Saturday 22 December 2012

Fear of falling ‘may isolate older adults‘

A study has found that between 40% and 50% of older adults with eye disease limit their activity due to a fear of falling. The researchers warn that this may put these individuals at risk for social isolation and disability. 
Led by Ellen Freeman, from the University of Montreal in Qu├ębec, Canada, the research team recruited 93 patients with AMD, 57 with Fuchs corneal dystrophy, 98 with glaucoma and 97 with normal visual acuity and visual field to examine whether patients with eye disease report limiting their activity due to a fear of falling as compared with a control group of older adults with good vision. 
Overall, 40% to 50% of patient with eye disease reported activity limitation due to a fear of falling compared with only 16% of controls.
The Fuchs group was most likely to report activity limitation due to fear of falling, followed by the glaucoma group and the AMD group.
“Although this compensatory strategy may protect against falls, it may also put people at risk for social isolation and disability,” write the authors in the journal Investigative Ophthalmology and Visual Science.

Glaucoma patients show silent reading difficulties

People with glaucoma have difficulty with out loud and silent reading, a group of American researchers has found. The group says that the greatest impact was observed during sustained silent reading, and suggest that this may be due to reading fatigue.
For the study, which is published in the journal Investigative Ophthalmology and Visual Science, the investigators compared the reading speed of glaucoma patients with bilateral visual field loss to that of normally sighted individuals (controls).
They found that the out loud reading speed of glaucoma patients was about 6-7% slower than controls, while sustained silent reading speed was 16% slower.
Furthermore, glaucoma patients were two times more likely to decrease their reading speed my 0.5 words per minute or more during sustained silent reading than controls. “It appears that persons with glaucoma fatigue during silent reading resulting in slower reading over time,” conclude the researchers.

Thursday 20 December 2012

Study finds fall in cataract care

More than half of NHS trusts are rationing treatments including cataract operations according to the latest report from the National Audit Office - Progress in making NHS efficiency savings (December 13).
It found that 56 per cent of primary care trust clusters reported they had introduced or raised eligibility criteria for at least one common elective procedure. Cataract patients may have to wait until their eyesight deteriorates to a greater degree before having surgery. Cataract procedures carried out in 2011-2012 dropped 1.9 per cent on 2010-2011.
The report found that eligibility was tightened for clinical reasons in most cases, but 11 per cent of clusters reported doing so mainly on financial grounds.

Global study reveals burden of vision loss

Successful treatment of blinding eye conditions has led to a lower prevalence of eye diseases than might be expected given the growth in population worldwide.
The finding is among the results of the largest review ever undertaken into global vision impairment and blindness, led by Professor Rupert Bourne of Anglia Ruskin University's Vision and Eye Research Unit in collaboration with 79 ophthalmologists and optometrists.

The review forms part of the Global Burden of Disease Study, funded by the Bill and Melinda Gates Foundation and published in a special issue of The Lancet(December 13). The study shows that, since 1970, men and women worldwide have gained more than 10 years of life expectancy but now spend more years living with injury and illness.

Visual impairment accounts for 21m years lived with disability (YLD) or 2.7 per cent of the overall global total. The largest cause of YLDs from visual impairment is 'other vision loss', primarily from trauma, occupational and idiopathic conditions. Uncorrected refractive error is second, while cataracts are the third largest contributor.
Professor Bourne said: 'The overall increase in the number of people suffering from blindness and vision loss is due to the huge population explosion that has occurred during the last couple of decades. However, the Global Burden of Disease findings actually show that this increase is not as large as one would expect given the increasing life expectancy in the world's population over this time.
'The age-standardised prevalence, which takes into account the changes in life expectancy, of blindness and visual impairment, decreased globally between 1990-2010. This points to the successful intervention in treating cataracts and other forms of blindness and infectious diseases such as trachoma.'
The work will be used to distribute resources and support VISION 2020: The Right to Sight, the global campaign to eliminate avoidable blindness.
● Access The Lancet issue here:

