Sight-saving drug approved on NHS

"A sight-saving drug that could prevent thousands of people from going blind has been approved for use on the NHS across England and Wales.

The National Institute for Health and Clinical Excellence (NICE) today (August 27) issued its final guidance on Lucentis, recommending the anti-VEGF drug for the treatment of wet-AMD.

The approval follows a collaboration between NICE, the Department of Health and, the drug’s manufacturer, Novartis. The agreement involves the implementation of a Ranibizumab Reimbursement Scheme (RSS) which will provide patients with universal access to the drug.

Under the scheme the first 14 injections will be funded by the NHS, with the cost of any additional treatment being met by the Swiss-based drug manufacturer.

Having already launched an interim version of the scheme in a bid to provide immediate access for patients to the drug on the NHS, the issuing of the final guidance means it can be rolled out nationwide."

Protein could reverse eye diseases

"Two of the leading causes of blindness could be reversed and even prevented by drugs that activate a protein found in blood vessel cells, researchers at the University of Utah have discovered.

The study found that the damage which occurs to the eye from age-related macular degeneration and diabetic retinopathy could be halted and turned back during experiments carried out on mice.

Published in Nature Medicine (March 16), the protein, Robo4, treated both diseases by inhibiting abnormal blood vessel growth and stabilising blood vessels to prevent leakage – two primary factors in both eye diseases.

Kang Zhang, associate professor of ophthalmology and visual sciences at the University of Utah, said: “This discovery has significant implications for developing drugs that activate Robo4 to treat AMD and diabetic retinopathy.”

The findings are the result of Professor Zhang’s and Dean Li’s, professor of internal medicine and an investigator at the University’s programme in Human Molecular Biology and Genetics, laboratories working together in a collaboration that could shorten the time required to test the approach on humans by years. The study could also aid new ways of treating other diseases such as Severe Acute Respiratory Syndrome (SARA)."

Doctors develop 'blackberry-sized' sight testing kit

"Two medical scientists at NHS Greater Glasgow & Clyde’s Gartnavel General Hospital have developed what they claim is the UK’s most advanced eye screening system.

Doctors Stuart Parks and David Keating unveiled their pioneering development, the equivalent of a cardiogram for the eye, at the Association for Research in Vision and Ophthalmology (ARVO) general meeting in Fort Lauderdale, Florida, last weekend, where they said their system can potentially save peoples’ eyesight because of its early detection technology.

The software developed by the two medical physicists provides diagnosis and monitoring of retinal problems at an early stage, including tunnel vision problems, vein occlusions or blockages.

It is achieved by plugging a machine little bigger than a blackberry into a PC, and in future they hope a simplified version may be available at High Street opticians, with representatives from Scottish Health Innovations Ltd (SHIL) marketing its commercial potential.
Dr Parks and Dr Keating, based at the Tennent Institute of Ophthalmology within the hospital, have spent 14 years refining their system, known as multifocal electrophysiology.

Key is the computer software which interprets many electronic signals sent from different areas of the retina."

Keratoconus

"Keratoconus is a vision disorder that occurs when the normally round cornea becomes thin and irregularly cone shaped. This abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion/blurring of vision.

In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light. These symptoms usually appear in the late teens or late twenties. Keratoconus may progress for 10-20 years and then slow in its progression. Each eye may be affected differently. As keratoconus progresses, the cornea bulges more and vision may become more distorted. In a small number of cases, the cornea will swell and cause a sudden and significant decrease in vision. The swelling occurs when the strain of the cornea's protruding cone-like shape causes a tiny crack to develop. The swelling may last for weeks or months as the crack heals and is gradually replaced by scar tissue. If this sudden swelling does occur, your doctor can prescribe eyedrops for temporary relief, but there are no medicines that can prevent the disorder from progressing.

