Volume 3, Number 11

Monday, March 17, 2003

In this issue: (click heading to view article)
		Nitric Oxide May Contribute to Development of ARMD
		Glaucomatous Visual Field Defects in Patients with Migraine
		Diclofenac Sodium 0.1% for Vernal Keratoconjunctivitis
		Retinal Detachment Without Macular Hole in Highly Myopic Eyes
		PRK and Use of Night Vision Goggles
		Briefly

Nitric Oxide May Contribute to Development of ARMD A Turkish study suggests that the free radical nitric oxide may contribute to the development of age-related macular degeneration. A study by Inönü University at Turkey’s Ozal Medical Center has shown that nitric oxide (NO), the most abundant free radical in the body, may be implicated in the pathophysiology of age-related macular degeneration (ARMD) in association with decreased antioxidant enzymes and increased lipid peroxidation status. NO, hydroxyl radical (OH), superoxide anion (O2-) and hydrogen peroxide (H2O2) are free radicals released in oxidative stress. Superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase (CAT) are antioxidant enzymes, mediating defense against oxidative stress. Excess NO and/or defective antioxidants cause lipid peroxidation, and cellular dysfunction and death. This multicenter, double-blind, cross-sectional study investigated plasma NO and lipid peroxidation levels in relation to antioxidant enzyme activities in erythrocyte and plasma of patients with ARMD, compared with healthy control subjects. Researchers measured NO, lipid peroxidation (measured as plasma malondialdehyde [MDA] levels) and the catalytic activity of SOD, GSHPx and CAT in 41 patients with maculopathy (19 men, 22 women; 67.12 +/- 3.70 years). They compared them with measurements from 25 age- and sex-matched healthy control subjects without maculopathy (12 men, 13 women; 68.04 +/- 3.02 years). NO and MDA levels were measured in plasma, CAT in red blood cells, and SOD and GSHPx in both plasma and red blood cells. Researchers used color fundus photographs to assess the presence of maculopathy. Maculopathy patients were divided into two groups using clinical examination and grading of photographs: 22 were categorized as early-ARM and 19 were categorized as late-ARMD. All patients with maculopathy had significantly higher plasma NO levels than control subjects (mean +/- standard deviation: 48.58 +/- 8.81 vs. 28.22 +/- 3.39 µmol/l). Plasma MDA levels in patients and control subjects were 4.99 +/- 1.00 and 2.16 +/- 0.24 µmol/l, respectively. On the other hand, SOD and GSHPx activities were significantly lower in both red blood cells and plasma of maculopathy patients than in control subjects. Red blood cell CAT levels did not differ between groups. Late-ARMD patients had significantly lower antioxidant enzyme levels and higher MDA levels than early-ARM patients. In addition, plasma NO and MDA levels correlated negatively with SOD and GSHPx activities.

SOURCE: Evereklioglu C, Er H, Doganay S, et al. Nitric oxide and lipid peroxidation are increased and associated with decreased antioxidant enzyme activities in patients with age-related macular degeneration. Documenta Ophthalmologica 2003;106(2):129-36.

Glaucomatous Visual Field Defects in Patients with Migraine This study investigated the visual fields in patients with migraine relative to glaucomatous visual field defects. Patients with headaches diagnosed as migraine were enrolled in the study. Researchers questioned each patient about frequency, side, localization and severity of the pain, as well as onset and duration of symptoms, existence and description (if present) of aura, additional systemic problems and family history of migraine and glaucoma. Clinicians then performed detailed ophthalmological examinations and computerized visual field (VF) analysis on 77 patients (61 female, 16 male), and made statistical comparisons between the group of patients with glaucomatous-like VF defects and the group without significant defects. VF tests revealed glaucomatous-like defects in 48 (62.3 percent) of 77 patients. Intraocular pressure (IOP) levels were within normal limits in all cases. Researchers observed no statistically significant differences between the groups with and without VF defects related to sex, localization and severity of pain, existence and description of aura, or family history of glaucoma; nor did they see differences related to duration of migraine, IOP or cup/disc ratio. The glaucomatous group was significantly older, with a significantly higher age of onset for migraine. Risk of having glaucomatous-like defects was higher in patients who had migraine attacks once a month or less frequently. The study showed a tendency of pain and VF defects to develop ipsilaterally. The authors conclude that a possible relationship exists between the pathophysiology of migraine, visual field defects and glaucomatous optic neuropathy; they recommend VF screening for normal tension glaucoma for patients with migraine.

