Inotek Pharma updates on glaucoma drug Phase 2b trial

Inotek Pharmaceuticals has concluded first two of three stages of a double-masked, dose-ranging, randomized and multi-dose trial evaluating an eye drop, INO-8875 in patients suffering from glaucoma or ocular hypertension.

The trial was designed to investigate the tolerability, safety, efficacy and pharmacokinetics of INO-8875 delivered as an eye-drop formulation in patients with primary open-angle glaucoma or ocular hypertension.

Inotek president and CEO Paul Howes said they believe that expanding the final stage of the Phase 2b study will produce a robust data package to support preparation for late-stage clinical trials and ongoing partnering discussions.

New study explain glaucoma risks

Glaucoma is one of the leading causes of visual deterioration on the planet, affecting millions of people worldwide, though it is more prevalent among some ethnic groups.

For years, experts have attempted to determine why African-Americans have a higher risk of developing glaucoma than Caucasians, although it seems that experts in the US may have finally found out why this occurs.

Specialists at the Washington University School of Medicine in St Louis claim that oxygen levels are significantly higher in the eyes of African-American glaucoma patients than in Caucasians who have the condition.

In a report published in the July issue of the Archives of Ophthalmology, they theorise that more oxygen may lead to damage in the eye's drainage system in the eye, resulting in elevated pressure which in turn damages the optic nerve and causes blindness.

First author Dr Carla Siegfried pointed out that the report is the first clue about the link between race and risk of glaucoma, which is approximately six times more common in African-Americans than Caucasians, while blindness caused by glaucoma is 16 times more likely.

The expert explained: "Our findings suggest there may be physiologic differences in oxygen metabolism between African-Americans and Caucasians.

"In our studies, we were not looking specifically at African-Americans, but the racial difference in oxygen levels was significant, and we believe this observation deserves further study."

Siegfried, who is also professor of ophthalmology and visual sciences at Washington University, said she is not surprised that oxygen may plays a major role in the development of glaucoma, given it could be a source of 'free radicals' that damage cells.

As with eye diseases such as cataracts, glaucoma is directly associated with ageing, as is oxidative stress, which is an imbalance between these 'free radicals' and antioxidants'.

This, in turn, is linked to the ageing process and several other age-related diseases such as cardiovascular and neurodegenerative conditions, she noted.

"However, more study is required. When we understand the underlying reason for elevated oxygen and how it may damage the eye, we will be in a better position to develop ways to prevent this disease," the expert said.

New Medicare diagnosis codes apply to stages of glaucoma severity

New Medicare glaucoma diagnosis codes that address glaucoma severity based on visual fields are scheduled to be implemented on Oct. 1, an expert said at the American Glaucoma Society meeting.

Many Medicare carriers already have policies in place allowing certain numbers of visual field or optic nerve imaging tests based on the severity of the glaucoma, and many private payers are currently using claims-based data to profile and rank physicians, according to Cynthia Mattox, MD, the chair of the AGS Patient Care Committee and a member of the AAO Health Policy Committee. Having physicians assign codes that reflect the actual clinical stage of disease will allow for more accuracy in claims-based payment or profiling methodologies that are already in place or may be designed in the future, she said.

“They’re not going to adversely impact our coverage policies now, so there’s no reason to be afraid of them,” Dr. Mattox said. “All of our original glaucoma diagnoses are still in there and will link to any coverage policies that are related to testing that we want to do or procedures that we want to do. … [They’re] also going to allow for some health policy research improvements, to be able to use claims-based codes so that we can understand a little bit more about the populations that everybody is taking care of.”

New device makes glaucoma surgery safer

Glaucoma is a disease of the optic nerves wherein the nerve fibers progressively disappear causing the field of vision to become narrower and narrower until total blindness ensues.

For patients with glaucoma, it is important to keep the internal eye pressure low, otherwise the damage to the optic nerves gets worse. Usually glaucoma medications will lower eye pressure but sometimes they don’t work very well.

One example is patient ABC. He had very severe glaucoma in both eyes, and, despite four different eye drops, placed one after the other during the course of the day, the targeted eye pressure of 12 mmHg or below could not be achieved. In the right eye, pressure was 26 mmHg, and in the left 20 mmHg.

Ordinarily, a glaucoma filtering operation, where a window in created to act as a passageway of the fluid within the eye to the outside, would be recommended. The problems with the original procedure in the immediate period after surgery would be inflammation and too much exiting of the fluid. Technological improvements have made the procedure less traumatic and much safer.

A patient who benefited from the new technology is Mr. ABC. He chose to follow the recommendation of having a stainless tube-like implant placed in his eye instead. The implant called an Ex-press shunt creates a passageway for the fluid to exit the eye in a controlled manner.

