Volume 5, Number 25
Monday, June 27, 2005



In this issue: (click heading to view article)
Editorial: Small World
Age-Related Eye Disease, Quality of Life, and Functional Activity
Coronary Artery Disease and Risk Factors in People with Post-Traumatic Vision Loss
Blunt Trauma of the Aging Eye: Injury Mechanisms and Increasing Lens Stiffness
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Editorial: Small World

Some years ago, I began feeling a bit stagnated when it came to my chosen profession of ophthalmology. Though I would have been considered successful by various measures, I was looking for a bit of a diversion from the rigors of daily clinical practice--but I wanted to identify opportunities in eyecare rather than forge a new path altogether. With that goal, I began to expand my clinical research projects and ultimately to speak on various related topics. Expanding my speaking role brought opportunities for domestic and international travel, and with that came fascinating interactions with colleagues not only across the country, but from outside the United States as well.

Recently, I traveled to Turkey and to Puerto Rico. Although I witnessed significant diversity among groups of ophthalmologists, I was also struck by how similar they could be in their understanding of my topics and in the ways in which they conducted their practices. They also had some of the same gripes and concerns that we American ophthalmologists frequently have. Indeed, the world is not a very large place after all.

I am not naïve enough to believe that significant disparities in healthcare quality do not exist among various nations and geographic regions today, but I hope we continue to witness the gradual elimination of these disparities. With the use of newer and better technology, we can try to ensure that eyecare in all corners of the globe is consistent, accessible and reliable.
Stephen E. Pascucci, MD
Medical Editor
[email protected]

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Age-Related Eye Disease, Quality of Life, and Functional Activity

Decreased visual function, regardless of the pathologic reason for the decrease, is associated with diminished quality of life and functional activities of living, according to a study by the University of Wisconsin Medical School.

A total of 2,670 people participated in the examinations of the Beaver Dam Eye Study and the Epidemiology of Hearing Loss Study, conducted from 1998 through 2000. Investigators assessed age-related eye disease (including age-related maculopathy, cataract, diabetic retinopathy, glaucoma, macula edema, occlusions, amblyopia and macular holes) by fundus, slit lamp and retroilluminated photographs, as well as self-reported ocular history. They also administered a standard interview that included the Medical Outcomes Study Short Form Health Survey, activities of daily living, instrumental activities of daily living, and visual function questionnaires and information on other medical conditions.

After controlling for age and sex, researchers found that people with an age-related eye disease had decreased scores in almost all the domains of the Medical Outcomes Study Short Form Health Survey, and that people with eye disease in both eyes had poorer scores than those with eye disease in only one eye. Stratifying by age-related maculopathy and central cataract yielded similar results. Further adjustment for current visual acuity and the number of comorbid conditions explained most associations. Several of the mental scales were still marginally significantly lower in those with age-related maculopathy after adjustment. Those who had an age-related eye disease were not more likely to have impaired activities of daily living or instrumental activities of daily living. After adjustment for current visual acuity and number of comorbidities, people who had trouble reading small print or recognizing people across the street were more likely to have an age-related eye disease. Otherwise, the investigators found no significant associations with the visual function questions and any of the specific ocular conditions.

SOURCE: Knudtson MD, Klein BEK, Klein R, et al. Age-related eye disease, quality of life, and functional activity. Arch Ophthalmol 2005; 123(6):807-14.		 Table of Contents






Coronary Artery Disease and Risk Factors in People with Post-Traumatic Vision Loss

Investigators at Israel’s Tel-Aviv University examined the prevalence of coronary artery disease (CAD) and its risk factors in people with post-traumatic vision loss (PTVL) in a cross-sectional, controlled study.

Study groups included 82 subjects with PTVL, 49 siblings, 58 blind subjects with retinitis pigmentosa (RP) and the general population in Israel. Main outcome measures were sociodemographic and biomedical data collected via a structured questionnaire and medical records.

The prevalence of CAD among subjects with PTVL (24 percent) was 2 to 3 times higher than the control groups. However, the prevalence of the CAD risk factors in these subjects was similar to or lower than those in the control groups. For example, significantly fewer subjects with PTVL were physically inactive (16 percent) than patients with RP (55 percent). The only variable that was significantly associated with CAD prevalence was the cause of blindness--that is, trauma vs. disease. The odds of having CAD after traumatic vision loss was 3.75 times higher than after RP.

The authors concluded that people with PTVL exhibit elevated rates of risk for CAD similar to those of other groups with physical disability, and that the traumatic injury that caused vision loss might be an important factor underlying that risk.

SOURCE: Defrin R, Holtzman S, Katz M, et al. Coronary artery disease and risk factors in people with posttraumatic vision loss. Arch Phys Med Rehabil 2005;86(5):968-73.		 Table of Contents






Blunt Trauma of the Aging Eye: Injury Mechanisms and Increasing Lens Stiffness

The Virginia Tech-Wake Forest Center for Injury Biomechanics, Winston-Salem, NC, investigated possible injury mechanisms in the eyes of elderly individuals and the effects of lens stiffness on model outputs indicative of injury as a function of age.

