Red Atlas: Online Atlas of Eye Disorders
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RedAtlas is a free online atlas of eye disorders designed to help Ophthalmologists and Optometrists-in-training learn to identify eye diseases through pattern recognition. . . .Since launching in February 2, 2002, we have received over 3,000,000 hits from more than 60 countries around the world. The atlas is currently being hosted through the generosity of the Doheny Eye Institute at the University of Southern California/Keck School of Medicine.
Click here to visit the site.
Sharing Medical Space
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Is your space empty one day a week or more while you are in the O.R. or satellite office? That’s insane- plenty of doctors want to use your space on a part-time basis. Go find another doctor to share your space, and this will be a great way to reduce expenses. Word-of-mouth, CraigsList and bulletin boards are not so reliable- try ShareMedicalSpace.com, a website dedicated exactly to help doctors find one another to share space.
EyeScience Launches Comprehensive Online Resource Devoted to Age-Related Macular Degeneration Education and Prevention
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EyeScience Labs, a Columbus, Ohio-based, ocular nutraceutical company, has launched a new website called Eye Science to meet consumer demand for comprehensive information and education on age-related macular degeneration (AMD) in a unique watch-and-learn video format. AMD is a progressive, hereditary eye disease that is the leading cause of blindness in Americans age 50 or older.
On the site, visitors can learn about basic eye anatomy, screening and diagnosis, risk factors, signs and symptoms and treatments for AMD. In addition, the site contains more than 20 watch-and-learn videos about eye anatomy, AMD symptoms, dry and wet macular degeneration, diagnostic tests, photodynamic therapy (PDT), intravitreal injection of Lucentis and Avastin, vitamin therapy, amsler grid testing, lasers and more.
Visit the EyeScience website to learn more.
Read the full press release announcing the launch.
Novagali Pharma Releases Data Pertaining to BAK-Free Eye Drops for Glaucoma Treatment
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Novagali Pharma, a French pharmaceutical ophthalmic company, announced the results of its first set of data pertaining to Nova21027, a BAK-free latanoprost formulation for glaucoma. The data was presented at the 9th Scientific Meeting of the Association for Ocular Pharmacology and Therapeutics (AOPT) held in Salzburg, Austria.
According to Novagali’s press release, acute toxicological studies confirm the ocular surface toxicity of anti-glaucomatous eye drops containing benzalkonimum chloride (BAK). In contrast, Novagali’s BAK-free cationic emulsion of latanoprost was well tolerated and did not induce any ocular surface damages upon stress conditions.
The company noted that the safer profile is of paramount importance taking into account that BAK exerts toxicity after long term use and that glaucoma is a chronic disease needing life-long daily treatment.
Read the full release on the IT News website.
Is Descemet's Stripping Endothelial Keratoplasty (DSEK) Effective For Treating Fuchs Endothelial Dystrophy?
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Surgery for corneal endothelial dysfunction has been moving away from penetrating keratoplasty in favor of posterior lamellar keratoplasty techniques, in which only selected tissues are grafted. A technique rapidly gaining popularity is endothelial keratoplasty with stripping of Descemet’s membrane, in which the host tissue is replaced by the membrane and endothelium — and a thin slice of cornea — from the donor eye.
The addition of the new tissue creates an interface that can scatter light and interfere with vision. As reported by MedPage Today, a study published in the February 2009 issue of Archives of Ophthalmology led by Dr. Sanjy Patel of the Department of Ophthalmology at the Mayo Clinic in Rochester Minnesota, suggests that the retained host cornea itself also undergoes changes that continue to reduce visual acuity, even six months after the procedure was completed when swelling in the cornea has resolved.
Read more about the study and its outcomes on the MedPage Today website, including a short audio presentation by Dr. Patel. An abstract of the published study in the Archives of Ophthalmology website, entitled ”The Effect of Corneal Light Scatter on Vision After Descemet Stripping With Endothelial Keratoplasty,” is available here.
We invite readers to submit comments below regarding their own experiences using PKP vs. DSEK vs. DLEK for treatment of Fuchs’ Dystrophy and pseudophakic bullous keratopathy.
Diaton Tonometer For Measuring Intraocular Pressure Through Eyelid Approved by Mexico Ministry of Health
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BiCOM Inc., has announced that its advanced trans-scleral Diaton tonometer has been approved by Mexico’s Ministry of Health. As explained on BiCom’s website, “diaton tonometry” is a unique approach to measuring intraocular pressure (IOP) through the eyelid in connection with the diagnosis and treatment of glaucoma. The pen-like, hand-held, portable tonometer requires no contact with the cornea, no anesthesia, and no sterilization.