SOURCES: Comoglu S, Yarangumeli A, Gurbuz Koz O, et. al. Glaucomatous visual field defects in patients with migraine. J Neurol 2003;250(2):201-6.

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Diclofenac Sodium 0.1% for Vernal Keratoconjunctivitis Researchers in this study found that diclofenac sodium 0.1% eye drops are safe and effective for treating VKC. Researchers at Italy’s University of Rome, the Civil Hospital of Mestre, and the G.B. Bietti Eye Foundation conducted a study showing that prolonged treatment of vernal keratoconjunctivitis (VKC) patients with preservative-free diclofenac sodium 0.1% eye drops provides safe and effective relief of VKC signs and symptoms. The prospective open study was performed in 22 patients with VKC. Subjects used the drops four times daily in both eyes for 120 days. Researchers graded and statistically evaluated signs (papillae, hyperemia and corneal lesions) and symptoms (itching, redness and photophobia) of the ocular surface before and after treatment, using a non-parametric test (Mann-Whitney U-test). At the end of treatment, 40 percent of the patients showed an improvement in their symptoms. Total signs and symptoms scores were significantly decreased at the end of treatment compared with the baseline values (from 6.13 +/- 1.45 to 0.81 +/- 0.90 and from 5.40 +/- 1.18 to 2.63 +/- 0.95, respectively). Researchers saw significant decreases in conjunctival redness, itching, photophobia and conjunctival hyperemia, and they observed no significant differences for corneal lesions and papillary size. No patient showed exacerbation of the disease during treatment.

SOURCE: D’Angelo G, Lambiase A, Cortes M, et al. Preservative-free diclofenac sodium 0.1% for vernal keratoconjunctivitis. Graefe’s Arch Clin Exper Ophthalmol Feb 2003 (online publication date);doi:10.1007/s00417-002-0612-6.

Retinal Detachment Without Macular Hole in Highly Myopic Eyes A study by the Tokyo Medical and Dental University Graduate School, Tokyo, Japan, found a significant prevalence level of foveal retinal detachment without macular hole in patients with highly myopic eyes who had severe myopic degenerative changes and posterior staphyloma. Clinicians performed complete ophthalmic examinations and studied cross-sectional images of the macula with optical coherence tomography (OCT) in 134 eyes of 78 consecutive patients with high myopia (refractive error of -8D or more). The patients were divided into two groups according to the presence (Group One: 78 eyes of 45 patients) or absence (Group Two: 56 eyes of 33 patients) of posterior staphyloma. Slitlamp examination with a Goldmann three-mirror lens indicated that none of the eyes had a macular hole. In seven (9.0 percent) of eyes in Group One, OCT revealed foveal retinal detachment, and 2 of those 7 had foveal retinoschisis. OCT revealed no retinal detachment or retinoschisis in any eye in Group Two. Visual acuity of the seven eyes with foveal retinal detachment in Group One ranged from 20/40 to 20/200. Two of these 7 eyes had visual acuity 20/50 or better. No patients complained of recent, progressive visual impairment. All 7 eyes with foveal retinal detachment had severe myopic fundus changes (focal chorioretinal atrophy or bare sclera). In eyes with this type of retinal detachment, visual acuity varies and foveal retinal detachment tends to be missed on routine examination. Researchers suggest periodic examination by OCT in patients with highly myopic eyes who have severe myopic degenerative changes and posterior staphyloma.

SOURCE: Baba T, Ohno-Matsui K, Futagami S, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia. Am J Ophthalmol 2003;135(3):338-42.