Time of CL replacement 'important'

For patients using continuous wear or extended wear contact lenses, replacing lenses at night has no beneficial effect on ocular events compared with monthly lens replacement, a study has found.
However, morning lens replacement significantly reduced the overall rate of adverse events compared with monthly replacement.
The authors of the study say that contact lens wearers on an extended wear or continuous wear schedule “should be advised to minimise lens handling before sleep to reduce the risk of complications.”
A total of 215 individuals were dispensed with silicone hydrogel lenses on a 30-night continuous wear schedule. They were either advised to replace their lenses daily each night before sleeping (n=178 eyes) or each morning after waking (n=252 eyes). Neophytes were required to complete one week of daily wear before commencing continuous wear. A control group (n=191 eyes) was also included in the study. These individuals replaced their lenses monthly.
Led by Jerome Ozkan, University of South Wales, Australia, the team observed a significant reduction in adverse events when lenses were replaced each morning compared with being replaced monthly. They found no such effect when they examined those who replaced their lenses each evening.
Interestingly, when the researchers assessed the handling-related lens contamination of unworn lenses they isolated the bacterium Staphylococcus aureus from the lenses of 35% of the individuals.
“Replacing lenses at night had no beneficial effects perhaps because the benefit of a fresh lens at night might be partially negated by contamination of the contact lens caused by lens handling before eye closure,” suggest the researchers. “Contact lens wearers on an extended wear or continuous wear schedule should be advised to minimise lens handling before sleep to reduce the risk of complications.”

Study shows regular aspirin use may increase AMD risk

Regular aspirin use may increase a person’s risk of developing AMD, according to a study published today (December 19) in the journal JAMA.
The results showed that adults who used aspirin regularly 10 years before the study had a statistically significant increase in the risk of incident late and neovascular AMD.
Aspirin is widely used for relief of pain and for cardioprotective effects. However, many ophthalmologists have expressed concern about aspirin use and the risk of AMD. 
To investigate further, the researchers examined the association of regular aspirin use with incidence of AMD using data from nearly 5,000 individuals aged between 43 and 86 years. Over a 20-year period, the participants underwent eye examinations every five years. Regular aspirin use was defined as using aspirin at least twice a week for more than three months. 
The researchers found that aspirin use five or 10 years prior to the retinal examination was not associated with incident early AMD.
However, they found that regular aspirin use 10 years prior to the retinal examination was associated with an increase in risk of incident late and neovascular AMD.

Tuesday 18 December 2012

Global data on visual impairment published

The results of a systematic review of all published, and several unpublished, sources of global data on vision impairment and blindness, from 1980 to January 2012, were published in a special issue of The Lancet journal this week.The study found that visual impairment accounts for 2.7% of the overall global years lived with disability (YLD).
The largest global cause of YLDs from vision impairment is ‘other vision loss’ which makes up 29.5% of the total, primarily from trauma, plus occupational and idiopathic conditions. Second was uncorrected refractive error, which accounts for 26.5% of vision impairment, while cataracts are the third largest contributor at 22.4%. Glaucoma and macular degeneration together explain 10.7%.
Professor Rupert Bourne (pictured) of Anglia Ruskin University’s Vision and Eye Research Unit led the research group, which involved collaboration between 79 ophthalmologists and optometrists.
“The overall increase in the number of people suffering from blindness and vision loss is due to the huge population explosion that has occurred during the last couple of decades,” he said. “However, the Global Burden of Disease findings actually show that this increase is not as large as one would expect given the increasing life expectancy in the world’s population over this time.
“The age-standardised prevalence, which takes into account the changes in life expectancy, of blindness and visual impairment, decreased globally between 1990-2010. This points to the successful intervention in treating cataracts and other forms of blindness and infectious diseases such as trachoma.”
The findings form part of the Global Burden of Disease Study 2010 – the largest systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries and health risk factors.