Eyeglasses or soft contact lenses may be used to correct the mild near sightedness and astigmatism that is caused by the early stages for keratoconus. As the disorder progresses and cornea continues to thin and change shape, rigid gas permeable contact lenses can be prescribed to correct vision adequately. In most cases, this is adequate. The contact lenses must be carefully fitted, and frequent check-ups and lens changes may be needed to achieve and maintain good vision.

In a few cases, a corneal transplant is necessary. However, even after a corneal transplant, eyeglasses or contact lenses are often still needed to correct vision."

Thyroid Eye Disease - Treatment

"Your Ophthalmologist will want to check a few points. A special x-ray called a CT scan may be done to confirm the diagnosis and make sure there is no other cause for your eye problem. An Ophthalmologist may use a special chart to record how your eyes move and will ensure that the pressure in the eye is not high (glaucoma). He will also want to make sure that the optic nerve is not affected. In mild cases, your doctor may not wish to do more than give you lubricating eye drops (artificial tears). Sometimes taping down the lid overnight with a mild adhesive strip like micropore helps to reduce the discomfort next morning. It avoids the eye drying out. You could try propping yourself up on more pillows or tilting the head end of the bed up on one or two bricks (about 6 inches: 15 cm). Some doctors will prescribe a diuretic to offload water to help reduce the swelling. Double vision is annoying, and special spectacles with prisms can be made to help correct this problem. If the eyes are getting worse, your doctor may suggest steroids (anti-inflammation tablets). These may need to be taken for some months, but often in reducing dosage. They are usually very effective. Some doctors will also suggest radiotherapy to the eyes. This is not because you have any sort of cancer cells, but because radiotherapy can dampen down this type of inflammation. The treatment is given daily over a couple of weeks. Other so-called immune-blocking drugs may also help sometimes.

Operations are necessary in certain cases, either because of severe protrusion of the eyes or because of affected vision. Sometimes they are done just for cosmetic reasons. One operation is done through the nose or gums. Bone is nibbled away from around the orbit of the eye to make more space for it. Another type of operation is done on the tendons of the eye muscles. One benefit of this is to allow the upper lid to "hang" lower and close more easily: other types of operation are done to reset the muscles into the eyes and improve double vision. Sometimes even "simple" plastic surgery to the lids can be done, since they tend to get rather baggy when the inflammation has settled."

Thyroid Eye Disease

"This is a disorder where the fat and muscles behind and around the eyes become swollen. There is still much that we do not know about it. However it seems to occur only in people who have a certain type of thyroid problem called an auto-immune disorder. Most commonly, it happens in people with an overactive thyroid gland (hyperthyroid); a condition called Graves' disease . To begin with either one eye or both have only a 'stary' appearance. They may water and be sensitive to light and especially wind. They may feel sticky in the mornings and gritty during the day. In more severe cases the lids may not close properly. If the muscles which make the eyes move also get inflamed and swollen, the eyes are pushed forward and you may get double vision. This may only be on looking in one direction, but it can worsen so that double vision is there all the time. If the eyes protrude a lot, the white of the eye becomes red (like conjunctivitis). If they protrude even further, vision can be affected. This happens either because the front of the eye (the cornea) becomes more exposed and therefore drier, or because the optic nerve which carries the images back to the brain is stretched."

Treatment Of Iritis

"Treatment of iritis is often directed at finding and removing the cause of the inflammation. In addition, eye drops and ointments are used to relieve pain, quiet the inflammation, dilate the pupil, and reduce any scarring which may occur. Both steroids and antibiotics may be used. The application of hot packs may also provide relief from the symptoms of iritis. In severe cases, oral medications and injections may be necessary to treat the condition. A case of iritis usually lasts 6 to 8 weeks. During this time, the patient must be observed carefully to monitor potential side effects from medications and any complications which may occur. Cataracts, glaucoma, corneal changes, and secondary inflammation of the retina may occur as a result of iritis and the medications used to treat the disorder."