His right eye was operated on first; the procedure took 35 minutes under local anesthesia. The eye was not patched and anti-inflammatory and antibiotic drops were given. His eye pressure went down to almost 10 mmHg even without any glaucoma drops. There was only mild inflammation at the site of operation, otherwise the patient was comfortable.

Mr. ABC was so relieved that he soon scheduled his left eye.

Galileo SurgiCenter believes that the Ex-press shunt which is distributed by Alcon Laboratories is a significant improvement over the traditional filtering surgery where the post-operative course would sometimes be complicated.

Glaucoma-Correction Glasses

My otherwise ridiculously healthy dad was diagnosed with glaucoma a while back, and though it now appears to be under control thanks to the right prescription meds, his vision isn't as good as it used to be. Specifically, the contrast and brightness of what he sees with that eye has been reduced.

An avid user photographer, my dad posed a fascinating solution to this problem. What if he hooked up a Looxcie-style video camera near his left eye, then fed the resulting video through an auto-contrast filter, which would display on a small screen inside a pair of glasses. It might look weird, but it'd be a real-life use of augmented reality that's actually useful. In rough visual terms, this is what the problem is and what the solution would do:

Glaucoma-Contrast.jpg

To me, the strange thing is that this sounds possible, even plausible. Then again, I don't know how technically challenging it is to provide that kind of real-time video correction. Where are the sticking points? My dad and I would love your help sketching out how this contraption could work -- and then building it.

Searching around for information on how difficult this task might be, I wasn't able to find much. Much of the discussion around augmented reality vision focuses on contact lenses, I suppose because they are futuristic and sexy. But my dad isn't looking for anything that crazy. He just wants a pair of glasses with an auto-contrasting screen for the left eye.

I found a Spanish team was working on a vision augmentation system back in 2005. They seemed to have made some progress, but that was years ago. The trail goes cold after that and I haven't really seen it.

So, how about it, hardware hackers: could you do this?

I pasted in my dad's original query below, so you can hear his specific descriptions. I'd be happy to put any interested hackers in touch with him, as long as you are not a crazy person. Or, rather, as long as you are the right kind of crazy person.

As any user of Picasa or probably any other photo manipulator program knows, there is a button, "Auto-contrast," that will sharpen and lighten up any image unless there is a large bright vs dark gradient e.g., big bright sunny sky on upper half of a composition and say, dark forest in the bottom part in the shot. Normally, if the image is within a relatively narrow range of lighting, it will light up and sharpen it as if by magic.

Well, I have observed that my left eye -- affected by advancing Glaucoma -- perhaps now being controlled by the right mix of prescription eye drops, perceives significantly less light and detail (contrast) than my almost normal right eye, with or without prescription glasses on. Probably there is no way to have a corrective prescription that would restore the ability of the optic nerve to perceive the full details of what it is seeing. However if the lenses themselves could auto-contrast the image as it goes through the lens by the application of some type of software embedded in the glasses frame along with some miniaturized hardware also embedded in the frame, the eye would be looking at the enhanced (brightened and sharpened) image in the lens providing the eyes cones and rods with enough additional light to offset some if not all the lost capacity. The lenses might have to look as Borg-like appendages to accommodate the additional technology.

IOP and primary open-angle glaucoma, pseudoexfoliation glaucoma

Study shows link between IOP and primary open-angle glaucoma, pseudoexfoliation glaucoma



IOP was the only risk factor associated with both primary open-angle glaucoma and pseudoexfoliative glaucoma, while moderate to high myopia correlated slightly with both conditions, a study found.

Vascular systemic diseases and treatments correlated solely with primary open-angle glaucoma.

“The implications of these differences for the pathogenesis between the two common types of [open-angle glaucoma] should be explored further,” the study authors said.


Data were culled from the Thessaloniki Eye Study, a cross-sectional population-based analysis of chronic eye diseases in Thessaloniki, an urban center in Northern Greece. The study included 2,554 patients age 60 years and older.

Investigators set out to assess risk factors for primary open-angle glaucoma and pseudoexfoliative glaucoma. Open-angle glaucoma patients were compared with a non-glaucomatous control group. Primary open-angle glaucoma subjects were compared with controls without pseudoexfoliation. Pseudoexfoliative glaucoma subjects were compared with controls with pseudoexfoliation for demographic, lifestyle, ophthalmic and systemic factors.

Multivariate analysis was limited to 2,078 patients who attended clinic visits and had at least one phakic eye.

Results showed that IOP (P < .001), pseudoexfoliation (P < .001), history of coronary artery bypass or vascular surgery (P = .017) and moderate to high myopia (P = .009) correlated most strongly with open-angle glaucoma.