Supplementation 'improves macular pigment in early AMD'

Supplementation with lutein and zeaxanthin significantly improves macular pigment in patients with early AMD, according to research published in the journal Ophthalmology.
It suggests that supplementation with these carotenoids could halt disease progression, the researchers say.
The study involved 108 patients, aged between 50 and 79 years, with early AMD. 
Participants were randomly assigned to receive lutein 10mg per day, lutein 20mg per day, lutein 10mg per day plus zeaxanthin 10mg per day, or placebo for 48 weeks.
Macular pigment optical density (MPOD) increased significantly in the 20mg lutein group and in the lutein and zeaxanthin group. Furthermore, the changes in MPOD from baseline to 48 weeks correlated negatively with baseline MPOD in all treatment groups. 
The researchers conclude that further studies are needed to evaluate the effect of these carotenoids on the incidence of late AMD.

Saturday 15 December 2012

NGOs tackle age-related sight loss

Three non-government organisations (NGOs) have come together to tackle the burden of age-related sight loss in Europe.
AMD Alliance International (AMDAI), World Blind Union (WBU) and the International Agency for the Prevention of Blindness (IAPB) Italy have launched a campaign today (December 13) to ‘disarm a European time bomb of age-related macular degeneration (AMD) sight loss.’ 
The organisations will provide tools for healthcare practitioners and local organisations which will help them raise awareness among the general public and plan appropriate interventions.
“We all have a role in preventing AMD and other eye diseases,” said Narinder Sharma, CEO of AMDAI. “The toolkit we are launching today at our Regional EU meeting in Rome should, in the first place, help local organisations and healthcare practitioners develop awareness-raising initiatives for older people who are at a higher risk of developing AMD, but also their friends, relatives and carers.” 
The initiative comes amidst a wider campaign of the European Forum Against Blindness which is seeking to raise these issues with the European Institutions and governments to reduce the incidence and burden of preventable blindness in Europe.
“In 2013 we will launch a Call to Action to EU policy makers as we believe that this problem is neglected at the moment,” said Ms Sharma. 
The toolkit can be found at

Friday 14 December 2012

Stem cell technique

Researchers from the University of Sheffield have developed a technique to help in the grafting of stem cells onto the eye. It is hoped that the technology will be used to treat damage to the cornea.  

The study authors made a disc of biodegradable material which can be fixed over the cornea, using a combination of techniques known as microstereolithography and electrospinning. The disc is loaded with stem cells which then multiply, allowing the body to heal the eye naturally.
The researchers designed the disc so that it contains pockets to house and protect the stem cells. These pockets mirror the niches found around the rim of a healthy cornea and can help cells to group together and act as a useful reservoir of daughter cells so that a healthy population of stem cells can be retained in the eye.
“One advantage of our design is that we have made the disc from materials already in use as biodegradable sutures in the eye so we know they won’t cause a problem in the body,” said professor Sheila MacNeil. “This means that we should be able to move to early stage clinical trials fairly quickly.”
Dr Frederik Claeyssens added: “We believe that the overall treatment using these discs will not only be better than current treatments, it will be cheaper as well.”

Wednesday 12 December 2012

Rapid eye movements delayed in glaucoma patients

Rapid eye movements are significantly delayed in patients with glaucoma, results of a study published in Eye and Brain show.


The findings may shed light on why glaucoma patients are at an increased risk of falls and car accidents.
The researchers used head-mounted devices to measure saccadic (rapid) eye movements of individuals with and without glaucoma. They found that people with early, moderate or advanced glaucoma had significantly delayed rapid eye movements compared with individuals without the condition.
Lead study author and ophthalmologist, Neeru Gupta, said: “Now that we know that eye movement reaction times are delayed in people with glaucoma there is an opportunity to understand the effects of glaucoma on daily activities of living that most of us take for granted, such as walking up and down stairs, driving, navigating and reading.
“Further studies are needed to determine pathological processes implicated in delayed initiation of saccades, and to assess whether alterations of saccades affects daily activities in glaucoma patients.”

