Volume 4, Number 47
Monday, November 22, 2004



In this issue: (click heading to view article)
Editorial: Correct Priorities
Levels of Free UV Filters and Amino Acids in Cataract vs. Normal Lenses
Outcome of CNV in Angioid Streaks After Photodynamic Therapy
Fundus Autofluorescence vs. Photopic and Scotopic Fine-matrix Mapping in Retinitis Pigmentosa and Normal Acuity Patients
Juvenile Arthritis-associated Uveitis: Visual Outcomes and Prognosis
Briefly











Editorial: Correct Priorities

First and foremost, I want to extend my sincerest gratitude to my many colleagues who took the time to write and extend to me their wishes for a successful and fulfilled life in Naples, FL. I was indeed touched by the kindness and sincerity that they displayed.

To stay busy while I await my return to clinical practice, I have traveled throughout the South speaking with many ophthalmologists about a variety of pharmaceuticals. I have enjoyed meeting many of you, and I appreciate your warm welcome. Interestingly, I have observed vast similarities among many of those whom I’ve visited, in terms of practice frustrations, insurance anxieties and your obvious desire for knowledge and a better understanding regarding what is best for your patients. It was the latter issue that affected me most. Physicians really want to help their patients, and anything they can glean from another colleague in terms of medical or surgical eyecare is readily absorbed. By far, you are a kind and generous lot, while being inquisitive, honest and direct. I learned from you, my fellow ophthalmologists, and I hope you have learned from me.

Please accept Bev’s and my warmest wishes for a Happy Thanksgiving to you and yours.
Stephen E. Pascucci, MD
Medical Editor
[email protected]

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Levels of Free UV Filters and Amino Acids in Cataract vs. Normal Lenses

Investigators at the Australian Cataract Research Foundation, University of Wollongong, New South Wales, Australia, conducted a study aimed at determining the levels of free ultraviolet (UV) filters and selected amino acids in cataract lenses compared with the levels in normal lenses.

Thirty-nine cataract lenses and six normal lenses were examined by high performance liquid chromatography to quantify levels of UV filter compounds, the UV filter precursor amino acid tryptophan (Trp) and tyrosine (Tyr) and uric acid. The levels of the two major primate UV filters, 3-hydroxykynurenine glucoside (3OHKG) and 4-(2-amino-3-hydroxyphenyl)-4-oxobutanoic acid glucoside (AHBG), in cataract lenses were markedly decreased compared with levels in normal lenses. By contrast, the levels of Trp were greatly increased in cataract lenses. Mean Trp concentrations were an order of magnitude higher than in normal lenses, with 86 percent of dark-colored cataract lens nuclei having Trp concentrations greater than the mean level in the normal lenses. The concentrations of Tyr were also higher in cataract lenses, but the levels of kynurenine were unchanged, and the uric acid levels were substantially lower.

These results suggest that the metabolism of a large proportion of patients with cataract may be substantially different than in persons with normal lenses. Although the mechanism of such metabolic defects is unknown, the authors of this study believe that an amino acid transporter system may be upregulated in patients with cataract. Because kynurenine levels in cataract were not significantly different from those of normal lenses, they believe that there may be a defect in the lenticular UV filter pathway at one or both of the steps that convert kynurenine to 3OHKG.

SOURCE: Streete IM, Jamie JF, Truscott RJ. Lenticular levels of amino acids and free UV filters differ significantly between normals and cataract patients. Invest Ophthalmol Vis Sci 2004;45(11):4091-8.		 Table of Contents











Outcome of CNV in Angioid Streaks After Photodynamic Therapy

Researchers at Italy’s University of Florence evaluated the visual and anatomic outcomes of photodynamic therapy for choroidal neovascularization (CNV) in patients with angioid streaks.

The authors retrospectively evaluated 40 consecutive patients (48 eyes) with visual acuity of 20/200 or greater who were treated at six referral centers for CNV associated with angioid streaks. Main outcome measures were visual acuity, greatest linear diameter of the lesion and, in patients with nonsubfoveal CNV, distance from the foveola.