Iritis, Uveitis

"Iritis is the inflammation of the iris, the coloured portion of the eye. It has been known cause extreme pain, light sensitivity and sight loss, which is often the result of a disease in another part of the body. Most cases of iritis are recurring, in what are small attacks. Once treated the attack will usually respond to various medications. However, the condition may become sight threatening when left untreated. Medication for iritis varies, treatment that works for one will not always work with another.

Since iritis is an inflammation inside the eye, the condition is potentially sight threatening. Proper diagnosis and prompt treatment of iritis are essential. To minimise any loss of vision, the patient should have a complete eye examination as soon as symptoms occur. If diagnosed in the early stages, iritis can usually be controlled with the use of eye drops before vision loss occurs. If you are experiencing the symptoms of iritis or have other vision problems, you should obtain a complete eye examination.

In many cases, iritis is related to a disease or infection in another part of the body. Diseases such as arthritis, tuberculosis, or syphilis can contribute to the development of iritis. Infection of some parts of the body (tonsils, sinus, kidney, gallbladder and teeth) can also cause inflammation of the iris. In other cases, iritis may follow injury to the eye or accompany an ulcer or foreign body on the cornea. Often, the exact cause of the disorder remains unknown."

Adie's Pupil

"Adie's pupil, sometimes called the Holmes-Adie syndrome, is an unusual neurologic disorder in which the ability of the pupil to constrict is impaired, usually in one eye (although the second eye has a tendency to become involved eventually, usually at a later time, in about 20-30% of cases).

It is generally associated with loss of some reflexes, such as the knee-jerk. It occurs mainly in middle age, and more commonly in women than in men. The cause is unknown, but it is thought to be a form of neuropathy, in which the nerves that control the pupils and the reflexes selectively degenerate.

Some people think this is due to an attack by a virus, other think it is 'auto-immune', meaning that the immune system makes antibodies that attack these specific nerves.

There is a feeling that light is too bright in the affected eye (because the pupil helps to reduce light intensity by constricting in bright light).

The pupil also helps to focus light in the eye, and sometimes the nerves that control the lens in the eye may also be involved, so that the vision from the affected eye is often blurry. However, the other eye is usually normal. Usually over time, the patient adapts to the large pupil (which generally is permanent but non-progressive) and does not notice it anymore.

Headache is not a common part of the syndrome, but could be due to problems with your vision. Wearing sunglasses, or even patching the affected eye, may reduce the strain, and perhaps relieve the headache.

Other causes of a tonic pupil include neurosyphillis, diabetes, herpes zoster, giant cell arteritis and alcoholism."

Conjunctivitis

"Conjunctivitis is an inflammation of the conjunctiva, the thin, transparent layer that lines the inner eyelid and covers the white part of the eye.

The three main types of conjunctivitis are infectious, allergic and chemical. The infectious type, commonly called 'pink eye' is caused by a contagious virus or bacteria. Your body's allergies to pollen, cosmetics, animals or fabrics often bring on allergic conjunctivitis. And, irritants like air pollution, noxious fumes and chlorine in swimming pools may produce the chemical form.

Common symptoms of conjunctivitis are red watery eyes, inflamed inner eyelids, blurred vision, a scratchy feeling in the eyes and, sometimes, a pus-like or watery discharge. Conjunctivitis can sometimes develop into something that can harm vision so you should see your optometrist promptly for diagnosis and treatment.

A good way to treat allergic or chemical conjunctivitis is to avoid the cause. If that does not work, prescription or over-the-counter eye drops may relieve discomfort. Infectious conjunctivitis, caused by bacteria, can be treated with antibiotic eye drops. Other forms, caused by viruses, cannot be treated with antibiotics. They must be fought off by your body's immune system.

To control the spread of infectious conjunctivitis, you should keep your hands away from your eyes, thoroughly wash your hands before applying eye medications and do not share towels, washcloths, cosmetics or eye drops with others."

Coloboma

"Coloboma describes a situation where the patient has a portion of the structure of the eye lacking. This gap can occur in a range of areas and be large or small.

