Volume 3, Number 44

Monday, November 3, 2003

In this issue: (click heading to view article)
		Review of Ophthalmology Online Welcomes Stephen E. Pascucci, MD
		Hypertensive Retinal Vessel Wall Signs in a General Older Population
		Bacterial Adherence of Staphylococcus epidermidis to Intraocular Lenses
		Visual Acuity and Contrast Sensitivity in Neovascular ARMD Patients
		Briefly

Review of Ophthalmology Online Welcomes Stephen E. Pascucci, MD Review of Ophthalmology Online is pleased to introduce Stephen E. Pascucci, MD, as its Medical Editor, beginning with the November 10, 2003 issue. Dr. Pascucci is a graduate of Jefferson Medical College, Thomas Jefferson University, in Philadelphia. He interned in internal medicine at Lankenau Hospital, Philadelphia, and completed his residency in ophthalmology at the University of South Florida in Tampa. He was a fellow in cornea and external disease under the directorship of Dr. Michael Lemp at Georgetown University, Washington, DC. Dr. Pascucci is a partner and member of the board of directors of Northeastern Eye Institute in Scranton, PA, where he founded the cornea and external disease service and the laser center. His practice focuses on corneal, refractive and anterior segment surgery and anterior segment complications. Dr. Pascucci"s research experience includes the pharmacologic treatment of dry eye using fibronectin, cyclosporine and emulsion tears; his current surgical research includes a study of the use of conductive keratoplasty for astigmatism and the restoration of near vision following LASIK. Dr. Pascucci is a medical monitor for the Collaborative Longitudinal Evaluation of Keratoconus Study, the Corneal Donor Study and a peripheral inflammatory marginal keratitis study. He is a member of the Gatifloxacin Advisory Committee and the Refractec Clinical Advisory committee of the Lions Eye Bank of Northeastern Pennsylvania, and is on the editorial board of the Review of Ophthalmology. Please join us in welcoming him to the newsletter.

Hypertensive Retinal Vessel Wall Signs in a General Older Population A study by the University of Sydney, Australia; the Singapore National Eye Center and National University of Singapore; and the University of Wisconsin at Madison shows a strong relationship between presence and severity of hypertension and retinal microvascular structural changes in a general older population. The study aimed at describing cross-sectional relations between hypertension and retinal vessel wall signs in an older white population. These signs were defined from fundus photographs in 3,654 Blue Mountains Eye Study participants 49 years or older. Researchers graded focal arteriolar narrowing and arteriovenous nicking using standard protocol. They digitized photos to measure retinal vessel diameters, and used average arteriolar diameter, summarized as central retinal arteriolar equivalent and arteriole-to-venule ratio, as indices of generalized arteriolar narrowing. Patient blood pressure was measured with the a mercury sphygmomanometer; hypertension was defined by the use of antihypertensive medications, systolic blood pressure >/= 160 mmHg, or diastolic blood pressure >/= 95 mmHg. The study characterized hypertension as controlled (using medication, normal blood pressure), uncontrolled (using medication, high blood pressure) or untreated (not using medication). Results showed that hypertensive subjects had a higher prevalence of all retinal microvascular signs. After adjusting for age, gender, body mass index and smoking, persons with controlled (18.2 percent), uncontrolled (13.8 percent) or untreated hypertension (13.8 percent) were significantly more likely than normotensive subjects (54.2 percent) to have the following: lower central retinal arteriolar equivalent and lower arteriole-to-venule ratio; focal arteriolar narrowing; and arteriovenous nicking.

SOURCES: Wang JJ, Mitchell P, Leung H, et al. Hypertensive retinal vessel wall signs in a general older population: the Blue Mountains Eye Study. Hypertension 2003;42:534.

Bacterial Adherence of Staphylococcus epidermidis to IOLs A study aimed at analyzing and comparing the adherence of Staphylococcus epidermidis to intraocular lenses (IOLs) made of five different biomaterials shows that hydrophilic polymer surfaces seem most useful in avoiding the development of bacterial colonies and resulting endophthalmitis. Researchers in the multi-site French study used a clinical strain of S. epidermidis carrying the intercellular adhesion (ica) locus. In a previous study, the extent of bacterial binding was measured by counting; the present study employed bioluminescence and scanning electron microscopy (SEM) to analyze the accuracy of each method, to obtain a comparison between the various IOLs (native or heparinized polymethylmethacrylate, silicone, hydrophilic acrylic or hydrogel) and to complete previous observations. Researchers compared results using the Kruskal-Wallis and the Mann-Whitney nonparametric tests. Bacterial adhesion was statistically weakest on hydrogel and then on hydrophilic acrylic polymer IOLs. Adhesion depended on the hydrophobicity or hydrophilicity of the biomaterials. Slight differences in results were evident between the bioluminescence and SEM methods. SEM observations also highlighted two different patterns of bacterial adhesion--isolated bacteria and clusters of bacteria--assuming that hydrophobic IOLs (silicone and PMMA) probably facilitate bacterial colonization and biofilm production. Attachment mechanisms may be different in each case, depending on the polymer material and the infecting organism, since various types of behavior exist among S. epidermidis strains. However, hydrophilic polymer surfaces (hydrogel and probably hydrophilic acrylic) appeared most useful in avoiding the development of bacterial colonies and endophthalmitis in IOL patients.

