Volume 5, Number 29
Monday, July 25, 2005



In this issue: (click heading to view article)
Editorial: EMR Woes
Retinal Detachment Secondary to Round Retinal Holes
Postmenopausal Hormone Replacement Therapy and IOP
Briefly











Editorial: EMR Woes

As many of you know, I moved to Florida last fall, and I have now opened a solo practice in Bonita Springs. To say it was a challenge would be an understatement, but we’ve worked through the process, taking the time to make the decisions we feel are best for the business. Fortunately, I have had excellent help along the way, and I do not think that we made many mistakes. I guess time will tell.

One thing I want to do is to make the practice essentially paperless. At present, we’re knee-deep in evaluating an electronic practice management (EPM) and electronic medical records (EMR) system. Undoubtedly, this has been the most stressful aspect of the start-up. We’ve seen system presentations that were slick and well-rehearsed, and others that were simply dysfunctional. In the case, it boggled the mind how the company could ever help a practice implement an EPM/EMR system when it couldn’t pull off a simple sales presentation.

There are countless systems out there, and they cost as much as my entire medical school tuition did, so making a wrong decision is simply not an option. You need to pick a company that has staying power, one that offers significant training and technical support, one whose representatives listen to what you need and configure your system to meet your practice’s current and future needs, and one that allows you not only to interface with present technology, but also to work well with future technology. At the same time, the system must enhance and not slow efficiency, and it must be fairly priced for what it offers.

Finding the right system is no small task; nor is it a duty that we can delegated to even the most skilled administrator. All future and key users of the system must offer input. A physician will view the system’s advantages and disadvantages in one way, but an administrator views it differently--as will a surgical counselor or certified ophthalmic technician. Are you starting to get the picture?

EPM/EMR systems will most likely become vital and integrated parts of our practices, rather than a luxury for only the most successful or largest practices. So it’s never too early to start the process of incorporating one into your practice. Allow for sufficient time to review a range of systems and figure out what you really need, so that you can make the best decision for your practice. Good luck!
Stephen E. Pascucci, MD
Medical Editor
[email protected]

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Retinal Detachment Secondary to Round Retinal Holes

The majority of rhegmatogenous retinal detachments result from pathological posterior vitreous detachment (PVD) and secondary horseshoe or giant retinal tears. Retinal detachment without PVD is usually associated with either retinal dialysis or round retinal holes. This study by Britain’s NHS Trust in Cambridge characterized the features, surgical outcome and incidence of bilateral involvement of detachment associated with round retinal holes.

The study included 110 retinal detachments from 96 consecutive patients with retinal detachment secondary to round retinal holes. Investigators analyzed patient age, sex, refraction, preoperative visual acuity, presented symptoms, position and extent of detachment, number and distribution of holes present, posterior hyaloid membrane status, surgical management, outcome of surgery and postoperative visual acuity of all patients. The mean age was 34 years, with a marked female preponderance (64 percent) and myopia (83 percent).

The posterior hyaloid membrane remained attached in 95 eyes (86 percent). Forty-five percent of patients had bilateral pathology, of which 33 percent had "mirror image" distribution. Detachments were predominantly shallow (93 percent) and progressed slowly (17 percent). One hundred detachments were repaired with cryotherapy and scleral buckling, eight with cryotherapy alone and one with laser retinopexy. In all, 99 percent of the detachments were successfully reattached with a single procedure. The mean follow-up period was two years; there were no instances of redetachment.

Investigators concluded that round hole detachments are slowly evolving detachments with attached vitreous gel in young, predominantly female myopes. They advise that examination of the fellow eye should be mandatory, since there a high incidence of bilateral pathology.

SOURCE: Ung T, Comer MB, Ang AJ, et al. Clinical features and surgical management of retinal detachment secondary to round retinal holes. Eye 2005;19(6):665-9.		 Table of Contents











Postmenopausal Hormone Replacement Therapy and IOP

Israeli investigators conducted a cross-sectional controlled study of 107 women aged 60 to 80 years who received hormone replacement therapy (HRT) and 107 controls who had never received HRT. All subjects underwent intraocular pressure (IOP) assessment and funduscopic photography for cup-to-disc (C/D) ratios, and they completed questionnaires regarding personal and family history of glaucoma, hormone replacement therapy, lifetime estrogen and progesterone exposure and cardiovascular risk factors.

