Eyeworld

EW SECONDARY FEATURE 72 Included in this study were 90 eyes from 70 subjects, 34 with dry and 29 with wet AMD, as well as 27 age-matched controls without AMD. Results with the 3D technology easily outstripped traditional testing. "We found that in both wet and dry patients, we were able to detect a higher percentage of abnormalities," Dr. Sebag said. In 74% of dry AMD cases and 21% of wet cases, patients showed no abnormalities on paper Amsler grid testing. However, in many of these cases defects were later found with the 3D technology. "Every one of the subjects who failed to have an abnormality on paper Amsler grid had one on the 3D threshold Amsler grid," Dr. Sebag said. "It increased our sensitivity for detecting these abnormalities in both wet and dry cases based on the contrast phenomenon." In addition, investigators found that they were able to differentiate wet from dry AMD cases. When it came to detecting wet AMD, the test boasted a sensitivity of 89.7%, a specificity of 85.3%, a positive pre- dictive value of 83.9%, and a nega- tive one of 90.6%. Considering clinical significance Dr. Sebag sees this as particularly im- portant in light of the fact that there is now effective treatment for wet AMD. "What good is treatment if we can't get it to the people who need it," he said. "That makes it more im- portant to be able to detect wet AMD so that we can institute these new therapies that we have." While patients could be identified in labo- ratory settings using optical coher- ence tomography (OCT) machines and fluorescein angiography appara- tus, many patients do not make it to such facilities early on. "We have to have something that is inexpensive, easy-to-use, quick, and non-invasive," Dr. Sebag said. "In this context, we hope that this will be available to people per- haps over the internet and thereby achieve our objective of detecting wet AMD early in the natural history of the disease so that therapy can be instituted and vision can be pre- served if not restored." Dr. Sebag and Dr. Sadun are now working with Dr. Rafat Ansari of NASA trying to transfer some of the laser nano-technologies originally developed for the space program to further improve the technology of ophthalmic diagnostics. "We believe that the eye is a window to the body and that this offers great opportuni- ties to monitor and promote the health of astronauts in space, as well as people on earth," Dr. Sebag said. Even as it stands, the clinical impact of the test could be consider- able, Dr. Sebag thinks. "This will en- hance our overall treatment for wet AMD by getting to a larger number of patients who need it," Dr. Sebag said. "It will also help by getting to these patients earlier in the natural history of the disease because our in- formation today is that the current form of therapy can prevent vision loss in 95% of cases and can im- prove vision in 40% of cases." Going forward, Dr. Sebag is hopeful that ophthalmologists will begin to place more emphasis on vi- sion and quality of life. "I think that especially in my subspecialty of vit- reoretinal diseases, we don't empha- size adequately visual function and quality of life," he said. "We think more in terms of structure and anatomy and reintegrating a normal structure rather than treating vi- sion." Dr. Sebag thinks that it is im- portant to start to develop ways to treat vision, not just the pathology found. To do so requires advanced nano-technologies, such as those being developed at USC and NASA. Dr. Sebag sees the 3D-CTAG test as helping to do this. "It is my hope that the anticipated success of the threshold Amsler grid approach that integrates contrast sensitivity with central visual field testing will be followed by more advanced tech- nologies to quantitate biological processes, as well as additional as- pects of the visual phenomenon, so that we can achieve improvements not just in structure but in visual function in the future," he said. EW Editors' note: Dr. Sebag has no finan- cial interests related to his comments. Contact information Sebag: 714-901-7777, jsebag@VMRinstitute.com February 2011 RETINA October 2011 That's all you need! One-size-fits-all punctum plug eliminates sizing and simplifies stocking Pre-stretched shape (on inserter) avoids dilation and facilitates insertion Expanded shape (once inserted) assures snug fit and virtually eliminates pop-out Soft collar prevents migration and provides patient comfort ™ FCI-Ophthalmics.com 800.932.4202 Plug into FCI for Dry Eye Treatment and watch the SnugPlug insertion video. Visit PlugintoFCI.com for promotional pricing Adding continued from page 71 The dry case has a central defect that is the same at all contrast levels representing an absolute scotoma Source: Craig Robison, M.D., Wolfgang Fink, Ph.D., and Alfredo Sadun, M.D., Ph.D. 68-75 Feature 2 AMD_EW October 2011-DL2_Layout 1 9/29/11 3:48 PM Page 72

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