Current treatments to slow the progression of myopia in children either don’t work or cause problematic side effects, according to a recent review published by pediatric eye doctors and study methodologists.

The reviewers analyzed data from 23 randomized controlled trials, which included a total of 4,696 participants. They considered a number of potential myopia treatments including bifocal glasses, eye drops, intraocular pressure-lowering drugs and contact lenses:

• Two studies investigated undercorrection of myopia.
• 12 studies investigated multifocal spectacles (progressive addition lenses [PALs] or bifocal spectacles).
• One study investigated bifocal soft contact lenses (BSCLs).
• Two studies investigated rigid gas permeable contact lenses (RGPCLs).
• Six studies investigated pharmaceutical eye drops (five of these were of anti-muscarinic medications).
• One study investigated new lenses designed to reduce peripheral hyperopic defocus (i.e., lenses that help to focus peripheral vision as well as central vision).
• One study evaluated both multifocal lenses and pharmaceutical eye drops.

The follow-up period was at least one year for all studies.

Of all the treatments, anti-muscarinic eye drops offered the largest positive effects for slowing myopia progression, the authors found, but they caused either light sensitivity or blurred near vision. Also, these drops are not yet commercially available, so their use is limited and impractical.

PALs and bifocal spectacles were found to yield a small slowing of myopia progression. RGPCLs were found to have no evidence of effect on myopic eye growth, while undercorrection of myopia was found to increase myopia progression slightly.

Lastly, “other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses (BSCLs) with a distance center, are promising but currently no published randomized clinical trials exist,” the authors concluded.

An overview of the report is available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004916.pub3/pdf/abstract.

Macular degeneration is a progressive eye condition affecting as many as 15 million Americans and millions more around the world. The disease attacks the macula of the eye, where our sharpest central vision occurs. Although it rarely results in complete blindness, it robs the individual of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision.
Because you never become blind with AMD, there is always sight available if you know how to use it. There are many different products currently in the market to assist people with low vision, and more are being developed.

Low vision devices in the past have been mainly extraocular (outside your eye). There are now four new devices that can be placed inside the eye, in different stages of development and implementation that are currently available. Three of them are implanted into the anterior segment:
Implantable Miniature Telescope (IMT, VisionCare Ophthalmic Technologies),
Intraocular Lens for Visually Impaired People (IOL-VIP, IOL-VIP System, Soleko), and
Lipschitz Mirror Implant (LMI, Optolight Vision Technology)
while the Argus II (Second Sight Medical Products) is implanted into the posterior segment.

The goal of these devices is to increase the patient quality of life.  The IMT is the only device that has been shown to increase the visual function.  It is the only FDA-approved device in the US while the Argus has been approved in Europe. Each of these prosthetics has potential benefits for patients. We’ll keep watching!

Dr Gregg Homer claims 20 seconds of laser light can remove pigment in brown eyes so they gradually turn blue.

He is now seeking up to $750,000 of investment to continue clinical trials. However, other eye experts urge caution because destroying eye pigment can cause sight problems if too much light is allowed to enter the pupil.

Stroma Medical, the company set up to commercialise the process, estimates it will take at least 18 months to finish the safety tests. The process involves a computerized scanning system that takes a picture of the iris and works out which areas to treat. The laser is then fired, using a proprietary pattern, hitting one spot of the iris at a time. When it has hit every spot it then starts again, repeating the process several times. However the treatment only takes 20 seconds.

“The laser agitates the pigment on the surface of the iris,” Dr Homer – the firm’s chairman and chief scientific officer – told the BBC.

“We use two frequencies that are absorbed by dark pigment, and it is fully absorbed so there is no danger of damage to the rest of the eye. It heats it up and changes the structure of the pigment cells. The body recognizes they are damaged tissue and sends out a protein. This recruits another feature that is like little pac-men that digest the tissue at a molecular level.”

After the first week of treatment, the eye colour turns darker as the tissue changes its characteristics. Then the digestion process starts, and after a further one to three weeks the blueness appears. Since the pigment – called melanin – does not regenerate the treatment is irreversible.

The current estimate to have such an operation done is about $5,000 for each eye, though the technology won’t be fully ready for prime time for at least three years. In the meantime, Homer is confident that the procedure will prove to be safe with minimal side effects. However, at east one expert has expressed that safety might be a concern.

Keratoconus is a degenerative disease of the eye that is characterized by progressive thinning of the cornea and represents the leading cause of corneal transplants in the United States. It affects 1 in every 2000 Americans.

The US Food and Drug Administration (FDA) has granted orphan drug status to a 0.1% riboflavin ophthalmic solution (VibeX) combined with an ultraviolet A (UVA) irradiation system (KXL, Avedro, Inc) to perform corneal cross-linking in the treatment of keratoconus.

The action was based on clinical data from 3 US multicenter phase 3 studies.

Corneal collagen cross-linking using UVA light with riboflavin photosensitizer is the first medical therapy available in the United States to control the progression of keratoconus. Most treatments to date have focused on using contact lenses or glasses to mitigate the refractive error induced by progressive thinning and bulging of the cornea. Other options have included corneal implants and corneal transplantation.