General Optical Council agrees to review corporate registration

Satirical newspaper Private Eye has accused Specsavers of using 'unregistered opticians' to test eyes and prescribe glasses.

The accusation was made in the November 16-29 edition of the paper and claimed that over 500 of the multiple's practices were not registered with the General Optical Council.

The article, the second that has attacked Specsavers' corporate registration status (News 28.09.12) also claimed the multiple had run rings around 'useless watchdogs' who had failed to address its regulatory failings.

Reacting to the new allegations, a spokesperson for the multiple said: 'All individual Specsavers' opticians are registered with the GOC and customers can rest assured that their eyes are tested and their glasses prescribed by fully qualified and registered practitioners. Specsavers is the largest employer of registered optometrists and dispensing opticians (around 3,500) in the UK.'

The GOC responded to the story by revealing that it would be conducting an internal review of corporate body registration in March, having already raised the issue with the Law Commission previously.
In its response to the Law Commission, the GOC said its current business regulation framework had limitations which meant significant parts of the business sector were not subject to regulation and described its framework as 'light touch' when compared to other regulators.
It added that it was aware that the current system could also create confusion for business owners, individual registrants and the public.

The GOC's internal review will be formed of independent research, due to take place in January, as well as its own legal advice. The results will be passed on to the Law Commission for consideration.
It has asked registrants from a variety of practice settings and sizes to participate in the research. Travel expenses and a small fee to compensate for time out of practice will be paid.
Those wishing to take part can contact acting communications manager Simon Grier on 0207 307 3478.

Tuesday 11 December 2012

Vision Care for Homeless People opens Birmingham centre

Lord Mayor of Birmingham John Lines recently opened the city's new Vision Care for Homeless People (VCHP) centre situated within homeless charity SIFA Fireside.

Pictured (above) with the charity's managing director Harinder Paul, Lines witnessed first hand how VCHP provides eye examinations and glasses as a first step for those who need help to reintegrate into society. Charity chair Elaine
Styles said: 'Charity starts at home and we are delighted to bring this new facility to SIFA Fireside. It is particularly relevant at this time of the year when we are all thinking about giving.' Donations to the charity can be made at its website

People needed for research project

Researchers at Kingston University are calling for people with visual impairments to participate in a new study.

The research project, funded by Moorfields Eye Hospital and University College London, aims to determine the distance at which visually impaired people can see the minimum contrast difference between two surfaces.
The work is due to start immediately and will be completed in nine months time.
The University is looking for people who are able to travel to Moorfields Eye Hospital (near Old Street tube station) in London.
If you are interested in the project, contact Alessio Corso () or Hilary Dalke ().

Moorfields establishes new patient support service

Moorfields has launched a new integrated patient support service which aims to assist patients coming to terms with sight threatening diseases, treatment and visual impairment. 
The service offers counselling, emotional and psychological support, practical advice and information on services outside the hospital.
Charitable funds from a number of organisations have made the new service possible, which includes four eye clinic liaison
officers, two nurse counsellors and a Certificate of Visual Impairment team. 
While the new eye clinic liaison post, which will be based in Northwick Park and Ealing hospitals, has been funded by Friends of Moorfields and Action for Blind People, the nurse councillor position is supported by the Marie-Louise Von Motesiczky Foundation. 
Moorfields director of nursing an allied health professionals, Tracy Luckett, said: “Moorfields has long recognised the importance of offering psychological, emotional and proactive practical support and advice to patients who often find them having to deal with devastating news about their sight conditions. We have offered a number of services in the past at several of our sites but are now able by integrating all our patient support services under one manager and – with the help of charitable support from a number of organisations – to offer a one stop shop approach for liaison and advice purposes.”