Data from 1,840 patients with primary open-angle glaucoma showed that age (P = .048), IOP (P < .001), history of coronary bypass or vascular surgery (P = .01) and history of diabetes treated with insulin (P = .045) were strongly associated with primary open-angle glaucoma.

Among 238 patients with pseudoexfoliative glaucoma, there was a correlation with elevated IOP (P < .001), the authors reported. There was a slight association with moderate to high myopia (P = .06).

Better tracking glaucoma progression

Having more frequent visual tests could be linked with better tracing of glaucoma progression, a study finds


More frequent visual tests for glaucoma patients could allow physicians to better follow the condition's progression, a study finds.

A study released online Monday in the Archives of Ophthamology examined data on 468 eyes of 381 patients age 35 to 80 who were part of a long-term intervention study. The participants had primary open-angle glaucoma no longer being controlled by medication. This type of glaucoma is the most common form and usually hits people over 50. It causes damage to the optic nerve and usually progresses slowly, sometimes without being noticed. The researchers' goal was to see if more frequent visual field tests to check peripheral vision resulted in earlier discovery of the progression of the glaucoma.

LASIK and Glaucoma

Glaucoma has affective the vision of roughly 3 million people in the United States. Many of these people do not know they suffer from glaucoma because there are no outward symptoms until the vision has been affected. Your ophthalmologist can catch glaucoma in its early stages before it affects your vision by conducting a routine eye examination.
Information About Glaucoma
Glaucoma is an eye condition that gradually damages the optic nerve in the eye. The optic nerve is responsible for transmitting the visual information supplied by the retina directly to the brain. A damaged optic nerve can lead to permanent blindness.
A thick, watery liquid called the aqueous humor moves through the space called the anterior chamber located between the cornea and the leans of the eye. The aqueous humor supplies nutrition to the tissues of the eye, the lens, and the cornea. The aqueous humor drains from the eye through the trabecular meshwork. Internal ocular pressure (IOP) builds up in the eye when the aqueous humor does not properly drain through the trabecular meshwork.
Increase of IOP will put pressure on the optical nerve and gradually cause damage affecting your vision. The only outward sign of glaucoma is affected vision. It is often too late to save your vision by the time your vision is affected by glaucoma. Early detection and treatment will prevent permanent damage to your vision.
Treatment for glaucoma depends on the severity of the condition and can include:
- Special medicated eye drops
- Laser surgery
- Other eye surgery
LASIK and Glaucoma
You may not be a good candidate for LASIK depending on the severity and stage of your glaucoma. It is important to schedule an initial LASIK surgery consultation with your ophthalmologist for a full eye exam to determine if LASIK is the best procedure for your vision correction needs. Your ophthalmologist will be able to suggest another vision correction procedure if you are not a candidate for LASIK.
During the LASIK procedure, a flap is created in the outer portion of the cornea to allow access to the area of the cornea that needs to be reshaped to improve your vision. The flap is created using a microkeratome. A vacuum ring is used to attach the microkeratome to your eye. The vacuum ring causes suction that will temporarily increase the pressure inside your eye. Patients without glaucoma will not be affected by the suction. However, the increase in pressure can cause negative affects to patients with glaucoma.
You can become a candidate for LASIK once your glaucoma is treated and your condition is stable. There are other laser vision correction procedures that can be performed if you have glaucoma. PRK is a laser vision correction procedure that does not require the use of a microkeratome or the use of suction. It is a good idea to discuss your vision correction options with your ophthalmologist before deciding on a procedure.

Eye-rubbing may indicate glaucoma

Penny is a 10-year-old cocker spaniel who has had her share of ear problems.

Pat isn't sure whether Penny is having a problem now, but she is noticing a new behavior. Penny is rubbing the left side of her face on the carpet, and she's started to do it more frequently.

Pat thinks Penny is specifically rubbing her left eye. There is some redness around the eye and the eyeball. Pat first thought Penny may have gotten something on her face, but she no longer believes that to be the case.

Well, Pat, there is a problem. That's the easy part. Determining the underlying problem is the not-so-easy part.

I am going to assume that Penny is indeed rubbing her eye and not some other area close to it. So we can conclude there must be something irritating Penny's left eye or the lids around it.

There are many possibilities that can cause eye irritation. Penny may have damaged the corneal layer of the eye, causing significant discomfort. The cornea is a very specialized layer of clear cells that covers the colored portion of the eye, the iris. The pupil is behind the cornea. Damage to the cornea can come from contact with anything that can score or puncture the tissue. Foreign material in the eye is but one possibility.