BiCOM recommends the Diaton tonometer as a solution in the following cases when the use of other devices is problematic or impossible:
mass prophylactic screening of patients;
IOP control during clinical observation of glaucoma patients;
ortoclinostatical probe, as an additional test to diagnose glaucoma and during select the adequate hypotensive therapy;
ophthalmotone monitoring (even at night time);
IOP measuring during contact correction (lenses are not taken out),
IOP measuring in immobilized patients;
IOP measuring in children;
IOP measuring on patients with the following conditions: chronic conjunctivitis, cornea pathology, including keratitis, keratotone, cornea dimness, after penetrating keratoplastics, keratoprosthesis, laser refractive correction of the eyesight, high degree of ametropy, astigmatism;
IOP measuring on patients with medicinal allergies;
Lasik/ LASEK / PRK (recent clinical trials have proved that Diaton is the only device that can be used for IOP measurement right after these surgeries)
Diaton tonometer comparison clinical trials and video are available on BiCOM’s website.
Fibrin Adhesive Versus Sutures in Pterygium Surgery
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I came across an article that compared pterygium surgery with Tisseel glue with sutures. Of course, it showed no difference. That’s it! I’m done with sutures. I plan on asking my ASC to stock that fibrin glue and I will use it on my next case. As one who trains residents, nothing would please me more than not having to watch another one try to suture! I love my residents, but that can be torture. I pride myself, as most of us who trained doing extracaps, on being a good suturer. But, like penmanship and knowing correct grammer and spelling, these skills are fast becoming obsolete due to technology. Oh well. Would you believe my daughter has never even seen a typewriter? Or knows what a rexograph machine is? Yeesh, I’m 46 but I feel old!
Injections of Cortisol Derivative Reduced Intraocular Pressure in Glaucoma Patients
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It was announced last week on MedPage Today that a study (published in the February 2009 issue of the Archives of Ophthalmology) of seven patients undertaken by Dr. Alan Robin and his colleagues at the Johns Hopkins Bloomberg School of Public Health found that injections of anecortave acetate (a synthetic molecule derived from cortisol that has been evaluated for use in age-related macular degeneration, but has not been approved by the FDA), successfully reduced IOP in patients with ocular hypertension induced by corticosteroid treatment (ocular hypertension being a well-recognized complication of intravitreal triamcinolone acetonide injection used to treat numerous vascular conditions of the eye).
Dr. Robin cautioned that “further investigation is required to confirm these preliminary results, establish optimal dosing, clarify the mechanism by which the drug lowers intraocular pressure, and determine the clinical indications for the use of anecortave acetate in the management of steroid-related ocular hypertension.”
Read the full story on MedPage Today.
TrueVision Systems Continues to Refine 3D Digital Visualization Technology for Cataract Surgery
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TrueVision System’s 3-dimensional, high-definition (3DHD) digital imaging system for microsurgery converts the stereoscopic optical view of surgical microscopes to a digital 3DHD image (called TrueView™), and displays it on a projection screen or monitor.
According to the company, TrueView™ delivers over twice the depth of field compared to the microscope view, and three times the resolution of standard definition, enabling surgeons to successfully perform “heads-up” microsurgery without looking into the microscope’s eyepieces. The 3DHD video recording accurately captures the surgical view. Thus, surgeons, residents and OR staff can view what traditionally only one surgeon could observe through the microscope’s binoculars.
A recent article on the Daily Sound website discussed how the TrueView™ technology is being used in cataract surgery. According to TrueView™ user Dr. Douglas Katsev, an ophthalmologist and cornea specialist, among other benefits, the visualization of surgery on a projection screen helps nurses anticipate what surgical instrument he will request next and be ready with it before he even asks, and eliminates the need for surgeons to remain hunched over a surgical microscope as they operate, thus providing ergonomic benefits. Recorded surgical footage can also be used for educational purposes.
TrueVision System programmers are currently developing software that will show surgeons where to make incisions for a variety of operations. Cataract surgeons will be able to take a scan of a patient’s eye prior to surgery, and then during the operation, the program will display lines on the 3-D screen showing the surgeon where and how incisions should be made. Dr. Katsev commented that the guidance system will make cataract surgery more accurate.
Read the full article.
Focal/Grid Photocoagulation vs. Intravitreal Triamcinolone for Treatment of Diabetic Macular Edema
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The March 2009 issue of The Archives of Ophthalmology contains a report on the 3-year outcomes of patients who participated in a randomized trial evaluating 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone compared with focal/grid photocoagulation for treatment of diabetic macular edema.
Eyes with diabetic macular edema and visual acuities of 20/40 to 20/320 were randomly assigned to focal/grid photocoagulation or 1 mg or 4 mg of triamcinolone. At the conclusion of the trial, 3-year follow-up data were available in 306 eyes.
Results did not indicate a long-term benefit of intravitreal triamcinolone relative to focal/grid photocoagulation in patients with diabetic macular edema.
Read the full report.