Using a validated finite-element model to determine the effects of changing lens stiffness on the eye when subjected to blunt trauma, researchers simulated three separate frontal impact scenarios: a foam particle (30 miles per second), a steering wheel (15 miles per second) and an air bag (67 miles per second). The lens stiffness of the model was increased with increasing age using stiffness values determined from the literature for three age groups.

The computational eye model demonstrated increasing peak stress in the posterior portion of the ciliary body and decreasing peak stress in the posterior portion of the zonules with increasing lens stiffness for the two most severe impact types (air bag and steering wheel). Peak deformation of the lens decreased with increasing lens stiffness. They concluded that, on the basis of their modeling analysis, the risk of eye injury increases with age. As a result, eyes of elderly patients may be more susceptible to ciliary body-related eye injuries in traumatic-impact situations.

The data support the contention that trauma-induced damage to the lens, ciliary body and zonules may be related to increased stiffness of the lens. The authors point out that their data show that all people, especially elderly individuals, should use safety systems while driving an automobile and sit as far from the air bag as is comfortable. They also advise that those in sports or work environments where protective lenses are required should adhere to this requirement, and that designers of air bags and automobile companies continue to work to reduce the potential that the air bag will contact the eye in an accident.

SOURCE: Stitzel JD, Hansen GA, Herring IP, Duma SM. Blunt trauma of the aging eye: injury mechanisms and increasing lens stiffness. Arch Ophthalmol 2005;123(6):789-94.		 Table of Contents





BRIEFLY
  • ACUITY FORMS STRATEGIC COLLABORATION WITH INTRADIGM. Acuity Pharmaceuticals has formed a strategic collaboration with Intradigm Corporation, a pioneer in the field of RNA interference (RNAi). The agreement gives Acuity exclusive rights to Intradigm"s leading technology for topical and systemic drug delivery for ophthalmic uses. Acuity and Intradigm will also collaborate to develop topical and other formulations, of Acuity"s lead compound, Cand5. The agreement exclusively licenses rights to Intradigm"s siRNA ophthalmic drug discovery platform and portfolio to Acuity, as well as the intellectual property associated with the ophthalmic drug discovery and delivery programs. Acuity"s lead compound Cand5 was the first RNAi therapy to enter human studies; the company intends to initiate Phase II trials of Cand5 in wet macular degeneration (wet AMD) later this year. The agreement between Acuity and Intradigm includes upfront payments, milestones and royalties. Intradigm personnel will also work with Acuity researchers on a collaborative basis to develop a topical formulation of Cand5. Further financial details were not disclosed. For more information, go to www.acuitypharma.com or www.intradigm.com.
  • COPERNICUS ANNOUNCES EFFICIENT DNA DRUG DELIVERY FOR BRAIN AND EYE DISEASES. Copernicus Therapeutics, Inc., recently announced that the company"s non-viral nucleic acid nanoparticle technology was very effective and non-toxic in introducing DNA into brain cells and was more than 10 times more efficient than any competing gene transfer system in effectively introducing DNA into the cells of the retina. The success of the technique suggests multiple treatment options for serious neurological disorders such as Parkinson’s and Alzheimer’s diseases; it also suggests that treating retinitis pigmentosa, macular degeneration, diabetic retinopathy and various viral infections of the eye may be possible using the nanoparticle technology. For more information, go to www.cgsys.com.
  • GENAERA ACHIEVES TARGET ENROLLMENT IN PHASE II AMD TREATMENT TRIAL. Genaera Corporation has reached the target enrollment for its third U.S. Phase II clinical trial in "wet" age-related macular degeneration (AMD). The company has enrolled 100 patients in a multi-center, randomized, double-masked, controlled clinical trial (MSI-1256F-209) with Evizon (squalamine lactate), a systemically delivered anti-angiogenic drug for treating choroidal neovascularization associated with AMD. The trial, the largest of Genaera"s three Phase II studies, will evaluate the safety and efficacy of Evizon in all subtypes of wet AMD over two years; it is designed to run concurrently with Phase III trials. The study will evaluate two dose levels (20 mg or 40 mg) of Evizon given once weekly for four weeks, followed by maintenance doses once every four weeks until week 48. After that point, each patient will be followed for an additional 12 months.
  • ENROLLMENT COMPLETED FOR CLINICAL TRIAL OF DRY EYE TREATMENT IN POSTMENOPAUSAL WOMEN. Nascent Pharmaceuticals, Inc., has completed enrollment of a 90-patient Phase IIb clinical trial of NP50301, the company’s topical ophthalmic therapeutic eye drop for treating dry eye syndrome in postmenopausal women. The randomized, vehicle-controlled, double masked clinical trial includes 30 patients in each of three arms, receiving either placebo or one of two active doses of NP50301. Data for both subjective symptoms and objective signs will be collected throughout the 14-week trial. NP50301 is an estrogen ester compound believed to act by multiple mechanisms, including influencing the health of the cornea, the meibomian glands and the conjunctiva. It is estimated that about 30 percent of postmenopausal women in the United States suffer from dry eye syndrome; previous clinical research has suggested the benefits of both topical and systemic estrogen therapy in the treatment of dry eye syndrome in this population.


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