Volume 3, Number 17

Monday, April 28, 2003

In this issue: (click heading to view article)
		Screening Older Patients for Disability, Depression and Dementia
		Pigment Epithelium-Derived Factor May Predict Progression of Diabetic Retinopathy
		Psychometric Performance in Visually Normal Latinos: The Los Angeles Latino Eye Study
		Vitreous Aspiration Needle Tap Successful in Differentiating Uveitis Causes
		Briefly

Screening Older Patients for Disability, Depression and Dementia Screening for geriatric syndromes in an ophthalmology clinic is rapid and easy to perform, and may detect a significant number of patients with functional disability, depression, and possible dementia, according to a study by the University of Iowa, Iowa City. In a prospective pilot survey study, researchers examined 50 consecutive ophthalmology clinic outpatients older than 64 years with visits to the comprehensive eye clinic and the neuroophthalmology clinic at the University of Iowa. They asked suitable subjects to complete a short questionnaire on instrumental activities of daily living, to answer a single question on depression, and to complete a clock drawing task in the office waiting room or examination room. The 50 questionnaires showed that 94 percent of respondents were functional in instrumental activities of daily living, 80 percent had normal clock drawing results, and 80 percent were not depressed. A significant minority, however, were identified by the screening to have functional impairment (6 percent), abnormal clock drawing results (20 percent), or depression (20 percent). These patients were offered geriatric assessment. The tests were rapid (fewer than 5 minutes to perform) and easy to administer. The study’s authors comment that the impending demographic shift in the United States toward an older population makes this an especially pertinent issue. They also point out that ophthalmology clinics and practices tend to have a higher number of elderly patients compared to other medical and surgical clinics, and that screening for depression, dementia and functional impairment has proven useful in other clinical settings. In addition, patients who have such conditions may not be able to cognitively process or interpret what they see, and may therefore misinterpret this inability as a visual problem.

SOURCE: Lee AG, Beaver HA, Jogerst G, Daly JM. Screening elderly patients in an outpatient ophthalmology clinic for dementia, depression, and functional impairment. Ophthalmol 2003:110(4):651-57.

Pigment Epithelium-Derived Factor May Predict Progression of Diabetic Retinopathy Pigment epithelium-derived factor is an important negative regulator of angiogenic activity of aqueous humor, and its content in the aqueous humor of diabetic patients strongly predicts who among them will develop progression of retinopathy, according to researchers at Germany’s University of Ulm Medical School. With the goal of determining the predictive value of pro-angiogenic and anti-angiogenic markers for progression of retinopathy, researchers collected aqueous humor at cataract surgery from 32 diabetic patients who had no or very mild retinopathy (ETDRS stage </= 20) and 33 normoglycemic control subjects. They determined the content of pro-angiogenic vascular endothelial growth factor (VEGF) and angiogenic inhibitor pigment epithelium-derived factor (PEDF), and quantified angiogenic activity by measuring its effect on the migration of capillary endothelial cells. They followed the probands for a maximum of 75 months to learn the predictive value of the initial level of these markers for progression of retinopathy. In the aqueous fluid, content of VEGF increased in diabetic patients (mean values 492 vs. 292 pg/ml), and PEDF values decreased (mean values 1740 vs. 3680 ng/ml) compared to control subjects. Of the diabetic patients, 10 progressed during follow-up (ETDRS stage > 47B). This subgroup showed lower PEDF content when compared to non-progressors and control subjects. Migratory activity in samples of patients from the control group and in diabetic patients without progression was generally inhibitory because of PEDF. Inhibition was blocked by neutralizing antibodies to PEDF. In diabetic patients, initial angiogenic activity was higher than controls and non-progressors in those who later developed retinopathy. Both PEDF and migratory response predicted progression.

SOURCES: Boehm BO, Lang G, Volpert O, et al. Low content of the natural ocular anti-angiogenic agent pigment epithelium-derived factor (PEDF) in aqueous humor predicts progression of diabetic retinopathy. Diabetologia 2003;46(3):394-400.