TV Station Interviews Dr. Carla Siegfried on Glaucoma Treatment Options
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Read this short, but informative interview on the website for a Florida TV station with Dr. Carla Siegfried concerning glaucoma treatment options. It provides a nice overview of the options for individuals suffering from glaucoma. See the interview here.
Embryonic Stem Cell Treatment for AMD
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The Times of London reports that a team of British scientists and surgeons at the Institute of Ophthalmology at University College London and Moorfields eye hospital have developed the world’s first stem cell therapy to cure age-related macular degeneration.
The treatment involves replacing a layer of degenerated cells with embryonic stem cells that are essentially replicas of the missing cells. The stem cells are placed on an artificial membrane inserted in the back of the retina.
Once perfected in about six to seven years, the procedure could be performed on an outpatient basis in under an hour.
Pfizer has agreed to provide financial backing for continued research and will manufacture the membranes used in the procedure.
For the complete story, see the report by The Times of London.
Vitreomacular Adhesion- Risk Factor for Wet ARMD
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I read a fascinating article in AJO yesterday that showed nicely how unilateral wet ARMD is often associated with vitreomacular traction syndrome (VMT), demonstrated with OCT. Seems reasonable that those at high risk might get intravit injection of vitreolysis agent to precipitate PVD to reduce the risk. Interestingly, it’s well known that those with PVD are protected from NVD secondary to DM. Retina- that’s where the action is!
On Demand Lucentis as Effective as Monthly Injections – Two-Year PRONTO Study
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According to two-year results of the PRONTO study due for publication in the American Journal of Ophthalmology, Novartis’ Lucentis (ranibizumab) administered on demand is as effective as monthly injections for neovascular age related macular degeneration (AMD), with fewer injections required.
This is the first study to show the efficacy of “on demand” treatment, depending on the results of optical coherence tomography (OCT), while Phase III studies concentrated on a regimen of monthly injections.
Dr Greeta Lalwani of Miami’s Bascom Palmer Eye Institute and colleagues report the results of this open-label prospective study in 40 patients. The patients received a monthly intravitreal injection (0.5 mg) of ranibizumab for three months. After the first three months, the need for re-treatment was evaluated during the monthly check-up visit and depended on results. Re-treatment occurred when central retinal thickness had increased by at least 100 ?m as shown by OCT, or when the patient had ‘lost’ at least five letters.
During the second year, re-treatment criteria were altered to allow re-treatment where the volume of liquid revealed by OCT had increased. Of the 40 patients, 37 completed the two-year study. Average visual acuity improved by 11.1 letters and retinal thickness decreased by 212 ?m. Visual acuity improved by at least 15 letters in 43% of patients.
These results were obtained with an average of 9.9 injections over 24 months.
The researchers conclude that “using an OCT-guided variable-dosing regimen with intravitreal ranibizumab resulted in visual acuity outcomes comparable with the outcomes from the Phase III clinical studies, but fewer intravitreal injections were required”.
For more, see the article in APM Health Europe.
Should a Child With Conjunctivitis Stay Home?
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I read recently from a pediatrician that most conjunctivitis is bacterial ( she cited a few studies in her footnotes), and that children should stay home until asymptomatic.
In my experience, most conjunctivitis is viral. If studies show that eyes cultured grow staph epi or other bug, so what- all eyes are colonized, and I can’t imagine how any study can prove that a bug cultured from an eye is responsible for the conjunctivitis (which is why, I think, she did not cite any literature from any peer-reviewed ophthalmology literature). I was also taught that viral conj is contagious for about a week, regardless of any symptoms. So I advise that kids stay home for a week (mine just did this past week- he was so pleased!), unless I suspect the conjunctivitis is bacterial (thick, greenish discharge, unilateral etc.)- then they stay home until the eye clears up.
Intravitreous Injections of Pegaptanib (Macugen) May Help Prevent Further Vision Loss From Central Retinal Vein Occlusion
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As recently reported in MedPage Today, a study published in the April 2009 issue of The Archives of Ophthalmology, researchers have found that intravitreous injections of pegaptanib (Macugen) may help prevent further vision loss from central retinal vein occlusion, but does little to reverse it.
Specifically, patients injected with the drug to treat macular edema from central retinal vein occlusion were no more likely to gain at least 15 letters on a visual acuity test than those who got sham injections (P=0.48 for the 0.3-mg dose and P=0.35 for the 1-mg dose).
On the other hand, substantially fewer pegaptanib-treated patients lost 15 or more letters in visual acuity compared with controls (9% at 0.3 mg and 6% at 1 mg versus 31% with sham, P=0.03 and P=0.01, respectively).
The drug was also associated with nonsignificant trends for less central retinal thickness and neovascularization.
Read the full story on MedPage Today.