Of 34 eyes with subfoveal CNV, 21 were followed up for at least 12 months (range, five to 33 months). Median visual acuity was 20/50 at baseline and 20/120 at the final examination. The 12-month estimate of the percentage of eyes with vision loss of fewer than three lines was 68 percent (95 percent confidence interval [CI], 50 to 85 percent) by using survival analysis, whereas eyes with no increase in the greatest linear diameter were 45 percent (95 percent CI, 27 to 62 percent). Eleven eyes had extrafoveal CNV and three had juxtafoveal CNV. Of these 14, 12 were followed up for at least 10 months (range, four to 36 months). Visual acuity was 20/40 or greater in all eyes with extrafoveal lesions at baseline and in five of 12 eyes at the last examination, when three cases of CNV had become subfoveal. At baseline, visual acuity was low in two eyes with juxtafoveal CNV and nearly normal in the third. It remained substantially stable at the end of follow-up (range, 10 to 36 months), when two lesions were subfoveal.

Most of the patients in the study had good baseline visual function and were thus at high risk for losing vision because of the poor prognosis of CNV in angioid streaks. Because most had no or limited vision loss after one year, the authors suggest that photodynamic therapy can be used to try to limit or delay visual damage caused by this aggressive disease.

SOURCE: Menchini U, Virgili G, Introini U, et al. Outcome of choroidal neovascularization in angioid streaks after photodynamic therapy. Retina 2004;24(5):763-71. 		Table of Contents










Fundus Autofluorescence vs. Photopic and Scotopic Fine-matrix Mapping in Retinitis Pigmentosa and Normal Acuity Patients

High-density rings of fundus autofluorescence (AF), which are present in some patients with retinitis pigmentosa (RP) with normal visual acuity, demarcate areas of preserved central photopic sensitivity. Scotopic sensitivity losses encroach on areas within the ring of high density and may reflect dysfunction before accumulation of lipofuscin, according to researchers at the Moorfields Eye Hospital and the Institute of Ophthalmology in London.

The study compared psychophysically determined spatial variations in photopic and scotopic sensitivity across the macula in patients with RP and normal visual acuity who manifest an abnormal high-density ring of AF. Eleven patients with a clinical diagnosis of RP were examined, all of whom had rod-cone dystrophy (International Society for Clinical Electrophysiology of Vision standard ERGs), visual acuity of 20/30 or better and an abnormal parafoveal annulus of high-density AF. Researchers performed fine-matrix mapping (FMM) over macular areas of abnormal high-density AF under photopic and dark-adapted conditions. They performed pattern ERGs (PERGs) in nine of 11 patients by using different sizes of circular checkerboards.

Rings of high-density AF varied between patients (approximately 3 degrees to 18 degrees in diameter). Photopic sensitivity was preserved over central macular areas, but there was a gradient of sensitivity loss over high-density segments of the ring and severe threshold elevation outside the arc of the ring. Scotopic sensitivity losses were more severe, and they encroached on areas within the ring. The radius of the high-density ring correlated with the lateral extent of preserved photopic sensitivity and PERG data.

SOURCE: Robson AG, Egan CA, Luong VA, et al. Comparison of fundus autofluorescence with photopic and scotopic fine-matrix mapping in patients with retinitis pigmentosa and normal visual acuity. Invest Ophthalmol Vis Sci 2004;45(11):4119-25. 		Table of Contents







Juvenile Arthritis-associated Uveitis: Visual Outcomes and Prognosis

The current issues in the management of uveitis associated with juvenile arthritis revolve mainly around the treatment of mild disease and how to treat patients with more severe disease. The aims of this study were to determine the incidence of uveitis in a cohort of patients with juvenile arthritis as well as the nature of treatment and the risk factors for visual loss.

The investigators reviewed the charts of 71 patients (47 girls and 24 boys) aged 16 months to 13 years, who had juvenile arthritis as defined by the American Academy of Rheumatology and who were seen between 1992 and 2001 at a combined rheumatology and ophthalmology clinic. The median age at diagnosis of juvenile arthritis was four years and one month. Twenty-seven patients (38 percent) had uveitis; the median age at uveitis onset was 5.9 years, with an average interval of 18 months from the diagnosis of arthritis; 11 patients had uveitis at the time of arthritis diagnosis. Information collected included rheumatologic diagnosis, results of serologic testing and details of systemic and topical treatments.