PRK and Use of Night Vision Goggles A study conducted by the Ophthalmology Service and the Center for Refractive Surgery at Walter Reed Army Medical Center, Washington, DC, shows that soldiers who have undergone photorefractive keratectomy (PRK) show no significant loss of visual acuity postoperatively and no change in best-corrected visual resolution using night vision goggles (NVGs). Uncorrected visual resolution was significantly enhanced compared with preoperative levels. These findings may translate into better function for soldiers who are unable to or choose not to use optical correction in operational environments. In the nonrandomized, comparative self-controlled trial, researchers measured visual acuity with best optical correction preoperatively and 3 months postoperatively in 19 patients (38 eyes) of active-duty U.S. Army Special Forces soldiers who underwent PRK for myopia and astigmatism. They used acuity charts of various contrast (100, 10, 2.5, 1.25 percent). They assessed preoperative and postoperative (3-month) uncorrected and best-corrected visual resolutions through NVGs using a high-contrast tribar chart presented at four light levels (3.44 x 10-3, 1.08 x 10-3, 1.04 x 10-4, 1.09 x 10-5 foot-Lamberts) simulating a range of night sky conditions. Subjects were trained before testing. Results showed no significant loss of visual acuity across a range of contrast levels 3 months postoperatively: Uncorrected visual acuity at the 3-month assessment was >/= 20/20 in 33 (86.8 percent) of 38 eyes. No eyes lost 2 or more lines of best spectacle-corrected visual acuity. Preoperative and 3-month postoperative best-corrected low-contrast acuity measurements showed no significant differences at all levels of resolution. Researchers also observed no change in best-corrected NVG visual resolution postoperatively. Preoperative visual resolution through NVGs decreased systematically with decreasing night sky conditions, while visual acuities before PRK were reduced without optical correction. Postoperative visual performance with NVGs (without optical correction) equaled or exceeded performance preoperatively with best correction.

SOURCE: Subramanian PS, O'Kane B, Stefanik R, et al. Visual performance with night vision goggles after photorefractive keratectomy for myopia. Ophthalmol 2003;110(3):525-30.

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BRIEFLY PHACOPEARLS.COM CONTEST SEEKS PEARLS. Phacopearls.com, the online exchange for cataract surgeons edited by Mark Jofe, M.D., announces a "Best Case Contest." Techniques or "pearls" in cataract surgery submitted in video form to Phacopearls.com will be judged on their usefulness to other cataract surgeons. The winning case will be showcased in an upcoming issue of Review Of Ophthalmology. The deadline for entry is June 15, 2003. Videos may be submitted, edited or not. Materials may be sent in PAL, NTSC, Mpeg1, AVI or DV format. Log on to http://www.Phacopearls.com for instructions. Any contest-related questions may be addressed to jofe@phacopearls.com. Share your expertise. PARAGON LAUNCHES CRT EDUCATION AND MARKETING PROGRAM. Paragon Vision Sciences recently launched an in-office educational and marketing program aimed at adolescent corneal refractive therapy (CRT) patients. (In June 2002, Paragon received FDA marketing clearance for CRT that did not restrict its use to adults.) The adolescent-geared materials are provided to certified Paragon CRT practitioners in their Practice Management Kit, a comprehensive marketing kit included with their Diagnostic Dispensing System. For more information, call 800-528-8279 or click here. COMPACT LIGHTING AVAILABLE FOR LOW-VISION PATIENTS. Connecticut-based Eschenbach Optik of America has introduced the Mobilight, a compact, portable task light for low-vision patients. The Mobilight uses LED bulbs and incorporates a diffuser to provide a wide field of view and uniform illumination; it runs on two AA batteries, which are included. For more information call Eschenbach at 800-487-5389. TLCVISION BUYS AMERICAN EYE INSTRUMENTS. Toronto-based TLC Vision Corp., which was formed from the 2002 merger of TLC Laser Eye Centers and Laser Vision Centers, has purchased American Eye Instruments Inc. of Gold Beach, Ore. TLC will integrate the privately held company into its Midwest Surgical Services unit, a cataract outsource provider. It expects the purchase to help boost profits in its cataract business to 10 percent of this year’s revenue.

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