Inotek Pharmaceuticals Presentations at ARVO 2009
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Inotek Pharmaceuticals announced that preclinical data supporting the Company’s lead clinical-stage drug candidate in glaucoma, INO-8875, will be presented in a poster session at ARVO.
INO-8875 is a highly selective adenosine-1 receptor agonist currently completing a Phase 1/2 trial as a topical agent for the treatment of elevated intraocular pressure (IOP) associated with primary open angle glaucoma and ocular hypertension. The preclinical data suggests that INO-8875 lowers IOP primarily by restoring trabecular meshwork outflow, the most important outflow pathway to maintain IOP in healthy eyes. Additionally, INO-8875 may have a secondary mechanism of action to decrease IOP by reducing aqueous humor production.
Read the full release.
Study Indicates Avastin (bevacizumab) May Work for Diabetic Macular Edema
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A small study reports improvement in diabetic macular edema following intravitreal bevacizumab injection. Thirty patients were followed for about 6 months after receiving bevacizumab injection as primary therapy for clinically significant macular edema. While some patients received pan-retinal photocoagulation (PRP) for control of proliferative changes, none received focal laser for treatment of the macular edema.
The study found that most of their patients did improve following the injections; visual acuity and fluorescein leakage improved in about 80% and retinal thickness improved (decreased) in 90% as measured by OCT.
What does this mean? In this small group of patients, Avastin ® may be indicated or for the treatment of diabetic macular edema. While focal laser has long been the mainstay of treatment, we have discussed its shortfalls before, that is, patients with diffuse macular edema and central areas of leakage cannot be treated with laser due to central scotoma formation. While this was not a study comparing focal laser to bevacizumab, the inference is made that this may be a plausible first line treatment. The study was small, it was not randomized and there was no cohort for comparison. The study duration was brief (< 6 months follow-up) and we do not really know whether injections need to be repeated. Still this merits some attention and may hopefully fuel a larger study leading to some clearer answers.
Read the full article here.
Randall V. Wong, M.D.
Retina Specialist
TotalRetina.com
Should We Prescribe Vigamox Eye Drops for Pink Eye?
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I see many patients who are referred to me by pediatricians and ER docs, and it seems they all are taking some fourth generation fluoroquinolone like Vigamox eye drops for bacterial conjunctivitis (or pink eye). What’s up with that? Is it just plain laziness to prescribe the same thing over and over? Or is it the result of drug rep pressure? I reserve these superdrugs to contact lens wearers. Otherwise, my patients with conjunctivitis get sulfa or gentamicin or some other cheap, old medicine. I wish doctors would take a moment before reflexively prescribing Vigamox and other very powerful drugs for what is a benign, self-limited disease.
Vitreous Tap When AC Shallow During Phaco
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I think this maneuver is under-utilized. When I am faced with a shallow anterior chamber with significant positive pressure, and I am having some trouble just getting my instruments in the eye, then I bite the bullet. Instead of trying to inject more and more viscoelastic, I take down conjunctiva, enter the pars plana at 3.5mm from the limbus, and either the liquified vitreous pours out, or I do a very quick (1 minute) vitrectomy. Immediately, the AC is deep and the eye is soft (don’t take out too much vit, or the eye will be too soft), and the phaco becomes an absolutely routine case. I don’t have to worry about my rhexis running away, or my posterior capsule coming up at me. I have done this only three times, and each time it saved the day. I know that Dr. Fine in Oregon is a big advocate of this. Close the sclera with a 7-o vicryl, and just look at the fundus the next day to make sure nothing funny happened.
This maneuver is very easy, and even low-volume guys like me can do it. Trust me- you’ll be grateful.
What is Treatment for Branch Retinal Vein Occlusion (BRVO)?
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I was diagnosed with BRVO 2 years ago, I have had 4 injections of Avastin and 3 laser procedures. My vision improves for a a while but then headaches begin and vision becomes blurry. Do we know how many injections and laser treatments are safe before further damage can be done to the eye?
ARVO 2009 Meta Analysis of Diabetic Retinopathy
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A poster presented at the 2009 ARVO Meeting of a systematic review and meta-analysis of diabetic retinopathy cases presented in the literature between 1975 and 2008 showed that the progression of proliferative retinopathy and severe visual impairment declined after 1985.
The study screened 3,130 abstracts and reviewed 323 full publications. Harry W. Flynn Jr., MD, and colleagues, reported that the incidence of progressive diabetic retinopathy at 4 years was 2.6% between 1986 and 2008 compared with 19.5% between 1975 and 1985. Severe vision loss was 3.2% between 1986 and 2008 vs. 9.7% between 1975 and 1985.
The poster also showed similar rates at 10 years.
“Although these findings are encouraging, continues to be a disease that is increasing in prevalence globally.” Dr. Flynn noted in the poster.
