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)."

Uni duo's software helps colour-blind

"Computer software that helps colour-blind people recognise colours they find hard to detect could be available by the end of the month.

Invented by Computer Science student Luke Jefferson, the software integrates models of colour vision deficiency, allowing the user to adjust colours for their own particular type of colour-blindness.

Named Huetility, it enables the user to place a transparent “window” over any part of their screen and improves the colours beneath it.

Mr Jefferson and his business partner Luke Walsh hope that opticians will promote the software to patients when they are first diagnosed with colour-blindness.

Mr Walsh, a 25-year-old Electronics student at the University of York, said: “Initially our software will be available online and through opticians. Currently opticians have nothing to offer someone who has been diagnosed as colour-blind and when we spoke to a number of high-street opticians about our software we received a really positive response.”

The duo, who met whilst on an entrepreneurship scholarship in America, set up a company called Scratchface last summer to develop and sell the product through and are now finalists in the first HSBC Unipreneurs Awards later this month.

The pair’s idea is one of five that have been selected from over 400 applications and will be vying to win the £20,000 prize when the awards ceremony takes place in London on April 23.

Expected to retail at around £25, to find out more about the software visit www.huetility.com when it goes ‘live’ on April 23."

First Aid For Your Eyes

"When eye injuries occur, knowing how to deal with them can mean the difference between minor eye damage and permanent injury, or even blindness. Here are some first aid suggestions for eye injuries. But, please remember, these suggestions are only first aid. It is important for you to contact your optometrist or doctor as soon as possible for any eye injuries.

If you have a foreign object in your eye, don't rub it. Lift your upper eyelid outward and gently pull in down over the lower lash. This causes tears to flow and often wash the object out of your eye. You may have to repeat this several times. If the object does not wash out, contact your optometrist or doctor. Do not try to remove a particle that is embedded. You can cause more damage. If you are wearing contact lenses, remove the lens and clean it thoroughly before putting it back in your eye. If discomfort persists, remove, clean again and reapply. If discomfort continues, remove the lens and call your optometrist.

For chemicals splashed in your eyes, immediately flush your eyes with cool water for at least 15 minutes. If possible, hold your head under a slowly running faucet, or pour water slowly from a glass or clear container. Seek professional attention immediately. If you are wearing contact lenses, remove them immediately. Then flush your eyes and seek professional help as described. A blow to your face resulting in a black eye can be treated with cold compresses for about 15 minutes every hour. Your eye should be checked by your optometrist for internal damage. If the blow breaks your contact lenses, try to remove pieces of the lens immediately. Rinsing with water will help. Then call your optometrist.

Do not try to treat a cut, laceration or penetrating eye injury. Do not flush the eye with water or put any medicine in the eye. If you are wearing a contact lens, don't try to remove it. Gently cover the eye with a bandage or gauze pad and go directly to your doctor or a nearby hospital.

Remember, the best way to treat eye injuries is to prevent them from happening in the first place. Don't forget to be aware of potential eye hazards and wear appropriate eye protection."

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."

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."

How To Use Ointments

Here is some general advice about correctly putting ointments in your eyes.

• Always wash your hands before handling medications

• Begin by expressing and discarding a ¼ inch of ointment from the tube at each use.

• If applying to your eye's surface, form a pocket by gently pulling the skin of your lower eye-lid between your thumb and index finger to create a pocket for the ointment. Then express a ¼' to ½' strip of ointment into the pocket (unless your doctor prescribes a different amount).

• Twist your wrist to break the strip of ointment from the tube.

• After placing the ointment in your eye, blink or close your eyes briefly. Your body heat will melt the ointment so it can spread across the surface of your eyes.

• If you are applying the ointment to the edges of your eyelids, express about a ½-inch stripof ointment onto your finger and glide it across the length of your closed lids near the base of your lashes.

• Use a soft, clean tissue to remove any excess ointment from the skin around your eyes. Be sure not to disturb the ointment placed in your eyes or on the edges of your eyes.

Be sure to follow all the directions that your optometrist or doctor gives and complete the course of medication that he or she prescribes. If you experience any side effects, (such as burning, inflammation, puffiness or itching) call your optometrist immediately."

How To Instil Eyedrops.

"Your optometrist or doctor may prescribe eyedrops for you to use to treat certain eye conditions, infections or diseases. Before you use any eyedrops, be sure to tell your optometrist about any other prescription or non prescription medications that you are taking or any allergies that you have.

Here are some general tips about correctly putting eyedrops in your eyes:

• Look at the ceiling by standing or sitting and tilting your head backwards. Some people like to lie down on a flat surface.

• The best way to ensure the drop remains in your eye is to gently pull the skin of your lower eyelid between your thumb and index finger to create a 'pocket' for the drop. If you are unable to master this, gently pull your lower lid down with your index finger.

• Look up (so you are not looking directly at the bottle) and gently release a drop into the pocket of your eye. Keep the bottle's nozzle or the eyedropper clean by not touching it to any part of your eyes.

If you are unable to get the drop into your eye because of blinking, try this: Close your eye and pull the lower lid down. Aim the drop into the inside corner of your eye. Open your eye and let the drop run into your lower lid. (Be sure to try the open-eye method at your next scheduled dose as it is a more reliable way to ensure the drop remains in your eye).

To help keep the medication in your eye and prevent it from escaping through the tear duct, your optometrist may instruct you to "occlude" this duct by gently pressing on the inside corner of your closed eye with your index finger for about three minutes. If drops have been placed in both eyes, you can perform occlusion by placing your thumb and index finger (or the index fingers of both hands) on either side of your nose and gently pressing down on the inside corners of both closed eyes. This step is very important with some medications, so do not skip it if your doctor specifies it.

Gently blot your closed eyes with a tissue to wipe away any excess drops.

If you use more than one kind of drop, wait at least five minutes between drops.

Be sure to follow all of the instructions that your doctor or optometrist gives you and to complete the course of medication he or she prescribes. If you experience any side-effects, (such as burning, inflammation, puffiness, itching, etc.) call your optometrist immediately."

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."

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."

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.'"

Payout hope for people with eye disease

"More than a hundred people across Norfolk could be in line for a refunded for medical treatment they should have received for free.

Some people who suffer with the degenerative eye disease wet, age related macular degeneration (AMD) were forced to pay for their treatment which can cost more than £1,000 per session.

Now, anyone who fits the criteria and paid for treatment of Avastin or Lucentis after May last year will get their money back and will not have to pay for treatment in the future, after the Norfolk Primary Care Trust (PCT) board held a review.

Health bosses said it was impossible to tell how much they would have to pay out because it would depend on how many people had been using the drugs, how many treatments they were given and whether one or both their eyes were affected.

But, if 150 people do turn out to be eligible, depending on the treatment they have had the cost could range from £450,000 to £1.3m......."

Treatment For Squint

"Treatment varies accordingly to the type of squint. An operation is not always needed. The main forms of treatment are:

• Spectacles - to correct any sight problems, especially long sight.
• Occlusion - patching the good eye to encourage the weaker eye to be used. This is usually done under the supervision of an orthoptist.
• Eye drops - certain types of squint can be treated with the use of special eye drops.
• Surgery - this is used with congenital squints, together with other forms of treatment in older children, if needed. Surgery can be performed as early as a few months of age."