The most common form of gap is caused by an imperfect closure of a cleft, present in the womb but usually closed by birth date. This gap can occur in the eyelid, iris, lens, choroid or optic disc. In some cases other developmental flaws accompany it.

The effects of the condition can be mild or severe and this will depend upon the extent and location of the gap, or incomplete closure. The gap is usually at the bottom of the eye. Coloboma may occur in the iris/lens, choroid, macula or optic nerve.

A lens coloboma, if large, may also include flaws in the iris and choroid and slightly increase risk of retinal tearing. In severe cases, the eye may be reduced in size. This condition is called Microphthalmous, a condition that may arise without coloboma.

Coloboma of the iris may sometimes give the appearance of a keyhole in the pupil. Central vision may be affected and may reflect the extent, location and shape of the gap.

In some cases the problem may be accompanied by other problems which may be neurological or chromosomal. A few syndromes also include coloboma among the potential problems.

There is a specific combination of flaws identified by the acronym "CHARGE" which stands for:

C - Coloboma;
H - Heart defects;
A - Atresia of the choanae (blockage of the nasal passages);
R - Retarded growth and development;
G - Genital hypoplasia (undescended testes);
E - Ear anomalies.

CHARGE is a very rare problem and will receive specialist attention and treatment from an early age."

New study finds resistant organisms at core of soft contact lens corneal infections

"In 2006, Bausch & Lomb withdrew its ReNu with MoistureLoc contact lens solution because a high proportion of corneal infections were associated with it. Now in a new study from a US university researchers show that these infections were fueled and made resistant to treatment by the formation of a highly resistant structure of microbial cells held together with a glue-like matrix material, what scientists call ‘biofilms’.

“Once they live in that type of state, the cells become resistant to lens solutions and immune to the body’s own defense system,” said Mahmoud Ghannoum, director of the Center for Medical Mycology at University Hospitals Case Medical Center, Cleveland and senior investigator of the study which appears in the January 2008 issue of the journal Antimicrobial Agents and Chemotherapy.

“This study should alert contact lens wearers to the importance of proper care for contact lenses to protect against potentially virulent eye infections,” he said.
“Biofilms are a constellation of resistant organisms.”

They were suspected with the spate of infections in 2005-2006, but until this study, there were no data to prove this.
This is the first in-vitro model for cornea keratitis infections caused by the fungus Fusarium, which was one of the main culprits in the ReNu with Moisture Loc cases, and another fungus called Candida albicans.

The researchers also discovered that the strain of fungus (ATCC 36031) used for testing the effectiveness of lens care solutions is a strain that does not produce biofilms as the clinical fungal strains do. Lens care solutions currently are tested against an old and rare genotype fungal strain obtained in the 1970s from a patient from Nigeria. The contact lens solutions, therefore, are effective in the laboratory, but fail when faced with strains in real-world situations. “The multipurpose contact lens solutions cannot kill these germs, to put it simply,” said Dr. Ghannoum.

“We recommend that solutions be tested for biofilms produced by more recent clinical isolates,” said Dr. Ghannoum. “One of the underlying reasons for ReNu with MoistureLoc not being effective against the outbreak of keratitis is that the solution is not effective against biofilms and the organisms contained in biofilms.”

The researchers tested six kinds of contact lenses made by three different manufacturers and two lens care solutions (Bausch & Lomb’s MoistureLoc and MultiPlus) against three fungal strains (two recent clinical strains and the one from the 1970s) of Fusarium and one strain of C. albicans.

Since biofilm contamination of contact lens cases is a common finding, and ReNu with MoistureLoc is ineffective against fungal biofilm, the industry must ensure that their multipurpose solutions are effective against biofilms, said Dr. Ghannoum. In the meantime, extreme caution must be taken to ensure the contact lens care case is not contaminated with biofilm.

