group, the largest support group in the world with more than 2500 members in 13 countries, I hope we are not only encouraging necessary psychosocial intervention, but providing an important educational service, as well. This, we trust, is helping to satisfy the need described by these researchers.
Source: Optometry & Vision Science (August 2013 – Volume 90 – Issue 8 – p 836-842)
Mobile Talking Books Service
Talking Books is a service of the National Library Service (NLS), Library of Congress. People who are certified as legally blind, or otherwise unable to comfortably read print, may access over 50,000 titles in audio format at no cost.
Until now, participants have been sent audio materials on tape, playable on special machines provided by a cooperating local library. Now, however, the books may be downloaded through a free application onto portable iDevices, making the service much more accessible.
The app provides access to Braille and audio materials directly from the NLS Braille and Audio Reading Download (BARD). With BARD Mobile, audio materials may be played on an iPhone, iPad, or iPod Touch. If the device is connected to a refreshable Braille display through Bluetooth, Braille materials can also be accessed.
Before using the BARD Mobile app, a user must be registered with a library in the NLS network. To apply, find a cooperating library at www.loc.gov/nls/find.html or call 1-800-NLS-READ.
Vision Testing
Researchers have addressed the question of why patients often notice a big difference between their vision at home and their results on clinical testing. Results from the test charts was found to be up to three lines better in the clinic.
126 subjects, ages 55 to 90 years, were examined for visual acuity and contrast sensitivity under various lighting conditions in the clinic and at home. Lighting was found to be the most significant factor associated with better vision in the clinic, with differences mainly caused by poor home lighting. It is hoped that these results may initiate clinician-patient discussions to optimize home lighting and improve the vision of older adults in their homes.
Source: JAMA Ophthalmol. Published online November 2013
Long-Term Care
Researchers have looked at a sample population of senior adults newly diagnosed with wet AMD and found that those who received either Lucentis or Avastin injections were 19% less likely to be admitted to a long-term care facility during the follow-up period. The reason? The introduction of anti-VEGF therapy reduced vision loss by 41% and onset of severe vision loss and blindness by 46%.
Source: The Effects of Technological Advances on Outcomes for Elderly Persons With Exudative Age-related Macular Degeneration. Frank A. Sloan, PhD, et al (JAMA Ophthalmol. Published online January 23, 2014)
Driving
A new cross-sectional study has concluded that most patients with AMD-related central vision loss continue to drive, but that they demonstrate significant driving restrictions, especially with more severe visual acuity and contrast sensitivity loss.
64 subjects with vision loss from AMD were compared to a control group of 58 normally-sighted subjects. Subjects with AMD who were still driving reported a greater number of driving restrictions than the control subjects, and they had a greater preference for having other people drive. Drivers with AMD-related vision loss were more likely to avoid driving over longer distances, beyond 1 hour, at night, and in unfamiliar conditions. Subjects who had stopped driving had developed significantly worse vision in the better-seeing eye compared with those who continued to drive.
It is encouraging that most people with low vision are evidently imposing their own restrictions on driving. This is useful information to have when discussing this sometimes contentious issue with people who are facing the possibility of limiting driving or giving up their car keys altogether.
Source: Driving Habits in Older Patients with Central Vision Loss.
Sabyasachi Sengupta, DNB, FRCS, et al (Ophthalmology online December 2, 2013)
Falling
New research has shed light on the possibility that falling may be partially blamed on a common condition in older adults called anisometropia.
This is a condition in which a person’s eyes have unequal refractive power, meaning different levels of myopia (nearsightedness) or hyperopia (farsightedness) After assessing refractive error over a period of 12 years in 118 subjects, the researchers found that amisometropia is at least 10 times more common in the elderly than in children. Eye care specialists are already aware of the consequences of binocular
differences caused by macular degeneration, and now this offers another ingredient to the mix. “Clinicians,” say the authors of the study, “need to be aware of this common condition that could …potentially cause falls in the elderly”.
Source: Longitudinal Increase in Anisometropia in Older Adults
Gunilla Haegerstrom-Portnoy, et al (Optometry & Vision Science., Published Ahead-of-Print 22 November 2013)
Smoking
A new study has found further evidence of the risk of cataracts caused by cigarette smoking. Smoking more than 15 cigarettes per day has been associated with a 42% higher likelihood of cataract development compared to those have never smoked. In people who quit smoking for 20 years, that risk had declined to a relative 21%. Further, the higher the intensity of smoking, the longer it takes for the increased risk to decline; but those who smoked less than 15 cigarettes per day remained at significant risk 20 years after quitting.
The analysis was based upon questionnaire responses from
44,371 men ages 45 to 79 years in the Cohort of Swedish Men study,
among whom 25% reported smoking and 39% had been smokers.
Admittedly, giving up tobacco smoking is very difficult; and an older person may think quitting will make little difference. Statistics from the American Cancer Society, however, show otherwise:
1 year after quitting: The excess risk of coronary heart disease is half that of a continuing smoker’s.
5 years after quitting: Risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Cervical cancer risk falls to that of a non-smoker. Stroke risk can fall to that of a non-smoker after 2-5 years.
