Volume 5, Number 28
Monday, July 18, 2005



In this issue: (click heading to view article)
Rate of Eye Injury in the United States: Young White Men Most at Risk
Transmission of Retinal Laser Wavelengths Through Blood
A New Method for Measuring Prorenin Serum Levels
Visual Outcome Following Vitrectomy for Diabetic Retinopathy
Briefly











Rate of Eye Injury in the United States: Young White Men Most at Risk

Investigators at the University of Alabama at Birmingham conducted a study aimed at providing a comprehensive estimate of the rate of eye injury in the United States using data from the National Ambulatory Medical Care Survey (NAMCS), National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Hospital Discharge Survey (NHDS) for 2001. These surveys examined eye injuries treated in emergency departments, inpatient and outpatient facilities and private physicians’ offices. They also analyzed the rate of injury according to demographic characteristics and the distribution of the types and causes of eye injury.

Results showed that in the United States in 2001, an estimated 1,990,872 (6.98 per 1,000 people) individuals experienced an eye injury requiring treatment in an emergency department, inpatient or outpatient facility or private physician’s office. Most eye injuries are treated in emergency departments (50.7 percent), followed by private physicians’ offices (38.7 percent) and outpatient (8.1 percent) and inpatient (2.5 percent) facilities. Eye injury rates were highest among individuals in their 20s, males, and whites. Injury rates were highest for superficial injuries, foreign bodies, contusions and open wounds.

SOURCE: McGwin G Jr, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol 2005;123(7):970-6.		 Table of Contents











Transmission of Retinal Laser Wavelengths Through Blood

Treatment of retinal and choroidal diseases may be influenced by overlying blood. The Scheie Eye Institute of the University of Pennsylvania, Philadelphia, compared the penetration through blood of various laser wavelengths used in thermal photocoagulation, photodynamic therapy and transpupillary thermotherapy.

Researchers directed laser light of wavelengths 514 nm, 568 nm, 647 nm, 689 nm and 810 nm through normal saline (control), whole blood with a hematocrit of 40 percent, and serial dilutions of whole blood until they obtained a steady-state reading of laser power output. Laser power output was measured with an Orion Laser Power/Energy monitor (Ophir Optronics, Ltd.). It was measured in milliwatts and expressed as a percentage of control.

Results showed 514-nm and 568-nm laser wavelengths penetrated the least through all dilutions of blood tested (more than 60 percent attenuation through the highest dilution tested); 647-nm, 689-nm, and 810-nm laser wavelengths penetrated most effectively through blood but were still significantly attenuated (approximately 46 percent, 49.6 percent and 47.0 percent attenuation, respectively, at the highest dilution tested). The authors of the study believe that the presence of hemorrhage may have a significant effect on the delivery of laser energy to underlying structures and tissue, and that this may affect parameters used in thermal and nonthermal laser treatment of ocular diseases such as choroidal neovascularization.

SOURCE: Stoltz RA, Glazer-Hockstein C, Tolentino MJ, Maguire AM. Transmission of retinal laser wavelengths through blood. Retina 2005;25(4):498-502.		 Table of Contents











A New Method for Measuring Prorenin Serum Levels

Japanese researchers conducted a study aimed at investigating the serum levels of prorenin and its correlation with the severity of diabetic retinopathy. They divided 248 patients with diabetes and 108 control subjects into four groups: no-DR (146 patients), no proliferative DR (no-PDR, 78 patients), PDR (24 patients) and controls (108 patients). They measured serum levels of prorenin from all subjects using the new antibody activating direct kinetic (AAD-PR) assay and compared serum prorenin levels among the groups.

The serum levels of prorenin in the control, no-DR, no-PDR and PDR groups, respectively, were mean 109.1 (SD 66.1) pg/ml, 194.6 (SD 160.4) pg/ml, 271.5 (SD 220.3) and 428.4 (SD 358.4) pg/ml. Prorenin in the PDR group was remarkably high compared with the control and no-DR groups, and with the no-PDR group. Serum levels of prorenin increased with increasingly severe retinopathy. Investigators found no correlation between the prorenin level and the duration of disease or HbA(1c). They concluded that increased levels of prorenin in diabetes may have an important role in the pathogenesis of DR.

SOURCE: Yokota H, Mori F, Kai K, et al. Serum prorenin levels and diabetic retinopathy in type 2 diabetes: new method to measure serum level of prorenin using antibody activating direct kinetic assay. Br J Ophthalmol 2005;89(7):871-3.		 Table of Contents











Visual Outcome Following Vitrectomy for Diabetic Retinopathy

Pre-operative and post-operative iris neovascularization (INV), post-operative macular ischemia and post-operative vitreous hemorrhage (VH) appear to be risk factors for light perception (LP) and no light perception (NLP) vision following diabetic vitrectomy, according to a study by the University of Alabama at Birmingham.