Dr Ghannoum recommends that soft contact lens wearers use only fresh lens care solution, not add fresh solution to old solution, a phenomenon known as topping off, and use solution by expiration dates written on the package. He also recommends a rub and rinse method, regardless of which cleaning or disinfecting solution used (which also is recommended by the Centers for Disease Control and Prevention).

An additional preventative measure to prohibit the development of biofilms is to ensure that the bottle caps and tips of multipurpose solutions are clean."

Bio-films make eye infection hard to treat

"Soft contact lens wearers need to be aware of how to fight the formation of a constellation of resistant organisms called bio-films, a U.S. study said.

Researchers at the University Hospitals Case Medical Center in Cleveland said bio-films -- microbial structures held together by a glue-like matrix -- make corneal infections hard to treat.

'Once they live in that type of state, the cells become resistant to lens solutions and immune to the body's own defense system,' study senior investigator Mahmoud Ghannoum said in a statement. 'This study should alert contact lens wearers to the importance of proper care for contact lenses to protect against potentially virulent eye infections.'

The study also found contact lens solutions need to be made effective on new micro-organism strains and in particular on bio-films. Ghannoum recommends soft contact lens wearers use :

• Fresh lens care solutions only and never add fresh solution to old solution.
• Solution that has not passed the expiration date on the package.
• Soap and water to wash hands and drying them before handling lenses.
• The rub and rinse method instead of the no-rub method
• Caution to ensure bottle caps and tips of multipurpose solutions are always clean."

Routine eye test saved Young Boy's Life

"IT SHOULD have been a routine eye test – but it turned out to be an appointment which saved 14-year-old Andy McNulty's life.

During the examination, optometrist Alister Blockley found serious haemorrhaging and swelling at the back of Andy's eyes and sent him straight to casualty.

Within days he was undergoing emergency surgery to drain fluid from his brain, and weeks later he had to have a second, six-hour operation in Leeds.

Doctors removed a tumour which, although was not big, was attached to his short-term memory nervous system, made the whole procedure fraught with danger.

His mum Sandra, of Scarborough Crescent, Bridlington, said: 'This has completely turned our world upside down – never did we expect to be sent to Scarborough's A&E department following a trip to the opticians.

'To be told your son's life is a ticking time bomb is the most distressing news any mother has to hear. I wouldn't wish that on any family.

'Andrew is a club swimmer so he is a fit and healthy youngster which has really helped him with his recovery as he amazingly spent just over a week in hospital following his operation.

'Doctors were stunned with the speed in which he has recovered and he's back at school already.'

Remarkably, Andy, who is a pupil at Headlands School, only went for an eye test after he had been to see his doctor to get his athlete's foot cured!

He mentioned in passing that he had been having headaches and his eyes were puffy, so the GP advised him to go for an eye exam."

Retinopathy of Prematurity Management

"Currently, treatment relies on the destruction of the areas of the retina that are without blood vessels. This becomes necessary only if the disease has reached a certain, well defined stage, as the milder forms often regress spontaneously. By destroying the retina, the stimulus for the growth of the abnormal blood vessels is removed. The destruction is achieved by cryotherapy (literally freezing the retina, using a small pulse) or photocoagulation with laser energy. Rarely, surgery is undertaken in an attempt to remove the scar tissue. To prevent ROP, Paediatricians attempt to minimise the amount of supplemental oxygen the infant is receiving."

Effects Of Retinopathy of Prematurity

"The milder forms of ROP may resolve spontaneously just as the more severe forms may lead to irretrievable blindness, despite treatment. Unless the ROP resolves, it exerts its effect mainly through the formation of scar tissue which then pulls the retina out of place. This may result only in a minor displacement of the area of the central vision or in a total retinal detachment. In the former case, the corrected visual acuity may be good, whereas in the latter case, even the ability to perceive light may be lost."

Retinopathy of Prematurity

"The normal development of this blood supply for the retina starts at 16 weeks into a pregnancy and is completed by 36 weeks.