Penny may have developed a conjunctivitis or inflammation of the conjunctiva. The conjunctiva is a very thin layer of tissue that covers the inside of the eyelids and eyeball itself. It can become inflamed from an allergic response or a bacterial infection or a combination of both. This list can go on, but there is one possible cause that is potentially very serious and could lead to blindness. Cocker spaniels are a high-incidence breed for this disease.

Penny may have glaucoma. Glaucoma occurs because of increased pressure within the eye. The eye is actually filled with a viscous fluid that supports its round structure. The fluid is maintained at a constant pressure through constant production within the eye and constant drainage out of the eye. If this system is disturbed, usually affecting the drainage, the pressure within the eye can increase; if left untreated, this increased pressure will destroy the retina at the back of the eye, causing blindness.

This process can be extremely painful and is considered an emergency.

In humans with acute glaucoma, the increase in pressure and corresponding discomfort can be communicated to the doctor and therapy immediately performed. Pets do not usually do this, at least early on, although Penny may have done so with her rubbing behavior.

Penny needs immediate veterinary attention. If she does have glaucoma and there is still sight present, we may be able to save her eye. If not, she will need to have treatment done to alleviate her pain. This might include removal of her nonfunctioning eye.

New gold standard in glaucoma treatment

The price of gold is going up but a clinical trial shows it may be worth it for some people with vision problems. Yale glaucoma surgeon Nils Loewen checks on his patient Ron Kortsep.

Ron recently had one of these inserted into his eye. It's called a "shunt made of gold." It's to prevent glaucoma from stealing his eyesight.

"My left eye was getting weaker, I was losing vision, peripheral vision which glaucoma tends to do, the glaucoma was getting more aggressive so we're trying some different things to bring the pressure down," Kortsep said.

Losing his eyesight would be devastating for Kortsep, who loves to travel the world and see the sights. Dr. Loewen is the first physician in the U.S. to insert a gold shunt into a patient's eye. It's part of a trial. The device reduces eye pressure by helping it drain properly.

"It all happens at the front part of the eye where the big surgeries with the drainage implants are at the very back, even back past the equator in some cases," Loewen said.

The procedure is already approved in other countries. In one picture you can make out the tiny shunt at the bottom of the eye. The shunt is made of gold and gold is really expensive, so you must be thinking these must be costly. They're actually only worth pennies apiece, but they do cost a lot because of the price of research and development to create them.

So you may be wondering why gold? It isn't like a bar of gold, it's highly purified. Scientists take out all of the copper and the body does not reject it. Dr. Loewen said this shunt could become the gold standard if approved for glaucoma patients, because results are promising and it's less invasive.

"With these smaller incisions less wound area, equals a quiet eye, equals a comfortable eye," Loewen said.

Glaucoma risks on rise

The silent killer of sight, glaucoma, is on the rise among the poor people as they are unable to afford surgery or prolonged medication expenses.

Half the population that forms the serpentine queue at the government eye hospital is likely to slip into blindness due to this problem as the disease can be cured only if detected early or would result in the patient losing vision, say doctors.

“Every month, we get as many as 150 new cases of glaucoma, but are able to conduct only 8-10 surgeries. Most of the patients are too poor to afford the drugs for treatment, which is out of reach even for the middle class,” says a doctor at the hospital.

While medicines are a more popular mode of treatment for the disease in western countries, surgeries, despite their complications, are the best option for people here,” explains Dr. Krishnaraj, an ophthalmologist, pointing out that 10 to 15 per cent of patients are not even aware that they are suffering from the disease.

As the cost of eye drops begins from `200 and above depending on the treatment many people do not have enough money to procure it as a long term medical solution.

The progress of glaucoma that affects the optic nerve, causing irreversible vision loss, can be arrested if detected early.

Steroid Can Cause Glaucoma

CHANDIGARH: When 25-year-old Raman was detected with glaucoma (a disease of retina that usually afflicts the elderly), ophthalmologists were surprised. After seeing his case history, it was found that to cure conjunctivitis, he overused steroids without a doctor's advice, which caused glaucoma. Of 60 to 70 cases of seasonal conjunctivitis (also known as pink eye) coming daily to city government hospitals, one-fourth show glaucoma and eye ulcers ' which eventually can cause loss of vision ' due to overuse of steroids on self-medication. Dr SK Arya, department of ophthalmology at GMCH-32, said, ''We are getting 30 to 40 patients daily and half of them are new cases. Also, most of these are severe cases that have turned into glaucoma due to steroid overuse.''