10 years after quitting: The risk of dying from lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx (voice box) and pancreas decreases.
15 years after quitting: The risk of coronary heart disease is that of a non-smoker’s.
Sources:
JAMA Ophthalmol published online January 2, 2014
www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-benefits
Medicare Coverage of Low Vision Devices
One of the biggest stumbling blocks in living well with low vision is the inability of many of us to afford low vision devices. Medicare will not pay for any device that uses a lens, including glasses, magnifiers, and telescopes.
Now, however, federal legislation might begin to change this policy by establishing a nationwide Medicare demonstration project to evaluate the fiscal impact of a permanent change in Medicare coverage to pay for low vision devices. H.R. 3749, introduced by Reps. Carolyn Maloney (D-NY) and Gus Bilirakis (R-FL), would initiate this project, which, if enacted, would makes $12.5 million available for the project over its five year span. If you would like to help get this bill through Congress, encourage your U.S. Representative to co-sponsor H.R. 3749.
Source: Mark Richert, Esq., The American Foundation for the Blind
Prevalence of Blindness and Low Vision
Every year we hear updates on the prevalence of blindness and low vision. The most recent research review has shown that rates of blindness and visual impairment have decreased from 0.2% to 0.1% of the population in developed countries during the past two decades. Macular degeneration now appears to be the leading cause of chronic vision loss, surpassing cataracts and glaucoma.
The most common cause of partial vision impairment continues to be long and short sightedness that is not being corrected.. The incidence, however, has dropped from 1.6% to 1% of the population. This is a positive trend, but more effort is still needed in the area of vision correction with adequate spectacles, and improved screening is needed for diabetic retinopathy and the effects of aging on the eye.
Source: Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: 1990-2010, Online First, DOI: 10.1136/bjophthalmol-2013-304033
Self-Management
Two studies this past year have stressed the importance of more diligent screening of AMD patients. One study found that patients with wet AMD in one eye rarely present for
an office visit when they develop wet AMD in their second eye. This in spite of the fact that the condition will usually affect the second eye within 3-5 years.
Another survey of 910 patients and 890 caregivers in nine countries showed that 73% of patients visited a healthcare professional within 1 month of first noticing a change in vision. For those who delayed visiting a healthcare professional, the main reasons were the belief that the symptoms would resolve (41%) and the assumption that it was part of getting older (20%).
Following diagnosis, about half (54%) of patients began treatment immediately, and a further 37% had an appointment scheduled within 1-3 weeks of diagnosis. Half (52%) of patients reported a temporary improvement or stabilization in vision as a result of their current treatment ,and 22% reported vision improvement.
Of the 16% of patients who reported having missed a wAMD appointment, the main reasons reported were that their caregiver was unable to take them (26%) and fear of injections (21%). Most patients and caregivers reported a number of obstacles in managing wAMD, including the treatment itself (35% and 39%, respectively), treatment costs (28% and 29%, respectively), and finding the right treatment options (27% and 31%, respectively).
From these statistics, the researchers concluded that, while most patients seek medical assistance promptly for a change in vision, about a quarter of them do not, highlighting a lack of awareness surrounding eye health and the impact of a delayed diagnosis.
Sources:
ARVO Program Number: 3063
Patients undergoing treatment for wet age-related macular degeneration in one eye rarely present for an unscheduled emergent office visit when they develop wet AMD in their second eye (Sabrina Prabakaran, et al)
ARVO Program Number: 3876 Poster Board Number: C0178
Current Management and Barriers to Treatment for Wet Age-related Macular Degeneration: Perspectives From Patients and Caregivers (Monica Varano, et al)
THE FUTURE
We have seen many advances in treatment and technology over the past two decades, and we are still waiting for even more exciting developments. These include more effective drugs and better ways to deliver them, stem cell therapy, gene therapy, driverless cars, more refined retinal prostheses, and improvements in low vision technology at lower costs.
And here is something that is still on the drawing board but worth following:
Smart Contact Lenses
Google has taken their new Google Glass technology a step further with an idea that could have significant benefits for the blind. The company has applied for a patent for a contact lens containing a built-in camera. With this, a blind person would be able, for example, to receive an audible signal warning of an approaching car at an intersection.
The lens would process the image and communicate with a remote device such as a smart phone carried by the wearer. The system, according to Google, also would be able to detect and describe faces; and, by extension, it should be able to act as a text reader (optical character recognition). Both of these capacities would be of enormous benefit to people with impaired central vision, as with macular degeneration. The user will be able to control the camera by way of different blinking patterns. The technology for this product is in place, but development and marketing are still further down the road.
Source: www.patentbolt.com/2014/04/google-invents-micro-camera-system-for-future-contact-lenses.html
CONCLUSION
Who knows what science will come up with next? And while we are waiting, our job is to stay prepared for what may come by keeping healthy, following our doctors’ orders, continuing to self-monitor our vision, and maintaining a positive attitude.
This concludes my report for this year, and I trust that the next 12 months will bring even more promise and hope to us and those who follow us.