If an infant is born prematurely, with the retinal blood vessel development incomplete, problems occur. Abnormal blood vessels may develop which can subsequently lead to bleeding and scar tissue formation. This may then stretch the retina pulling it out of position. Visual loss may result.

The lack of oxygen in areas of retina which have not developed blood vessels, results in the release of chemicals that promote the growth of new blood vessels. These blood vessels often grow in an irregular manner, for reasons that are not completely understood. The presence of large amounts of oxygen (often needed for the baby's survival) is thought to be possibly toxic to the developing blood vessels. As premature babies have underdeveloped lungs they usually require additional oxygen therapy. There are other undetermined factors also contributing."

A Mobile operating theatre has been brought to Tewkesbury

"A Mobile operating theatre has been brought to Tewkesbury.In a UK first the NHS has teamed up with the independent sector in Gloucestershire while the town's main hospital theatre is refurbished throughout January.

The mobile unit is the result of a partnership deal between Gloucestershire Hospitals NHS Foundation Trust and Vanguard Healthcare.

Knee surgery, cataracts, hand surgery, urology and pain management procedures will all be carried out at the unit in the grounds of the hospital.

Up to 20 patients will be treated each day in the unit, which expands hydraulically to 40ft by 30ft to house an admissions suite, anaesthetic room, full operating theatre and recovery unit.

The unit will contain all the equipment found in Tewkesbury's day surgery unit and additional x-ray machinery.

All operations will be carried out by Gloucestershire Hospitals Trust medical staff.

Patient's appointments will be managed as though they were being seen in the hospital.

The mobile unit will be on the hospital site in Barton Road for six weeks while the permanent operating theatre has air conditioning equipment upgraded.

Health bosses say the mobile unit will ensure patients in Tewkesbury receive surgery close to home instead of travelling to Cheltenham and Gloucester during the refurbishment.

Managers are also keen not to fall behind with surgery waiting times as they continue to clear a backlog left over from cancellations during last summer's floods."

12 lose eyesight

"Several persons, most of them senior citizens, who were operated upon on January 11 at a cataract surgery camp in Barabanki district here have lost their vision a few days after operation.

An FIR has been lodged by the health department of Barabanki district against Kanpur-based NGO Maa Vashnavi Charitable Chikitsa Sewa Sansthan, that had conducted the camp. The organisation has even been blacklisted.

Nearly two-dozen patients have been admitted at the Balrampur hospital here with swelling in the eyes and loss of vision. “The vision loss seems to have happened due to infection. A team of three eye surgeons has been deputed to look after these patients,” said Dr MK Saxena, chief medical superintendent of the hospital.

The NGO was reportedly only given permission for conducting screening of patients at the camp and the operations were to be performed at the Primary Health Centre (PHC) in Trivediganj.

However, the operations were conducted at the camp site, a college, without informing the Medical Officer (In Charge) of the Trivediganj PHC or the concerned health officials."

Smoking linked to age-related eye disease

"Smoking may speed up the progression of age-related macular degeneration, an eye disease common among seniors, U.S. researchers say.

The study, published in the Archives of Ophthalmology, determined smokers had a 47 percent increase in their odds of developing early age-related macular degeneration, known as AMD. Smokers also develop AMD at a younger age -- 69.2 years -- than former smokers -- 72.3 years -- and those who had never smoked --74.4 years.

Dr. Ronald Klein and colleagues at the University of Wisconsin School of Medicine and Public Health in Madison studied 4,926 residents of Beaver Dam, Wis., who were between ages 43 to 84 when initially examined in 1988 to 1990. Their eyes were re-examined every five years for the next 15 years. The presence and status of AMD was measured with photographs of the retina.

'While controlling for other factors, smoking appears to be related to the incidence and progression of AMD in our population,' the study authors said in a statement. 'This has important health care implications, because early AMD is associated with an increase in the risk of developing late AMD and smoking behavior is modifiable.'"