''Pollen and dust are the common causes of pink eye. On an average, 30 to 40 cases come to our out patient department daily,'' said Dr Jagat Ram, eye specialist at advanced eye centre, PG

New way to diagnose Glaucoma

Scientists have been constantly pursuing newer tests to diagnose Glaucoma. Glaucoma is an incurable condition of the eye and if left untreated can cause blindness and once it effects the vision � this cannot be restored. It is the second leading cause of blindness in the world - according to the World Health Organization.


Recently scientists they have been combining visual field and imaging data, utilizing the anatomical arrangement of retinal ganglion cells to diagnose the condition more accurately.

In a recent study by Michael V Boland, Assistant Professor of Ophthalmology at The Wilmer Eye Institute, Baltimore, data from 1499 eyes of glaucoma suspects and 895 with confirmed glaucoma eyes was identified to be studied. All the subjects underwent standard automated perimetry and Heidelberg Retinal Tomograph (HRT) imaging. The structure function index (SFI) was defined in three steps by a new technique combining the above two tests. The data was studied to study the following:-

Glaucoma treatment breakthrough

As part of a team of Australian researchers, scientists at the Queensland Institute of Medical Research (QIMR) have discovered two new genes linked to open angle glaucoma in the only study of severe glaucoma cases in the world.

The study has been published online in the prestigious international science journal, Nature Genetics.



Dr Stuart MacGregor from QIMR’s Queensland Statistical Genetics Laboratory said this discovery will help to identify patients at the highest risk of severe glaucoma.

“It opens the pathway to developing completely new ways of treating glaucoma patients that could delay disease progression and prevent blindness,” he said. 



"Open angle glaucoma, sometimes called chronic glaucoma, is the most common type of glaucoma, and tends to progress at a slow rate.

"Sufferers may not notice that they have lost vision until the disease has progressed significantly.



“We found that 18% of the population carry risk variants at these two genes, making them up to three times more likely to develop severe glaucoma than those that don’t.

”

Glaucoma is the leading cause of irreversible blindness worldwide, affecting an estimated 300,000 people in Australia, half of which are currently undiagnosed."

It is the collective name for eye diseases causing irreversible loss of peripheral vision, often associated with too much pressure developing inside the eyeball.



“Although open angle glaucoma is the most common form of the disease, it is poorly understood and difficult to diagnose in its early stages,” said Dr MacGregor.

"Many cases still remain undiagnosed until irreversible loss of vision has occurred.”

Researchers from QIMR collaborated with groups from five other Australian universities on the ground-breaking study of 4,500 patients from Australia and New Zealand. 

Dr MacGregor emphasized the important role of twins in the research.

“The genetic information provided by the twins was used in the study as a comparison to those affected by glaucoma,” he said.


Glaucoma genes point to increased risk

Researchers say they have discovered two new genes that increase people's susceptibility to glaucoma.

The findings could lead to better screening and more effective treatments, says study leader Professor Jamie Craig from the Department of Ophthalmology at Flinders University in Adelaide.

Glaucoma is a loss of peripheral vision due to damage to the retina and optic nerve, which occurs mainly in older people, and can lead to blindness.

In a study published online this week in the journal Nature Genetics, Craig and colleagues studied the most common form of glaucoma in Australia, called "open angle glaucoma".

The disease advances very slowly and many people are not diagnosed until they start bumping into things.

"It's a bad thing if people present at that late stage because all the treatments that we have are able to slow the disease down and potentially [stop it] getting worse, but none of the treatments at this stage can bring back vision that's already lost," says Craig.

Genetic link
People with a family history have been known to have a greater risk of glaucoma, says Craig, but until now, only one gene has been linked to the disease.

A mutation in a gene called "myocilin" is believed to account for just 3 per cent of cases, he says.

Craig and colleagues studied 1500 glaucoma cases and 8500 control cases in Australia and New Zealand.

They compared the DNA of the two groups and found two common gene variants that seemed to be associated with a greater risk of glaucoma.

People who had these gene variants were three times more likely to have glaucoma than the general population, says Craig.

Craig says the association is even stronger for severe blinding glaucoma.

He estimates the genes variants could be responsible for a substantial proportion of glaucoma cases in the wider population - possibly 30 per cent.

New treatments?
Craig says the latest genetic discovery could help in the development of more effective treatments.

Current treatments, including eye drops, laser and surgery, are aimed at reducing pressure in the eye but sometimes they don't work, he says.

While glaucoma is usually associated with raised fluid pressure within the eye, 20 per cent of people with glaucoma do not have this raised pressure.

The researchers carried out tests in rats with glaucoma and found that one of the newly discovered gene variants was more active in the retina.

They believe it could be linked to death of the optic nerve, independent of pressure from fluid in the eye.

Craig says further research could show that a drug that blocks the expression of this gene could slow down the damage to the optic nerve in all cases of glaucoma.

