Eyeworld

JUL 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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EW NEWS & OPINION 24 This year's presentations covered the gamut from in vivo to post- marketing studies T he 2014 Association for Research in Vision and Ophthalmology (ARVO) meeting featured posters and presentations on topics including gene therapy, post-ap- proval analyses, and multicenter on- going surveys. This year, more than 11,000 attendees representing more than 70 countries viewed presenta- tions on more than 6,150 abstracts. Here is a sampling of some of the highlights. Donor tissue with positive sputum culture still viable for transplantation The Lions Eye Institute for Trans- plant & Research (LEITR, Orlando, Fla.) and the University of Florida suggest that donor corneal tissue that is routinely disqualified for pos- itive sputum culture results obtained prior to the donor's death may still be suitable for transplantation. Investigators found that for six common pathogens under study, positive sputum cultures prior to death were not correlated with positive graft cultures following up to 3 weeks of preparation. "Current screening practices for donor corneal tissue automatically exclude tissue samples with positive cultures from certain pathogens, while others require a medical consultation before the tissue can be used for transplantation," explained Anup Kubal, MD, clinical assistant professor of ophthalmology, Univer- sity of Florida. "This pilot study sug- gests that eye bank disqualification criteria may need to be adjusted." Reversible glue shows potential with battlefield wounds The first reversible glue— Poly(N-isopropylacrylamide), or pNIPAM—that has potential for use in battlefield ocular injuries may be able to save soldiers' vision. When applied to the wounded eye, the adhesive warms up and becomes sticky, sealing the wound and mini- mizing further damage while the soldier is transported for treatment, according to a poster presented by Yi Zhang and colleagues, University of Southern California, Los Angeles. Upon arrival at a hospital, physi- cians can simply apply cool saline solution to the glue, causing it to revert to its non-adhesive form and be removed with minimal discom- fort. According to the study authors, improvised explosive devices (IEDs) now account for 16% of all military- related ocular injuries. Presbyopia questionnaire shows promise A near vision questionnaire com- bined 12 items (questions related to 6 different targets in bright and dimmed lighting) to produce sum- mary scores for ease of near vision post-surgical correction of presby- opia. Corina van de Pol and colleagues developed the AcuFocus Corneal Inlay Presbyopic Question- naire (ACIPQ) using the Food and Drug Administration's Patient-Re- ported Outcomes guidance, the U.S. Navy Refractive Questionnaire, and applicable NEI RQL 42 questions. The group confirmed the scale was uni-dimensional, well targeted, and repeatable. Further, it could detect changes in near vision before and after surgery. MGD loss may be age-related Progressive meibomian gland loss is naturally age related and may or may not occur with an increase in reported dry eye symptoms, Nisha S. Yeotikar, Brien Holden Vision Institute, Sydney, Australia, and colleagues found. In an evalua- tion of 156 asymptomatic subjects (91 were female) who had no pre- existing ocular or systemic abnor- malities, there was a "significant worsening" in the grade severity of meibum quality, meibomian gland expressibility, and meibomian gland loss factor with increasing age. The latter steadily decreased with age, while the first two only began to decline in those older than 44 years. Lipid layer thickness, tear meniscus height, noninvasive and invasive tear breakup times increased after 54 years of age and correlated to a de- creased osmolarity. Ilomastat in MMP prolonged when crosslinked Ilomastat is a matrix metallopro- teinase inhibitor (MMPi) that has been shown to inhibit fibrosis after glaucoma filtration surgery (GFS) in a rabbit model of ocular fibrosis, according to a poster presented by Abeer Mohamed Ahmed and colleagues, National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London. Reducing scarring and fi- brosis by using a sustained dosage form would allow a prolonged local concentration of ilomastat to be maintained within the subconjunc- tival space, they said, and they used hyaluronic acid (HA) as a matrix to fabricate a small tablet for subcon- junctival implantation after filtering surgery. They dissolved 1.0 mg ilomastat in butanol (40% w/v) July 2014 by Michelle Dalton EyeWorld Contributing Writer Highlights from ARVO 2014 continued on page 26 found no statistically significant influence of the genetic variants in response to AREDS supplements. The publication is in press in Ophthalmology. Dr. Awh said that AREDS was originally designed to compare placebo, antioxidants only, zinc only, and antioxidants plus zinc. "Although AREDS ultimately recommended the combination of antioxidants and zinc, we hypothe- size that the benefit shown for the average patient with moderate AMD can be significantly improved for individuals based upon genetic risk. Some patients benefit tremendously from the AREDS formulation. It's important to emphasize compliance to those patients and to modify treatment in those who don't benefit." Dr. Awh also cautioned against nutritional supplements for patients without clinical evidence of AMD. "If there are no signs of AMD, there is no indication for genetic testing or nutritional supplements," Dr. Awh said, even for patients with a strong family history. "Patients with a family history of advanced AMD should be told that modifiable envi- ronmental factors such as smoking may increase their risk of developing AMD and they should be advised to have regular dilated eye examina- tions as they age." Dr. Ehlers counsels patients about the tests, noting some are asking about which nutritional supplements to take. "We have to be ready for the questions," he said. At this point, however, Dr. Ehlers said he believes that there is not enough information available to alter how he manages the condition, but he believes that genetics may have a more significant role in both future clinical practice and in clini- cal trial design. "Down the road, these types of tests may certainly have more of a role as we continue to provide more individualized care," he said. EW Reference 1. Awh CC, Lane A, Hawken S, Zanke B, Kim IK. CFH and ARMS2 genetic polymorphisms predict response to antioxidants and zinc in patients with age-related macular degeneration. Ophthalmology. 2013;120(11): 2317–2323. Editors' note: Dr. Awh has financial interests with ArcticDx. Drs. Chew, Ehlers, and Stone have no financial interests related to their comments. Contact information Awh: carlawh@gmail.com Chew: echew@nei.nih.gov Ehlers: EHLERSJ@ccf.org Stone: Edwin-stone@uiowa.edu Questions remain continued from page 22 More than 11,000 attendees representing more than 70 countries viewed presentations on more than 6,150 abstracts. 12-29 News_EW July 2014-DL_Layout 1 6/30/14 8:38 AM Page 24

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