The new treatment works by strengthening the cross-links between fibrils that serve as “natural anchors” within the cornea, thereby reducing the abnormal curvature associated with keratoconus.

Widely used in Europe and Asia over the past 12 years, the procedure is being performed in approximately 450 centers worldwide.

“Avedro’s effort to make this clinically important treatment available to US patients will be applauded by all US ophthalmologists who today lack any approved therapeutic treatment to halt the progression of keratoconus,” said Peter S. Hersh, MD, refractive surgeon and medical monitor for Avedro’s clinical trials, in a company news release.

echnology is on the rise that scans palm prints, eyes and voices to allow access into rooms or data and to verify identities. Based on biometrics, these systems recognize individuals by analyzing unique characteristics of a person’s body or behavior.

But with recent advances in the technology, new biometric systems are coming onto the scene, such as the full-body scanners used by the U.S. Department of Homeland Security announced. And as more scanning systems roll out, and through which citizens are linked to databases, privacy advocates stress the risks of having personal information in the open.

Other choices to identify patients biometrically are:

Photography;  but that was imprecise.
Fingerprints;  some patients associated that with the police and crime.
Palm readers: that required physical contact because that would easily spread germs.

Far from the sleek European airports, a South Bronx clinic that receives federal funding and operates in one of the most impoverished U.S. areas uses an iris scanning instrument to prevent medical record mishaps. The clinic formed a partnership with the company Eye Controls to develop a more user-friendly model, consisting of a handheld iris camera and software to reduce identification errors. Read the story here on CNN.

The iris, which is the colored ring of the eye, is unique for every human being. The company tested the iris scanner with simulated IDs and found zero errors in 8 million transactions. The abundance of detail in the iris, its variability and lack of genetic dependence, and its accessibility for imaging without physical contact all make the iris an excellent personal identifier.  Each of the three main biometrics has applications where it excels.  However, for patient identification, iris has the edge.  Iris recognition is more accurate than either fingerprints or facial, which is important where the standard is a zero error rate.

Welcome to the new world!

The gene behind nearsightedness has been identified for the first time ever by an Israeli research group.
The team of researchers at Ben-Gurion University of the Negev found a mutation to of a gene called LEPREL1 that cause myopia (nearsightedness) in members of a Bedouin tribe living near the university in southern Israel.

Nearsightedness is the most common human eye disorder, and it can lead to a higher incidence of retinal detachment, macular degeneration and premature glaucoma and cataracts.
Leader of the research team, Prof. Ohad Birk of the National Institute for Biotechnology and the Dayan Clinical Genetics Wing at Soroka Medical Center says LEPREL1 encodes an enzyme essential for the final modification of collagen in the eye.

He explains that if a mutation in the gene harms the activity of this enzyme, the collagen is malformed and the eyeball will be longer than normal. As a consequence, light entering the eye gets focused in front of the retina rather than directly on the retina as it should be. That’s the definition of myopia.

A pilot study in the August 30 online edition of PLoS Biology notes that video game playing can help improve amblyopia in adults. Although there are several effective methods of amblyopia correction for pediatric patients, including occlusion therapy and atropine drops, there are no proven treatment options for adults.

In this study, researchers recruited 20 adults with amblyopia aged 15 to 61 years. The patients were randomized into one of three treatment arms: an “action” videogame group; a “non-action” videogame group; and a control group.

Patients in the action group were asked to wear an occlusion patch over their good eye and were instructed to play Medal of Honor: Pacific Assault, a fast-paced, first-person shooter.

Patients in the non-action group were asked to wear an occlusion patch over their good eye and were instructed to play SimCity Societies, a slower-paced, construction and management simulation.

Finally, patients in the control group received conventional occlusion therapy only. Patients in both gaming groups played for 40 total hours, two hours at a time, over the course of one month.

At one-month follow-up, the researchers determined that patients who spent 40 hours playing either game exhibited a 30% improvement (1.5 LogMAR lines) in visual acuity from baseline. In comparison, the researchers noted that patients often require a minimum of 120 hours of occlusion therapy alone to gain just one LogMAR line.

Additionally, patients in both gaming groups experienced average improvements of 16% in positional acuity, 37% in spatial attention and 54% in stereopsis.

“This study is the first to show that video game play is useful for improving blurred vision in adults with amblyopia,” said lead author Roger Li, O.D., Ph.D., research optometrist at the Helen Wills Neuroscience Institute and School of Optometry at University of California, Berkeley. “Very surprisingly, besides enhanced visual attention, all participants showed a remarkable improvement in amblyopic visual acuity following a short period of video game play.”

Despite these findings, Dr. Li noted that further research is required to determine the clinical safety of video game therapy. “It is very important that patients should not try self-treating amblyopia,” he said. “Patients should consult their eye doctors. Response to treatment must be closely monitored to avoid possible unwanted conditions, such as double vision, reverse amblyopia, eye strain and headache.”