He and colleagues are continuing to work with animal models to understand the mechanism by which the genes act to increase the risk of getting glaucoma.

Better screening
Craig says the new genetic association could also be used to identify which people are at a highest risk from glaucoma before any clear signs appear, and to help decide when treatment should be begin.

This is important, as treatment comes with costs and side-effects and is something people must take for the rest of their lives.

Craig is now involved in a study to see whether the new genetic information can be successfully used to help identify people who should be treated for glaucoma.

He advises people to have eye check-ups every two years with an optometrist or ophthalmologist after the age of 40, especially if they have a family history of glaucoma.

The study drew on the Australian and New Zealand Registry of Advanced Glaucoma, funded by The Eye Foundation, with support from Pfizer, which produces current glaucoma treatments.

Another Treatment Option for People With Glaucoma

A delicate surgery which gives people with glaucoma another treatment option has been performed here for the first time.

Called “glaucoma tube shunt surgery,” the procedure Tuesday at Scott & White-Brenham yielded outstanding results, said Dr. Shawn Khan, a local ophthalmologist who performed the operation.

“She’s doing great,” Khan said of the 67-year-old patient from Bryan. “Her pressure’s back to normal.”

Glaucoma, a disease of the optic nerve that can result in vision loss, is treated by lowering eye pressure.

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“Glaucoma can’t be reversed, but you can stop the progression,” said Khan.

Initial conventional treatment is to use pressure-lowering eyedrops or a laser to treat the drainage angle of the eye.

The laser surgery makes it easier for fluid to flow out of the front part of the eye, decreasing pressure.

But tube shunt surgery is another viable option if the “conventional” methods don’t work, said Khan.

The patient treated Tuesday was using five different eyedrops in an attempt to lower the pressure “and still wasn’t having any success,” he said.

“She was using all these eyedrops ... there’s the expense and hassle of those. And she was using so many drops that the skin around her eyes was getting red and hardened.”

The tube shunt surgery is exactly as it sounds; a tiny flexible tube is inserted in the front of the eye to just behind the cornea, allowing minute amounts of fluid to drain through the back of the eye, said Khan.

A valve ensures that not too much fluid is drained, he added.

Khan said he has performed the surgery many times, but Tuesday was the first time it’s been done locally.

“It’s been around for a while, but there was nobody here with a glaucoma fellowship background,” said Khan.

The outpatient surgery takes about an hour and recovery time is minimal.

“The patient goes home with a patch and a shield,” Khan said. Those were removed Wednesday, and there were not even any restrictions on things like driving.

Khan said he also found it interesting that a patient was Bryan was referred to medical facilities here for treatment.

“Usually it’s the other way around,” he said.

Phacoviscocanalostomy for open-angle glaucoma with concomitant age-related cataract

Phacoviscocanalostomy controls IOP in eyes with pseudoexfoliation glaucoma, POAG

Phacoviscocanalostomy controlled IOP and improved visual acuity in eyes with pseudoexfoliation glaucoma and primary open-angle glaucoma, a study found.

The prospective study included 30 eyes that underwent phacoviscocanalostomy for cataract and pseudoexfoliation glaucoma and 30 eyes that underwent the procedure for cataract and uncontrolled primary open-angle glaucoma (POAG). Mean age was 70.7 years in the pseudoexfoliation glaucoma group and 58.6 years in the POAG group; the difference was statistically significant (P = .001).

Mean follow-up was 19.7 months. Examinations were performed 1 day, 1 week, and 1, 3, 6 and 12 months after surgery.

Both groups had immediate and statistically significant decreases in mean IOP from baseline (P < .0001).

The pseudoexfoliation glaucoma group had significantly lower mean IOP than the POAG group at all follow-up points (P < .01).

Mean IOP reduction was 12.2 mm Hg (49.7%) in the pseudoexfoliation glaucoma group and 6.7 mm Hg (30.9%) in the POAG group at final follow-up.

Also at final follow-up, 25 eyes in the pseudoexfoliation glaucoma group (83.3%) and 16 eyes in the POAG group (53.3%) achieved IOP of 15 mm Hg or lower without medication; the difference was statistically significant (P < .05).

Uncorrected and corrected visual acuity improved significantly in both groups (P < .005) at all follow-up points.

The complication rate was low and did not influence surgical outcomes. No cases of shallowing of the anterior chamber, hypotony, choroidal detachment or endophthalmitis were reported.

Early Detection of Glaucoma

PATIALA:Dr Gursatinder Singh, an eminent eye surgeon working in the Government Rajindra Hospital, here Tuesday said that the damage caused to the eye because of glaucoma was irreversible. However, medication or surgery, traditional or laser, could slow-down any further vision loss. Therefore, early detection was essential to limiting visual impairment and preventing the progression towards blindness.