Psychometric Performance in Visually Normal Latinos: The Los Angeles Latino Eye Study A study by the Department of Pharmaceutical Economics and Policy at the University of Southern California, Los Angeles, shows that inconsistencies occur when the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) is administered to visually normal Spanish-speaking Latinos versus English speakers. The results, say investigators, suggest that these differences in psychometrics (the design and analysis of research and the measurement of human characteristics) must be taken into account in the development of population norms of visual function. The Los Angeles Latino Eye Study (LALES) is a population-based study to assess the prevalence of eye disease and self-reported visual functioning in Latinos aged 40 or older. Researchers assessed self-reported visual functioning by using English and Spanish versions of the NEI VFQ-25. Psychometric properties of the NEI VFQ-25, including internal consistency of the subscales and the individual items, were assessed through the Multi-trait Analysis Program-Revised (MAP-R) analysis. Adjusted mean and median subscale scores were compared between English and Spanish speakers to identify any systematic differences. Of the 1,917 participants from two census tracts, 1,171 participants with no visual impairment were included in this analysis. The mean age of the participants was 52.3 years, 57 percent of the participants were female, and 67.5 percent of the participants were Spanish speaking. Median scores for Spanish-speaking participants were significantly lower than those of the English-speaking participants on four subscales: Ocular Pain, General Vision, Vision-Specific Mental Health, and General Health. Internal consistency for three of eight measurable subscales for the study group was poor (Cronbach alpha < 0.6). Researchers suggest that further detailed psychometric evaluation is necessary to determine the validity of the NEI VFQ-25 in Latino populations.

SOURCE: Globe D, Varma R, Azen SP, et al. (the Los Angeles Latino Eye Study Group). Psychometric performance of the NEI VFQ-25 in visually normal Latinos: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci 2003;44(4):1470-8.

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Vitreous Aspiration Needle Tap Successful in Differentiating Uveitis Causes Vitreous aspiration needle tap appears to be a safe clinical procedure with a high success rate in differentiating among infectious, inflammatory and malignant causes of uveitis, according to a study by London’s Moorfields Eye Hospital. The procedure is quick and can be completed at the first outpatient visit. In a retrospective, noncomparative case series, clinicians collected data on 53 patients who had undergone vitreous aspiration needle tap (using a needle and syringe) as outpatients in the clinic. The patients underwent the tap for the following indications: when masquerade syndrome or infective retinitis was the primary diagnosis, and to diagnose or exclude infective or malignant entities in patients not responding to treatment. Researchers determined results of the analysis of the biopsy specimen and any complications that arose from the procedure. Vitreous aspiration needle tap generated an adequate sample for the relevant investigations in 92 percent of cases. Clinicians confirmed the initial diagnosis of intraocular malignancy or infection in 40 percent of patients. They treated the remaining patients with immunosuppressives for the ocular inflammation, and all showed clinical improvement over the follow-up period. Four patients required multiple procedures: two to make the diagnosis of B-cell intraocular lymphoma, and two with acute retinal necrosis who were treated for the presenting clinical features.

SOURCE: Lobo A, Lightman S. Vitreous aspiration needle tap in the diagnosis of intraocular inflammation. Ophthalmol 2003;110(3):595-99.

BRIEFLY ALLERGAN AND ACADIA COLLABORATE ON DRUG DEVELOPMENT. Allergan has collaborated with Acadia Pharmaceuticals, a California-based drug discovery and development company dedicated to discovering novel small-molecule drug candidates with a proprietary chemical-genomics platform. The collaboration focuses primarily on eyecare applications and is the third major arrangement of this kind between the two companies since 1997. Under the agreement, Allergan will have the exclusive right to license chemistry and related assets for up to three drug targets, while Acadia will receive an up-front payment, research funding and additional fees over three years. It is also eligible to receive license fees, milestone payments and royalties on future product sales worldwide. DISTRIBUTION RIGHTS SECURED FOR CAPSULAR TENSION RING. Advanced Medical Optics, Inc. (AMO), manufacturer of ophthalmic surgical devices and eyecare products, has secured distribution rights for a capsular tension ring developed by Netherlands-based Ophtec BV. After FDA approval is granted, the device will be known as StabilEyes capsular tension ring. The ring is used in posterior chamber intraocular lens implantation when capsular bag integrity is compromised. Under the terms of the agreement, Ophtec will be responsible for obtaining FDA approval, after which AMO plans to introduce the product initially in the North American market. INFINITI VISION SYSTEM DEBUTS. Alcon, Inc. introduced a tri-modal cataract removal surgical instrument, the Infiniti Vision System, during the American Society of Cataract and Refractive Surgery (ASCRS) Symposium this month. The instrument supplies surgeons with a choice of three methods for removing a cataract: advanced ultrasound phacoemulsification alone, a combination of ultrasound and oscillation provided by the NeoSoniX handpiece, or Alcon's AquaLase liquefaction device that generates pulses of surgical solution to safely break up and remove the natural lens material. The Infiniti Vision System was developed with input from surgeons for ease of use, improved ergonomics, and versatility.

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