I wish the author(s) had explained what the findings meant.
Aspheric IOL's Give Better Vision In Low Contrast Conditions Than Acrysof Lens
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An article in Ophthalmology compared the traditional Acrysof lens to the IQ aspheric lens. In high contrast conditions, there was no difference. Under lower contrast conditions, the aspheric IOL had better vision. Since the patient pays no more for the aspheric lens (Medicare pays an extra $50 I believe), I think it’s a no-brainer to implant this kid of lens, even though for the vast majority, in real life conditions, patients won’t appreciate much of a difference.
AudioDigest Is a Great Way to Keep Current
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I read the three major journals, four ophthalmology newspapers, Survey, as well as stuff on the internet. But I also find AudioDigest to be a great way to stay current, and best of all, it’s a lot of easy CME credit. I pop the disc in my car DVD player every two weeks, and I typically hear some good lectures from all over the world. For its clinical relevance and easy CME credit, I think it’s a good investment. (I have no financial interest).
Palomar Medical Technologies Secures OTC Clearance from FDA for Home Use Laser To Treat Eye Wrinkles
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Palomar Medical Technologies Inc. (Nasdaq: PMTI) announced that it had become the first company to receive a 510(k) over-the-counter (OTC) clearance from the FDA for a new, patented, home-use, laser device for the treatment of periorbital wrinkles. OTC clearance allows the device to be marketed and sold directly to consumers without a prescription.
Commenting on the achievement, Palomar CEO Joseph P. Caruso said, “This FDA clearance for a laser to treat wrinkles in the home opens up a tremendous opportunity to tap into the multi-billion dollar consumer skin care market with our patented technology. The professional treatment of fine lines and wrinkles using lasers has been well established and proven to be safe and effective for years in the doctors’ office using large and expensive lasers. With this breakthrough, consumers will be able to use similar technology in the privacy of their own home for a fraction of the cost. This latest clearance further validates Palomar’s investment in research and development in the field of light-based anti-aging treatments and adds to the list of distinctions for Palomar as a technology leader in our industry.”
Mr. Caruso continued, “Years ago, we believed that light-based anti-aging applications could be brought to the home. We invested significant resources in research, development, clinical testing, and patent protection to make this a reality and ensure that Palomar would be the leader with this innovative technology. We envision a strong market for this OTC device and an increase in consumer awareness to help drive growth in our professional business.”
This consumer device was developed by Palomar and Johnson & Johnson Consumer Companies Inc., and is the result of years of research and clinical testing, according to company officials.
For more, read here.
ORange- Nifty Tool to Assess Intraoperative Astigmatism
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I read about this new device from ORange- it measures refraction through the O.R. microscope, so one can immediately confirm the refraction. This would eliminate “refractive surprises”, and I am sure is quite helpful for those who use LRI’s and toric IOL’s, as it would allow one to refine those procedures at the time of surgery and thus decrease the need for enhancements.
QLT Announces Positive Results from Visudyne-Lucentis Combination Therapy for Wet AMD
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QLT Inc. announced last week positive twelve month results from the Phase II RADICAL study (Reduced Fluence Visudyne Anti-VEGF-Dexamethasone In Combination for AMD Lesions) in patients with wet age-related macular degeneration. The purpose of the study is to determine if Visudyne combined with Lucentis reduces retreatment rates compared with Lucentis monotherapy, while maintaining similar vision outcomes and an acceptable safety profile.
Three Visudyne–Lucentis combination therapies were evaluated against Lucentis monotherapy. The overall results showed that fewer retreatment visits were required with the combination therapies than with Lucentis monotherapy, and the differences were statistically significant:
1. Triple therapy with quarter-fluence Visudyne followed by Lucentis and then dexamethsone (P=.04)
2. Triple therapy with half-fluence Visudyne followed by Lucentis and then dexamethsone (P<.001)
3. Double therapy with half-fluence Visudyne followed by Lucentis (P=.04)
While the mean visual acuity (VA) may appear to have improved similarly across all treatment groups,
the confidence intervals were wide. There were no unexpected safety findings, and adverse event
incidence was similar across treatment groups.
Of the four treatment groups, the triple therapy half-fluence group demonstrated the best results, with the
fewest retreatment visits and mean VA improvement most similar to Lucentis monotherapy through 12
months. Patients in the triple therapy half-fluence group had a mean of 3.0 retreatment visits compared
with 5.4 for patients who received Lucentis monotherapy (P<.001). At the month 12 examination, mean
VA in the triple therapy half-fluence group improved 6.8 letters from baseline compared with 6.5 letters
in the Lucentis monotherapy group (P=.94). While all combination groups had significantly fewer
retreatment visits than the Lucentis monotherapy group, the better results (both in VA change and
retreatment visits) in the triple therapy half-fluence group compared with the other combination groups
was a trend and was not statistically different.