Speaking at a Continuing Medical Education (CME) programme organized under the aegis of the Patiala Academy of Ophthalmology by Aromed Pharmaceuticals in collaboration with the Patiala Eye Hospital and Lasik Laser Centre, he said that glaucoma caused progressive damage to the optic nerve at the point where it leaves the eye to carry visual information to the brain and if left untreated glaucoma progressed to gradually worsening visual damage and could lead to blindness. He said that once incurred visual damage was mostly irreversible and this had led to glaucoma being described as the “silent blinding disease” or “the sneak thief of sight.”

Dr Singh said intraocular pressure was a "risk factor" for glaucoma together with other factors such as racial ancestry, family history, high myopia and age. There is no clearly established difference in glaucoma incidence between men and women.

Dr Ranjit Singh Dhaliwal, an eye surgeon from Nabha, a pioneer in small invision cataract surgery north india. said that SICS is the surgery for the comman man as it does not cost much,though the surgeon's skill involved has to be good.results were as good as any machine surgery world over.

Dr Balbir Khan, from the Gian Sagar Medical College and Hospital, highlighted the management of retinoplastry during the coming times.A large number of practicing doctors from Patiala and the surrounding areas participated in the deliberations.

The academic session was followed by a karaoke music competition in which Bollywood film songs relating to eyes and eyesight were played. It proved to be an icing on the proceedings of the evening wherein academics were blended with entertainment.

Glaucoma treatment for old patients

About 675 people turned up during the two-day eye check up camp at the Thimphu referral hospital, which was organised by the Druk lions club.

Most patients, who came for the check up had cataract and retina problems, although the camp was for screening glaucoma.

Glaucoma refers to a group of eye conditions that lead to damage of the optic nerve, the nerve that carries visual information from the eye to the brain.

In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).

Secretary of the Druk lions club Duptho Rinzin said there were around 40 patients, who needed immediate treatment for glaucoma.

“We’re now contacting the Siliguri lions hospital for treatment,” he said. “Then we’ll arrange funds for them.”

Treating a glaucoma patient at Siliguri lions hospital costs about Rs 700, he said.

Lions club will be organising a similar eye camp in Trashigang during the moenlam chhenmo in March this year and a blood donation camp in Paro.

“There’ll be more people gathered during the moenlam chhenmo,” he said. “And we can provide services to more people.”

Opthalmologist at Thimphu referral hospital, Dr Nor Tshering Lepcha, said glaucoma is treated at the hospital as well. “Only some complicated cases are referred to eye hospitals in India,” he said. “Most referred patients are children.”

The rapid assessment on avoidable blindness (RAAB) survey 2009 showed 5.9 percent of eye cases in Bhutan are glaucoma-related, while cataract was 68 percent.

Besides the eye camp, the club is also planning to train teachers in counselling in the next two months. “In a way we’d be helping the government to place a counsellor in each school,” said Duptho Rinzin.

Women's Risk of Open-Angle Glaucoma

Obesity may be associated with reduced risk of the eye disease open-angle glaucoma in women, but not in men, a new study suggests.

Open-angle glaucoma is the most common form of glaucoma, a condition that causes damage to the optic nerve.

In the study, researchers in the Netherlands analyzed data from 3,939 participants, aged 55 and older, who took part in the Rotterdam Study and who did not have open-angle glaucoma when the study began between 1991 and 1993.

Over an average follow-up period of nearly 10 years, open-angle glaucoma developed in 108 participants (2.7 percent). The condition was most likely to occur in those who were older, had severe nearsightedness and in men, said Dr. Wishal Ramdas of the Erasmus Medical Center in Rotterdam, and colleagues.

The investigators found that, for women, there was a link between increased body mass index (BMI) and pressure within the eyes (intraocular pressure), which is a risk factor for open-angle glaucoma. However, they discovered that each one-unit increase in BMI was associated with a 7 percent decrease in the risk of developing open-angle glaucoma, but only among women.

Although the high intraocular pressure among obese women should have put them at increased risk for glaucoma, that didn't appear to be the case, the authors noted. "High estrogen levels and hormone therapy might be protective to open-angle glaucoma, and obesity seems to be positively related with postmenopausal plasma estrogen levels," Ramdas and colleagues wrote.

The study was released online Feb. 14 in advance of publication in the May print issue of the journal Archives of Ophthalmology.

The Best Hope for Glaucoma

The cause of glaucoma is still largely a mystery to medical researchers, but the increasingly common eye disease is among the leading causes of blindness all over the world.