SOURCE: Kodjikian L, Burillon C, Roques C, et al. Bacterial adherence of Staphylococcus epidermidis to intraocular lenses: a bioluminescence and scanning electron microscopy study. Invest Ophthalmol Vis Sci 2003;44(10):4388-94.

Visual Acuity and Contrast Sensitivity in Neovascular AMD Patients Visual acuity (VA) and contrast sensitivity (CS) do not always show the same progression in visual function loss, although they show a moderate correlation in eyes with neovascular age-related macular degeneration (AMD), according to a study by Germany"s University of Heidelberg. Patients with advanced AMD suffer not only from impairment in central VA, but also from reduction in CS. Researchers examined VA and CS changes over time in patients with subfoveal choroidal neovascularizations (CNV) as well as the correlation between the two parameters. VA was determined according to a standardized protocol with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. CS was measured with Pelli-Robson charts. The angiographic characteristics of CNV, the presence of CNV in the fellow eye, gender and age were evaluated as possible prognostic factors of VA and CS progression. Researchers in the Radiation Therapy for Age-Related Macular Degeneration (RAD) Study recruited 205 patients with neovascular AMD and reviewed over a period of two years. The treatment and control groups showed no significant difference for VA or for CS, and both groups were considered together. At baseline, mean VA was 55.6 +/- 14.5 letters (ETDRS chart), and mean CS was 22.8+/-6.9 letters (Pelli-Robson chart). Over two years, the mean VA loss was 23.6 +/-21.4 letters and mean CS reduction was 9.0 +/- 9.7 letters. Agreement between change of VA and change of CS was moderate; proportional hazard models did not show any apparent influence of type of CNV, or CNV in the fellow eye, on change in VA and CS. The authors suggest that both parameters provide important information about visual disability and should be evaluated as outcome in interventional studies.

SOURCE: Bellmann C, Unnebrink K, Rubin GS, et al. Visual acuity and contrast sensitivity in patients with neovascular age-related macular degeneration: results from the Radiation Therapy for Age-Related Macular Degeneration (RAD) Study. Graefes Arch Clin Exp Ophthalmol 2003;Sep 6 [Epub ahead of print].

BRIEFLY EPIKERATOME DEVICE RECEIVES CE MARK APPROVAL. CIBA Vision"s Centurion SES EpiEdge epikeratome has received CE Mark approval for sub-epithelial separation during Epi-LASIK, a new refractive surgical procedure developed by LASIK pioneer Ioannis Pallikaris, MD, PhD of Greece. The EpiEdge epikeratome is compatible with the Centurion SES System, which is available with two separate handpieces and blades: one for use in traditional LASIK procedures and one for Epi-LASIK procedures. The EpiEdge epikeratome is not a blade per se; it is a blunt "separator" that produces an epithelial sheet via a disposable, oscillating PMMA block, with no cutting. It eliminates the need for alcohol used in some refractive laser procedures, thus offering a less toxic environment with faster healing and less pain for patients. For more information, go to www.cibavision.com. NEW TONOMETER INTRODUCED. Ziemer Ophthalmic Systems AG will introduce its Pascal Dynamic Contour Tonometer for measuring intraocular pressure (IOP) at the annual meeting of the American Academy of Ophthalmology (November 15 to 18, 2003). The Pascal, which was developed by Swiss Microtechnology AG, a member of Ziemer"s Ophthalmic Systems group, is said to eliminate the influence of corneal thickness and rigidity on IOP estimates that occur with conventional applanation tonometers. Its "SensorTip" is a built-in pressure sensor that matches corneal curvature and measures IOP directly. The Pascal is slitlamp mounted and operates in a similar fashion as the Goldmann tonometer, but it records the dynamics of IOP and thus allows the operator to gather information on the entire range of short-term pressure fluctuations to which eyes are subjected. For more information, go to www.smtag.ch or www.ziemer-ophthalmics.com. VISUDYNE APPROVED IN JAPAN FOR TREATING WET AMD. Health authorities in Japan have approved Visudyne (verteporfin) for the treatment of the wet form of age-related macular degeneration (AMD). Visudyne, the product of QLT, Inc. and Novartis Ophthalmics, the eye health unit of Novartis AG, was approved by Japanese authorities for the orphan indication of AMD with all types of subfoveal choroidal neovascularization (it was designated as an orphan drug in Japan in 1997). Approval of Visudyne was based on the results of a 12-month clinical study in that country; approximately two out of every three patients participating either maintained or improved their vision as a result of Visudyne therapy. QLT, Inc. says it will now focus on securing reimbursement for Japanese AMD patients who previously had no treatment options.

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