PRACTICE PULSE

AMD AND DIABETIC RETINOPATHY PATIENTS BENEFIT

Studies Reveal Additional Perimetry Uses

■ Two separate studies show perimetry is effective in aiding in the diagnosis of age-related macular degeneration (AMD) and in identifying visual function changes in diabetic retinopathy patients.

“Ultimately, I think that this [perimetry] could be another tool in the box for making an accurate and early diagnosis. Where I think that it will really have relevance is down the road when we have more personalized treatments for AMD and diabetes,” explains Jeffry D. Gerson, O.D., F.A.A.O., who sees a great deal of retina patients at his Kansas City, Mo., practice. “What I mean by that is that, ideally, we will identify an AMD patient earlier (by technologies like this), and then get genetic information that will ultimately guide us in how to treat them to prevent any vision loss. Genetics are not at the same place in diabetes as they are in AMD right now, in regards to vision and vision loss, but one would hope that one day we will be able to do the same for diabetes as we do with AMD.”

The AMD study reveals you, the eyecare practitioner, can accurately diagnose the condition with the help of a perimeter and without requiring “dark adaptation,” or having patients sit in a dark room, for 20 minutes pre-testing.¹ The reason: The cones of an AMD patient are just about as damaged as the rods, the researchers discovered.

Specifically, the researchers used the TrueField Analyzer (Seeing Machines Limited) to test how pupils at light levels appropriate for rods or cones react to images on LCD screens.² The device provided an array of stimuli to each eye at 24 locations in the patient’s visual field.

Meanwhile, two video cameras that employed infrared lighting recorded the immediate pupil response, which a computer then analyzed. The researchers found little-to-no difference in the results, regardless of the amount of light to which the eyes were exposed during the test.

The diabetic retinopathy study shows roughly half of those who had no or mild/moderate retinopathy demonstrated deteriorated perimetric sensitivity at 18 months of follow-up. Specifically, more than five points out of 54 in standard perimetry, employing the Swedish Interactive Threshold Algorithm.

1. Rosli Y, Bedford SM, James AC, Maddess T. Photopic and scotopic multifocal pupillographic responses in age-related macular degeneration. Vision Res. 2012 Sep 15;69:42-8.

2. Hellgren KJ, Bengtsson B, Agardh E. Functional and structural change in diabetic eyes. Interim results from an ongoing longitudinal prospective study. Acta Ophthalmol. 2012 Oct 1.

RESEARCHERS TO SPEND THREE YEARS STUDYING N-ACETYLCYSTEINE AMIDE.

Antioxidant Studied to Treat or Cure Degenerative Eye Conditions

■ Missouri University of Science and Technology researchers are working with the antioxidant N-acetylcysteine amide (NACA) to see whether it could effectively treat or cure degenerative eye conditions, such as age-related macular degeneration, says the University.

“NACA’s characteristics as a drug were improved over N-acetylecysteine (NAC) [another experimental treatment] by neutralizing the carboxylic group of NAC, which makes the NACA pass cellular membranes easily,” head researcher Nuran Ercal, M.D. Ph.D., told the University. “And because NACA can be administered at a lower dose, the drug has a greater therapeutic index and lowers the risk of side effects traditionally associated with NAC. NACA is also an excellent source of glutathione, a cell’s main antioxidant power, which is diminished during degenerative eye disorders.”

Dr. Ercal has received a $378,000 three-year research grant from the National Eye Institute for this work.

A FOCUS ON NUTRITION

ONS Launches Fellowship Program

■ The Ocular Nutrition Society (ONS) announced it will launch a new Fellowship program (FONS), which recognizes that formal nutrition science education should be a part of the eyecare professional’s focus in their efforts to prevent disease.

The fellowship program was created in response to the lack of “quality nutrition courses available to eyecare professionals,” according to a press release distributed by ONS during the recent American Academy of Optometry meeting.

Completion of the fellowship program requires 150 hours of nutrition science education, followed by an application process that includes a case report and oral examination.

Upon attaining fellowship status in the ONS, eyecare professionals may continue their educational training in nutrition and receive another 150 hours of credit to become a Diplomate in Nutrition. Accreditation as a diplomate will be provided through the American Clinical Board of Nutrition (ACBM), a professional certification organization that has partnered with ONS. The requirements to earn diplomate status through the ACBM include the presentation of three case studies, authoring an article of publishable quality and the successful completion of a two-part examination.

More information on the society’s fellowship program is available to ONS members at www.ocularnutri tionsociety.org.

PREPARE YOUR PATIENTS, AND PROTECT YOURSELF

O.D.s Play Role in Identifying Common Cold

■ Just as you can identify systemic diseases, such as diabetes, through an eye exam, so too can you “catch a cold” before the patient or other healthcare professionals are aware of it, says Joel Kestenbaum, O.D., who practices in Plainview, N.Y.

“Marked conjunctival redness, watery eyes without itching, follicles or papillae on the conjunctiva, filamentary keratitis and epidemic keratoconjunctivitis, are all telltale signs the patient is developing or already has a cold,” he explains. “Also, obvious preauricular nodes by their ears are a red flag as well.”

Given the common cold usually includes a runny nose, sneezing, coughing and a sore throat, all of which can last for up to two weeks and, therefore, affect work and social plans, patients sans symptoms no doubt appreciate a heads up regarding these ocular signs.¹ This way, they can attempt to weaken the cold before it officially strikes.

In keeping in mind that cold and flu patients who have not yet developed symptoms will present to your practice for comprehensive exams, among other eyecare services, through the beginning of spring, Dr. Kestenbaum recommends you do the following to protect you and your staff:

• Get the flu shot.
• Wash your hands before and after every patient encounter.
• Wear gloves when examining patients.
• Wash instrumentation with alcohol wipes in between patients.
• Wear a mask, if the patient appears to have a cold.

1. Centers for Disease Control and Prevention. Common Cold and Runny Nose. www.cdc.gov/getsmart/antibiotic-use/URI/colds.html (Accessed 11/1/12’)

PERIPHERAL DEFOCUS VIA MULTIFOCAL CLS CHANGES EYE GROWTH AND REFRACTIVE STATE

Multifocal CLs May Reduce Myopia Progression

■ Multifocal contact lenses that add positive defocus to the myopia correction over the retina or confine it to the periphery of the retina may effectively prevent and possibly reverse myopia development, reported David Troilo, Ph.D., F.A.A.O., F.A.R.V.O. at the Optical Society of America’s Annual Meeting in Rochester, N.Y., last month. Dr. Troilo is a professor of biological sciences and vice president and dean for Academic Affairs at the SUNY College of Optometry.

“We know from earlier experimental studies that the eye uses visual stimuli related to defocus imposed on the retina to guide its growth rate and refractive state,” he explains. “We found in marmoset monkeys that soft multifocal contact lenses with a mix of positive and negative power can slow axial growth and shift refraction toward hyperopia. This finding supports the use of similar CLs for refractive therapy in human myopes, and in particular, children, in whom myopia progresses most rapidly.”

When asked where his research now stands, Dr. Troilo says there is more work to do in both the laboratory and the clinic:

“We need controlled clinical trials on larger populations that build on promising earlier, but small scale, clinical studies,” he says. “Right now, we don’t know how much positive defocus in the periphery works best and whether putting more over a smaller area of the retina is different from putting less over a larger area. Also, we know very little about the amount of time needed for these doses of positive defocus to be effective.”

Other researchers, and the CL industry are also working on this, he added. Stay tuned.