These are some of the points that will come into renewed focus next month when Antigua & Barbuda’s ongoing glaucoma awareness gets an annual booster.

A packed programme has been planned for Glaucoma Week, which begins on March 6 and continues until World Glaucoma Day on March 12.

Optometrist and president of Antigua & Barbuda Glaucoma Support Group Dr Jillia Bird is also president of the World Glaucoma Patients Association.

“Glaucoma is the leading cause of blindness in people of African descent,” she told The Daily OBSERVER. “It is silent and therefore you have to be tested in order to be aware if you have it. The statistics in our part of the world are particularly staggering in black Caribbean eyes. It is probably the leading cause of blindness in Antiguans.”

According to Dr Bird, people should be examined for glaucoma “even in childhood.” She said the condition “is really a group of diseases.”

The optometrist stressed that early diagnosis and treatment offer the only hope of preventing loss of sight from the disease.

She adds that this is even more important, given the type of glaucoma that tends to be common in countries such as Antigua.

She expanded further on why the risk should be treated with utmost seriousness. “The problem with the type that affects us black Antiguans – mainly the open angle glaucoma – is that as doctors we have a patient for one visit at one particular time of the day where the pressure (inside the eye) may be normal or considered normal, and we really have no way of knowing what that pressure is throughout the rest of the day.”

She added that “scientists have worked in the dark for a very long time trying to figure out what is this disease that damages the optic nerve and seems to be related to the intra-ocular pressure, but may not always be.”

Stressing how essential it is to get tested early, Dr Bird noted that “so many people are unaware they have it. It is a silent disease that steals sight slowly, painlessly and you may have well advanced disease before you are even aware that it exists.”

Activities for Glaucoma Week will include a donation of closed circuit TV for visually impaired readers, and glaucoma screenings.

World Glaucoma Day on March 12 will feature a march for sight and a rally.

Comparing glaucoma treatments

It is estimated that around 4,000 people are registered blind or partially sighted in the UK each year because of the eye disorder.

Diagnosing glaucoma can be difficult but new diagnostic tests are available and easy to perform.

However there is a need for robust evidence to guide how best to use these tests which could be potentially very useful, particularly as eye clinicians are already dealing with high numbers of patients.

University of Aberdeen researchers have been commissioned by the National Institute for Health Research Health Technology Assessment programme to compare three new diagnostic technologies - Heidelberg retina tomograph, scanning laser polarimetry and optical coherence tomography.

Augusto Azuara-Blanco, Professor and Honorary Consultant Ophthalmologist at the University’s Health Services Research Unit, is leading the research.

He said: “If one or more of the tests prove to be sufficiently accurate and easy to perform, people would not need to attend lengthy examinations in the hospital eye department in order to establish whether or not they have glaucoma.

“This would give ophthalmologists more time and resources to treat patients who do have eye diseases.

“The majority of people who are referred to hospital by their optometrist do not have glaucoma, however they must be checked out because glaucoma can cause blindness and must be treated early.

“Clinicians in Scotland see 400,000 patients with eye problems a year and glaucoma is a big part of that.

“In the UK the NHS deals with more than one million visits by patients with glaucoma in a year so we are trying to deal with a very large flow of patients.”

The study will involve patients who have been referred by their optometrists with suspected glaucoma or who may be at risk of developing the disease.

The centres involved in the study are Aberdeen Royal Infirmary, St Paul’s Eye Unit in Liverpool, Moorfields Hospital in London and Hinchingbrooke Health Care NHS Trust in Cambridgeshire and patient recruitment will begin in March.

The tests are based on imaging the posterior part (fundus) of the eye where glaucoma damage can be observed. The team will evaluate the performance of these new tests by identifying those who are most likely to have glaucoma and require treatment.

Tiny Device for Tracking Progress of Glaucoma

Scientists at the University of Michigan have developed a pressure monitor device which can be implanted in an individual's eye ball to track the progress of glaucoma. They claim that it is the world's smallest computer system which is just 1 sq mm in size. This device has been developed by Professors Dennis Sylvester, David Blaauw and David Wentzloff. It is yet to be named.

The device contains an ultra low-power microprocessor, a pressure sensor, memory and a thin film battery. It also consists of a solar cell and a wireless radio with an antenna which can transmit data to an external reader device. This radio does not require tuning to find the right frequency and so it can link to wireless network of computers. To charge the battery, the device requires 10 hours of exposure to indoor light or 1.5 hours of sunlight. Information can be stored in the device up to a week. The device takes measurements every 15minutes and consumes an average of 5.3 nanowatts energy.

This device is being seen as the future of the computing industry, though it requires few more years to be available commercially.