Read the full release.
Prevalence of Diabetic Retinopathy Continues to Rise
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Preliminary data indicates that the prevalence of diabetic retinopathy has increased across ethnic/racial borders from 1988-1994 according to the latest 2005-2006 National Health and Nutrition Examination Survey. The researchers indicate that while this may be due to a change in screening techniques for diabetic retinopathy, it may also mean that glycemic control in the diabetic population is getting worse, that is, patients are not keeping good control of their serum glucose.
Increases were noted in non-hispanic whites, non-hispanic blacks and Mexican americans. While all 3 groups saw a rise, the non-hispanic blacks demonstrated the highest prevalence of diabetic retinopathy.
The prevalence of non-proliferative disease was about 20% with just 3% demonstrating proliferative eye disease. Interestingly, the highest risk factor to developing the disease is still the number of years a patient is diabetic. For every 5 years a patient is diabetic, the chances of demonstrating the disease increases by 60%.
Other associated risk factors include; male gender, difficulty in controlling sugar (e.g. insulin vs. oral vs. diet/exercise), higher systolic blood pressure and higher hemoglobin A1C.
What does this mean? To me, this underscores the importance of carefully explaining that the development of eye disease is highly likely to develop despite good sugar control. Patients should be told to expect the development of the eye disease as time progresses as the duration of the disease is a huge factor. Sugar control is important, but not the key to preventing disease.
For a more complete discussion of these issues, see the article on MedPage Today.
Randall V. Wong, M.D.
Retinal Specialist
TotalRetina.com
New Diabetic Retinopathy Screening Approaches Allow for Faster Detection With Lower Burden on Ophthalmologists
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As reported on MedPage Today, two new studies report that new screening approaches for diabetic retinopathy appeared to retain good specificity and sensitivity for detection while reducing the burden on ophthalmologists and patients.
In the first study, 1,229 people with diabetes and no or minimal insurance were screened. A trained technician took retinal pictures, determined the presence of significant retinopathy using EyePacs imaging software, and provided immediate referral if it was present.
A retinal specialist independently read all the images to determine accuracy of the screening. Comparing them, the technician’s screening had an overall accuracy of 92% with a specificity of 96% and sensitivity of 86%.
With this screening strategy,technicians could do preliminary screening, with only positive screens sent to a retinal specialist for review to maximize use of the specialist’s time and expertise. Patients also benefit from accurate, sameday evaluation without long wait times as well as an opportunity for patient education.
A second study compared outcomes of dilated seven-field retinal photography with single-field photography without dilation encompassing only the central 45º of the retina most vital for vision-threatening complications.
The study concluded that the single-field method would be accurate “when used in conjunction with integrated diabetes care.”
Read further details on MedPage Today.
Transcend Medical Raises $35 Million for Development of CyPass Glaucoma Treatment System
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Transcend Medical, an ophthalmic device company that focuses on advances in the treatment of glaucoma, announced today that the company has completed a $35 million series B round of funding. Transcend also noted that the development of the Transcend CyPass™ System, which is a proprietary system for the minimally invasive treatment of glaucoma, is still underway.
Significant contributions to this round were made by lead investor HLM Venture Partners, along with other new investors Canaan Partners, Technology Partners and Latterell Venture Partners.
The Transcend CyPass™ System is planned to both replace current glaucoma therapies and to broaden the reach of treatment to a larger patient population. The system uses a proprietary system to lower intraocular pressure while offering various ease of use features for physicians.
Read the full press release.
Molteno vs. Ahmed Implants for Treatment of Glaucoma
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A recent article in AJO reported on 2-year follow-up data after Ahmed valve implantation versus Molteno single-plate implantation surgical treatment of refractory glaucoma. 92 patients with refractory glaucoma were allocated randomly to each of the study groups and underwent implantation of either the Ahmed valve implant or Molteno single-plate implant, and were followed up for 24 months.
Those who successfully completed the trial achieved significantly less IOP and fewer glaucoma medications, but worse visual acuity 24 months after surgery. The Molteno group, compared with the Ahmed group, achieved significantly lower IOPs after the early postoperative period until the end of the study. Both groups reasonably maintained visual field during the follow-up. The rate of surgical failure was comparable in both groups. There were no devastating intraoperative or postoperative complications in either group.
I don’t think these results are enough to sway surgeons one way or the other.
Subscribers to AJO can access the full article on the AJO website.