The groups did not differ in mean IOP (15.3 mmHg vs. 15.3 mmHg), mean vertical (0.18 vs. 0.21) and horizontal (0.17 vs. 0.14) C/D ratios, and in prevalence of increased IOP (15 percent vs. 14 percent), C/D ratio (7 percent vs. 7 percent) or glaucoma (9 percent vs. 11 percent). The only risk factor associated with increased IOP was a personal history of ischemic heart disease. Lifetime estrogen and progesterone exposure--including pregnancies, deliveries, menstruation years and the use of oral contraceptives--did not significantly affect the risk for increased IOP.

SOURCE: Abramov Y, Borik S, Yahalom Claudia, et al. Does postmenopausal hormone replacement therapy affect intraocular pressure? J Glaucoma 2005;14(4):271-5.		 Table of Contents










BRIEFLY
  • GENENTECH SAYS LUCENTIS IMPROVES VISION. Genentech’s Lucentis, a treatment for wet age-related macular degeneration, maintained vision in subjects and improved vision in up to one-third of patients in a clinical trial of 716 patients. In the trial, Lucentis reached the primary endpoint of maintaining vision in patients with AMD after a year. Ninety-five percent of patients treated with Lucentis lost fewer than 15 letters, compared with 62 percent of the placebo group to lose fewer than 15 letters. Patients treated with Lucentis for one year could read seven more letters than before treatment, compared with placebo-treated patients, who lost an average of 10.5 letters during that time. Up to 34 percent of patients given the treatment had improved vision, with a gain of 15 letters or more, compared with a 5 percent improvement in the placebo group. Genentech plans to begin submitting trial data to the FDA on a rolling basis by the end of 2005 should it receive the fast-track designation it applied for earlier this month. The company is developing Lucentis in conjunction with Novartis AG"s ophthalmic unit; Genentech retains rights for North America, while Novartis retains rights for other countries.
  • NEW COMPOUND MAY REDUCE RISK OF VISION LOSS IN DIABETIC PATIENTS. Results of a multicenter international Phase III clinical trial led by Joslin Diabetes Center showed that 32 milligrams per day of ruboxistaurin (RBX) was well tolerated and may reduce the risk of moderate vision loss, especially in patients with diabetic macular edema. The purpose of the PKC-Diabetic Retinopathy Study (DRS), the results of which appeared in the July issue of Diabetes, was to evaluate the safety and effectiveness of RBX on retinopathy progression or visual loss in patients with moderately severe to very severe nonproliferative diabetic retinopathy. In the double-masked, randomized multiple-dose study, 252 patients with Type II or Type II diabetes received either RBX or a placebo over three to four years. The study measured the effect of three orally administered doses of RBX (8, 16 or 32 mg/day) on the progression of diabetic retinopathy, moderate visual loss and sustained moderate visual loss. The study was conducted at medical centers across the United States and at centers in Canada, Denmark, the Netherlands and the United Kingdom. Oral treatment with RBX inhibits the activity of protein kinase C-beta, which has been linked to diabetic complications of the eye and other parts of the body. Part of the treatment’s safety profile is that it is selective for protein kinase C-beta, according to researchers. The study was funded by Eli Lilly.
  • PHASE I TRIAL OF DME INTRAVITREAL IMPLANT BEGINS. SurModics, Inc., which provides surface modification and drug delivery technologies to the healthcare industry, has completed the first clinical implants of its I-vation intravitreal implant. The implantation procedures are part of a Phase I clinical study assessing the safety and tolerability of the device in patients with diabetic macular edema (DME) under an Investigational New Drug application with the FDA. The intravitreal implant delivers a drug via sustained release for more than a year, requires a minimally invasive procedure for implantation and can be removed once the drug has been fully released. (Current treatments being developed for DME usually require repeat injections into the eye every one to three months, often with a suboptimal drug dosing profile.) I-vation is among the drug delivery technologies that SurModics acquired in January 2005 as a result of its acquisition of InnoRx, Inc. Although the technology can be used for treating other conditions, SurModics’ initial focus is to use the technology to treat age-related macular degeneration (AMD) and DME.


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