Friday 7 December 2012

NICE reject intravitreal implant for diabetic macular oedema

The UK National Institute for Health and Clinical Excellence (NICE) has not recommended a fluocinolone acetonide intravitreal implant (Illuvien, Alimera Sciences, Alpharetta, Georgia, USA) for individuals with diabetic macular oedema who do not respond to existing therapies.
The decision was made on cost implications, with NICE's independent Appraisal Committee concluding that the most plausible incremental cost-effectiveness ratio (ICER) for the implant compared with current available treatments was at least £ 47,600 (US$ 76,350; € 58,677) per quality-adjusted life year (QALY).
QALY's take into account disease burden in addition to the quality and quantity of life lived.
Andrew Dillon (NICE, London, UK) said in a press release that the Committee is aware of the "significant impact" that macular oedema can have on those with the condition and their carers.
"However, when NICE recommends any drug or treatment, we have to be sure that it is both clinically and cost effective, because money has to be diverted from elsewhere in the health service to pay for it."
Fluocinolone acetonide intravitreal implant is a corticosteroid with anti-inflammatory and antivascular endothelial growth factor properties, explains the NCIE final appraisal. Only patients with diabetic macular oedema who have not responded to laser photocoagulation or other therapies should receive it.
In addition to the cost implications, NICE also maintains that the manufacturer of the implant has not taken into account the potential negative side effects of the treatment, which include cataract, increased intraocular pressure, floaters, retinal detachment, and glaucoma, and the associated costs of these comorbidities.
The manufacturer provided further evidence to the Committee involving a subgroup of individuals who had already undergone operation for cataract removal, and had been fitted with an intraocular lens. The results indicated further benefits of treatment in this population since a known adverse event was in effect, removed, maintained the company.
However, the most plausible ICER for this group was £ 29,700-50,600 (US$ 47,640-81,160; € 36,611-62,375) per QALY gained, and therefore the technology was not recommended in this population either.
"The Committee concluded that the evidence provided did not show that the benefits fluocinolone intravitreal implant provides to patients justify the price the NHS [National Health Service] is being asked to pay," concluded Dillon.
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Macular Disease Society Renamed

Members of the public are reported to find the word ‘disease’ so off-putting that a national charity has removed it from its name. 

The Macular Disease Society will be known as the Macular Society with immediate affect. The news comes following research which reported that many patients thought the word disease suggested contagion. 
Chief executive of the charity, Helen Jackman commented: “Many members have been telling us for years that they disliked the word ‘disease’. Our research suggested that some people felt it was so negative it may even put them off using our services, or joining us. Members already often left it out when talking about the Society, suggesting that they didn’t even like saying the word.”

New treatment for AMD licensed.

A new injection for the treatment of wet AMD has been licensed for use in the EU. 
Eylea, which is also known as Vegf Trap Eye, works in a similar way to current treatment with Lucentis, but its effect is reported to last longer. 

Developed by Bayer, the treatment will now be appraised by NICE and, if approved, could be made available on the NHS.
Welcoming news of the licensing, chief executive of the Macular Disease Society, Helen Jackman (pictured), said: “We hope that this new treatment for wet AMD will be good news for patients if it means people can keep their vision with fewer injections.” 
A recent survey by the charity found that 80% of eye clinics are failing to meet the recommended monthly follow-ups for re-treatment of wet AMD patients with Lucentis. 
Ms Jackman added: “Many elderly patients find frequent hospital appointments extremely hard. We also know that eye clinics are struggling to cope with the number of patients needing treatment. This could be putting patients’ sight at risk so a treatment which is needed less often would be welcome.” 
Expressing concern that with the number of people affected by AMD set to rise by one third by 2020, Ms Jackson said that even the new treatment may not be enough to relive the pressure in eye clinics. “We urgently need more investment in AMD services if the NHS is to meet demand for these sight saving treatments,” she added.