Como mejorar tu página web
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Ventajas del Posicionamiento Natural o Search Engine Optimization (SEO): Aumenta la Exposición de su sitio, Aumenta el tráfico, Relevancia y Conversiones en su sitio, Atrae mayor cantidad de visitantes, vuelve a su sitio Accesible y bien administrado termina siendo una estrategia de marketing a largo plazo. El Seo impulsa su negocio y aprende a promover su marca, productos o servicios y por ende lo ayuda a vender más. servicio de posicionamiento web. Por eso los profesionales que queremos atraer nuevos clientes a nuestras páginas web, necesitamos una actualización continua con expertos que en el día a día viven con sus clientes estos cambios en vivo y en directo, y que son capaces de evaluar las nuevas herramientas y técnicas, así como sus resultados.
Cuando hablamos de posicionamiento SEO, involucramos muchos elementos que influyen de forma directa o indirecta en el proceso y ayudan al éxito o no del mismo, tales como: código HTML, arquitectura del sitio, calidad de contenidos y estrategias de intercambio de enlaces relevantes.
En cuanto a los enlaces entrantes y salientes, debes enfocarte en tres tipos de enlaces: los internos (sitios que desees enlistar dentro de tu sitio), externos (aquellos sitios amigos que deseen enlistar tu sitio en sus Web) y dentro del mismo sitio (referidos a la navegación propia del sitio).
La mayoría de responsables SEO piensa que los que trabajan en SEM, perdón, en PPC no son grandes profesionales, porque con dinero es fácil conseguir visitas. No es ningún problema, la mayoría de profesionales del PPC (ahora sí lo dije bien) piensan que los SEOs son gente de poco fiar, ya que no pueden asegurar nunca en qué posición aparecerá un resultado. Y lo mejor de todo es que nos llevamos muy bien, pese a esto. También es cierto que los que piensan así, ambos, se equivocan totalmente (esa es mi opinión).
Si se hace un curso de posicionamiento en buscadores para profesionales del marketing online, que ya veremos si se hace algún día, todos seremos mucho más felices. Sobre todo los clientes.
Es importante saber elegir bien a nuestro optimizador (SEO), ya que hay múltiples trampas en el proceso de posicionamiento que podrían suponer la eliminación definitiva de una Web de los motores de búsqueda.
Google a través de muchos algoritmos que usa, ha indexado o clasificado millones de sitios webs según un conjunto de factores y ha determinado cuales son más relevantes para determinado conjunto de palabras, en este caso ”accesorio para carros” y nos ofrece su lista de resultados que muy probablemente encaje con lo que estamos buscando. Estos factores y el orden de importante de cada uno es secreto de cada compañía (léase Google, Yahoo, MSN y similares) debido a la alta probabilidad que sea mal usado para lograr posicionamiento.
Tratamiento de células madre
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Son células pluripotenciales o multipotenciales, es decir, que pueden originar diversos tipos de tejidos (muscular, nervioso, óseo, etc.). Las células totipotenciales pueden generar un ser vivo completo; éstas, en cambio, sólo una porción. Por ejemplo, durante la cicatrización de una herida hay una generación nueva de unos pocos tejidos donde estas células intervienen.
Una de las aplicaciones del tratamiento con células madre es la alopecia.
Al ser la utilización de embriones una cuestión de gran controversia en términos éticos, los científicos de todo el mundo buscan otras fuentes de células madre. El tipo de célula madre encontrada en la médula ósea de los adultos parece ser una posibilidad. Estas células madre ya presentan la posibilidad de diferenciarse de una gran variedad de diferentes glóbulos rojos a lo largo del ciclo de la humanidad..
En las fases iniciales del desarrollo humano, las células madre, en el embrión, son “diferentes” a todos los tipos de células existentes en el organismo -cerebro, huesos, corazón, músculos, piel,…..Los científicos están entusiasmados con la posibilidad de controlar el espectacular poder natural de estas células madre embrionarias para curar varios tipos de enfermedades. Por ejemplo, las enfermedades de Parkinson y de Alzheimer resultan de lesiones en grupos de determinados células del cerebro. Con la realización de un transplante de las células madre de un embrión a la parte del cerebro lesionada, los científicos esperan sustituir el tejido del cerebro que se perdió.
En la sangre del cordón umbilical.
No diré más al respecto
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Mi laptop está tan lento que parece que hay que rogarle a Cristo que haga algo. Se demora al partir, se demora al correr los programas, al salvar un documento, es terrible. Es una molestia enorme que me tiene aburrido. Sé que la causa es Windows Vista, el OS más malo desde la creacion de los PCs. Tengo super claro que es lento, pero el computador es de ripley y la licencia es original, así que no debo cambiarme. Busqué manuales para sacarle partido y que funcione un poquito más veloz, pero todos son para optimizar windows 7 y no hay nada de Windows Vista. Supongo que tendré que formatear y pasarme al lado pirata , mi chequera no es tan resistente como para pagar la licencia original.