In a retrospective medical record review, investigators examined the charts of 100 consecutive patients who underwent vitrectomy for proliferative diabetic retinopathy between November 1, 1997, and November 30, 1998. Surgical technique included standard pars plana vitrectomy with combination of delamination and segmentation of gliotic tractional membranes using bimanual techniques. All patients had post-operative follow-up of at least 12 months. Investigators analyzed several factors for their effect on poor visual outcome (LP and NLP) using Fisher"s exact test.

Post-vitrectomy, 73 percent of diabetic patients had stable or improved vision; 16 percent had worsened but functional vision (defined as worse but still 20/400 or greater); 4 percent had worsened but ambulatory vision (defined as worse but still count fingers [CF] or hand motion [HM]); and 7 percent had poor visual outcome, LP or NLP. Resultant visual acuity was 20/40 or greater in 38 percent of patients, 20/50 to 20/100 in 34 percent, 20/120 to CF in 18 percent, HM in 3 percent, LP in 4 percent and NLP in 3 percent of patients. Risk factors for eyes with LP and NLP vision included pre-operative iris neovascularization (INV), post-operative INV, post-operative macular ischemia, and post-operative vitreous hemorrhage (VH). The authors of the study note that overall improvements in surgical technique and visual outcome continue to be reported.

SOURCE: Mason JO 3rd, Colagross CT, Haleman T, et al. Visual outcome and risk factors for light perception and no light perception vision after vitrectomy for diabetic retinopathy. Am J Ophthalmol 2005; Jun 28 [Epub ahead of print].		 Table of Contents










BRIEFLY
  • B&L TO ACQUIRE CHINA’S LEADING OPHTHALMIC PHARMACEUTICALS COMPANY. Bausch & Lomb has entered into a definitive agreement to acquire a 55 percent controlling interest in the Shandong Chia Tai Freda Pharmaceutical Group (CTF), China’s leading ophthalmic pharmaceutical company, from Sino Biopharmaceutical Ltd, for $200 million. B&L has also agreed in principle to a future acquisition of an additional 15 percent interest in CTF for $54.5 million. CTF primarily develops, manufactures and markets medications for treating ocular inflammation and infection, glaucoma and dry eye. Its products include the Moisten and Mioclear lines of eye drops. CTF recorded sales of US $62 million in 2004. The acquisition is expected to close in the third quarter of 2005.
  • CIBA VISION SEEKS RESTRAINING ORDER AGAINST VISTAKON OVER SILICONE HYDROGEL TECHNOLOGY. CIBA Vision has filed suit against Johnson & Johnson’s Vistakon division for infringement of CIBA Vision’s patent rights to silicone hydrogel contact lens technology. The lawsuit, filed by CIBA Vision in the Federal District Court for the Middle District of Florida in Jacksonville, seeks to halt a planned launch of a Vistakon silicone hydrogel extended-wear contact lens product. CIBA Vision asserts that its "Nicolson" patents protect the company’s proprietary Night & Day and O2Optix contact lens technologies. The patents were the subject of protracted global litigation with Bausch & Lomb, resulting in a 2004 license granted to Bausch & Lomb in exchange for a royalty payable to CIBA Vision through 2014 in the United States and through 2016 in other countries. CIBA Vision has asked the Florida court to issue a temporary restraining order to prevent Vistakon from manufacturing, marketing and distributing its silicone hydrogel product; it will ultimately seeks to permanently prevent Vistakon from infringing on its patents.
  • GENAERA INITIATES PHASE III AMD TRIAL FOR EVIZON. Genaera has begun the first of two planned global Phase III clinical trials of its systemically administered anti-angiogenic drug, Evizon (squalamine lactate), for the treatment of "wet" age-related macular degeneration (AMD). The identical international Phase III studies will enroll subjects with predominantly classic, minimally classic and occult forms of wet AMD. Each study is a multi-center, randomized, double-masked controlled trial and will evaluate two systemically-administered doses of Evizon (40 mg and 20 mg) versus placebo, dosed weekly for four weeks, followed by maintenance doses every four weeks until Week 104. Photodynamic therapy with QLT"s Visudyne will be allowed for all subjects if deemed necessary by the study physician. The total number of subjects enrolled in each Phase III study will be based on analyses of data from the company"s existing and ongoing Phase II clinical trials, as agreed upon with the FDA. Genaera anticipates launching its second Phase III trial in the second half of 2005. The studies’ objectives are to demonstrate safety and significant clinical benefit of Evizon therapy on visual acuity at one year in the study eye. Planned secondary analyses include evaluation of changes in visual acuity from baseline in the study eye at Year Two and change in visual acuity in fellow eyes affected with wet AMD and quality of life at Years One and Two.
  • IRIDEX AND INNOVATECH SURGICAL ENTER JOINT LICENSING AGREEMENT. IRIDEX Corp. and Innovatech Surgical, Inc., have entered a joint marketing and licensing agreement in which IRIDEX obtains worldwide distribution rights to Innovatech"s current and future disposable endo ocular probes, while Innovatech will license IRIDEX’s proprietary probe/laser connector. The agreement increases the consumable probe offering that IRIDEX currently offers ophthalmologists and gives its customers greater clinical versatility and a wider selection of probes compatible with IRIS Medical laser photocoagulators.


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