Results showed a positive relation between antinuclear antibody positivity and the development of uveitis. Thirteen (48 percent) of the 27 patients with uveitis had mild anterior segment inflammation with fewer than 25 cells in the anterior chamber. This group had spontaneous resolution of uveitis without topical therapy. All the patients without uveitis had a final visual acuity of 6/9 (20/30) or better. Five of the patients with uveitis had a final visual acuity of 6/36 (between 20/100 and 20/125) or worse. Cataract was the most common complication affecting visual outcome. Cataract extraction initially improved the visual acuity, but posterior segment complications and glaucoma compromised the final visual outcome.

SOURCE: Chen CS, Roberton D, Hammerton ME. Juvenile arthritis-associated uveitis: visual outcomes and prognosis. Can J Ophthalmol 2004;39(6):614. 		Table of Contents




BRIEFLY
  • PHASE III TRIAL DATA IN FOR POST-CATARACT SURGERY TREATMENT. ISTA Pharmaceuticals has released integrated results for the company"s two Phase III studies of Xibrom (bromfenac sodium ophthalmic solution) 0.1%, a topical, twice-daily, nonsteroidal anti-inflammatory solution. Xibrom is initially being developed for the treatment of ocular inflammation, eye pain and photophobia following cataract surgery. In the two double-masked, placebo-controlled Phase III studies conducted under a single protocol, a statistically significant proportion of patients treated with Xibrom achieved treatment success, defined by the complete absence of ocular inflammation, as compared to placebo. Analyses of the Phase III data also showed that Xibrom"s treatment effect was evident as early as Day Three. Results also showed that the treatment was well-tolerated, with a lower incidence of ocular adverse events compared with those in the placebo treatment group. The incidence of burning and stinging was less than 2.5 percent in the Xibrom group, and efficacy and safety findings were consistent with results of previous studies of the product conducted in Japan by Senju Pharmaceuticals.
  • NEW PHARMACEUTICAL WEBSITE LAUNCHED. The Pharmaceutical Research and Manufacturers of America (PhRMA) recently announced the launch of its Innovation.org [add link] website. The site provides a one-stop resource for timely health information; interactive features on the science, challenges, impact and future of pharmaceutical innovation; current debates and commentary from leading healthcare experts; an information database for medicines in development; information about the researchers behind new treatments and about patients who may benefit from them; and a description of how many pharmaceutical compounds are manufactured. PhRMA represents leading research-based pharmaceutical and biotechnology companies in the United States. The industry invested more than $33.2 billion in 2003 to discovering and developing new medicines. For more information on PhRMA, visit http://www.phrma.org.
  • ABSORBABLE TEMPORARY PUNCTAL PLUG TO DEBUT IN 2005. Medennium, Inc., is launching Xsorb, a synthetic, absorbable temporary plug, for worldwide sale in early 2005. Xsorb is a short-term plug designed for occlusion in refractive and cataract patients or in any short-term occlusion therapy requiring less than three months of treatment. For more information, go to www.medennium.com or call (888) 727-6100 in the United States.
  • FDA APPROVES EPI-LASIK ENHANCEMENT. Ophthalmic devices company Norwood EyeCare, a subsidiary of Norwood Abbey Ltd., has received 510(k) clearance from the FDA for its new 9.0-mm version of the suction ring used in its Centurion SES Epikeratome with EpiEdge for Epi-LASIK. The new device allows surgeons to choose the ring most suitable for the size of the eye, thus reducing the chance of involvement of epithelial stem cells at the limbus. The suction ring will continue to be available in its current 10.0-mm size as well. The company’s bladeless Epi-LASIK technology provides the benefits of LASIK but aims to reduce trauma to the eye and the risk of LASIK-induced dry eye, facilitating faster recovery and less postoperative pain. For more information on Norwood EyeCare, go to www.norwoodeyecare.com.

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