Ahora que menciono Internet, mi note, que es viejo pero aún funciona como nuevo, se infectó con un malware brigido que me llena el safari de publicidad de adultos y venta de medicamentos. De verdad, eso es lo que hace, altera la publicidad que aparece en internet. Y, lo otro, en el momento en que uno trata de bajar un antivirus y spywares gratis para limpiar el equipo, lo que hace es enviarte a una página con antivirus de mentira que dañan aún más tu equipo.
Smoking Is a Risk Factor For Uveitis
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An article in Ophthalmology found that smoking increases the odds of getting uveitis 2.2 fold. Uveitis is an inflammatory disease of the eye, often of no particular cause, but sometimes related to inflammatory diseases like sarcoid, autoimmune diseases and arthritis. It usually does not cause too much harm to the eyes, but a fair number can get cataract, glaucoma and retinal problems that can cause vision loss. The researchers speculate it’s due to toxic chemicals in the tobacco which may alter the body’s immune response. Just another good reason to stop smoking.
Smoking Is a Risk Factor For Uveitis
Posted by admin | Filed under Uncategorized
An article in Ophthalmology found that smoking increases the odds of getting uveitis 2.2 fold. Uveitis is an inflammatory disease of the eye, often of no particular cause, but sometimes related to inflammatory diseases like sarcoid, autoimmune diseases and arthritis. It usually does not cause too much harm to the eyes, but a fair number can get cataract, glaucoma and retinal problems that can cause vision loss. The researchers speculate it’s due to toxic chemicals in the tobacco which may alter the body’s immune response. Just another good reason to stop smoking.
Eye Pressure of First Eye Is Typically Higher Than Second Eye
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Here’s an interesting observation that I noticed myself in my own practice. Measuring the first eye reveals a higher pressure than the second eye, regardless of whether it’s the right or left. Furthermore, the pressures in the eyes is typically lower when it’s checked on the second visit. The researchers speculate it’s because the patient is squeezing more initially. These findings are interesting, and they support the practice of getting multiple pressure readings to establish a baseline before treatment. Here’s the link to the abstract.
Eye Pressure of First Eye Is Typically Higher Than Second Eye
Posted by admin | Filed under Uncategorized
Here’s an interesting observation that I noticed myself in my own practice. Measuring the first eye reveals a higher pressure than the second eye, regardless of whether it’s the right or left. Furthermore, the pressures in the eyes is typically lower when it’s checked on the second visit. The researchers speculate it’s because the patient is squeezing more initially. These findings are interesting, and they support the practice of getting multiple pressure readings to establish a baseline before treatment. Here’s the link to the abstract.
How Effective Are Bepreve Eye Drops in Treating Allergic Conjunctivitis?
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ISTA Pharmaceuticals, Inc. today announced additional results from the Company’s BEPREVE(R) (bepotastine besilate ophthalmic solution) 1.5% Phase 3 clinical studies to treat allergic conjunctivitis.
Presented in poster sessions at the 2011 American Academy of Allergy, Asthma and Immunology (AAAAI) Annual Meeting in San Francisco, the results demonstrated that BEPREVE was statistically superior to placebo in reducing nonocular symptoms associated with allergic conjunctivitis.
Click here for the full press release.
Lucentis Approved in Europe to Treat Patients With Macular Edema Secondary to Retinal Vein Occlusion
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Novartis announced Friday that it had received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) for Lucentis® (ranibizumab) to treat patients in the European Union with visual impairment due to macular edema secondary to retinal vein occlusion (RVO).
Lucentis was shown to improve vision and vision related quality of life for patients with visual impairment due to macular edema secondary to both branch-RVO (BRVO) and central-RVO (CRVO) in two Phase III studies in patients with BRVO (BRAVO) and CRVO (CRUISE). These studies showed that approximately 60% of BRVO and 48% of CRVO patients treated with monthly Lucentis gained at least 15 letters of visual acuity at six months, compared with 29% and 17% of those treated according to current standard practice, respectively. Patients maintained their visual acuity gains through to 12 months with as-needed dosing of Lucentis.
Read the full press release.
Lucentis Approved in Europe to Treat Patients With Macular Edema Secondary to Retinal Vein Occlusion
Posted by admin | Filed under Uncategorized
Novartis announced Friday that it had received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) for Lucentis® (ranibizumab) to treat patients in the European Union with visual impairment due to macular edema secondary to retinal vein occlusion (RVO).
Lucentis was shown to improve vision and vision related quality of life for patients with visual impairment due to macular edema secondary to both branch-RVO (BRVO) and central-RVO (CRVO) in two Phase III studies in patients with BRVO (BRAVO) and CRVO (CRUISE). These studies showed that approximately 60% of BRVO and 48% of CRVO patients treated with monthly Lucentis gained at least 15 letters of visual acuity at six months, compared with 29% and 17% of those treated according to current standard practice, respectively. Patients maintained their visual acuity gains through to 12 months with as-needed dosing of Lucentis.
Read the full press release.
