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NEW RESEARCH AND TECHNOLOGIES FOR TREATING VARIOUS EYE DISEASES
The UK’s National Institute for Health and Care Excellence (NICE) has changed the primary intervention from instillation of eye drops, the long-time standard of care, to selective laser trabeculoplasty (SLT) for glaucoma. Prior to this, SLT had been the second treatment choice when drop instillation proved problematic for some patients.
The new guidelines were formed due to the findings of the multicenter Laser in Glaucoma and Ocular Hypertension (LiGHT) study, led by Ophthalmology Consultant and Chief Investigator Gus Gazzard from Moorfields Eye Hospital, and professor of Glaucoma Studies at the University College London Institute of Ophthalmology, London.
The LiGHT study, which took a close look at the effects of laser therapy, compared the quality of life and visual acuity in two patient groups: those who started glaucoma treatment with drops and those who were treated first with SLT and then later were prescribed drops as needed. Earlier, no study patients were treated for glaucoma.
The findings of the LiGHT Study reiterated the fact that laser treatment was indeed safer and more cost effective over the long term because laser application reduced the need for drop instillation and the number of hospital visits.
The American Academy of Ophthalmology’s Preferred Practice Pattern and the European Glaucoma Society has also decided to issue updated guidelines due to the LiGHT Study results.
There is a clear link between cooking with wood or coal and acquiring eye diseases that can lead to blindness.
In a new study, researchers from the University of Oxford’s Nuffield Department of Population Health (NDPH) and the Chinese Academy of Medical Science and Peking University, Beijing, analysed data from almost half a million Chinese adults in the China Kadoorie Biobank.
The researchers questioned the study participants on their cooking habits through a survey form, then tracked for hospital admissions of major eye diseases through linkage to health insurance records. Over the ten-year follow-up period, they found around 4,877 cases of conjunctiva disorders, 13,408 cataracts, 1,583 disorders of the sclera, cornea, iris and ciliary body (DSCIC), and 1,534 cases of glaucoma among study participants.
The study results showed that long-term use of solid fuels for cooking was associated with 32%, 17%, and 35% higher risks of conjunctiva, cataracts, and DSCIC, respectively, compared with those who cooked using clean fuels. Individuals who switched from using solid to clean fuels for cooking had smaller elevated risks (over those who had always used clean fuels) compared to those who did not switch. People who switched had 21%, 5% and 21% higher risk for conjunctiva, cataracts, and DSCIC, respectively.
While explaining these findings Dr Peter Ka Hung Chan, research fellow in the Nuffield Department of Population Health, University of Oxford, and lead author of the study stated: “The increased risks may be caused by exposure to high levels of fine particulate matter (PM2.5) and carbon monoxide, which can damage the eye surface and cause inflammation.”
A new study has found a link between increased myopia levels and rhegmatogenous retinal detachment (RRD) in the Netherlands.
Dr Redmer van Leeuwen of University Medical Center Utrecht and colleagues revealed that RRD is one of the most common sight-threatening emergencies in the Western world and can lead to severe visual impairment even if its surgery is done on time.
According to the report appearing in JAMA Ophthalmology, the researchers compared results of an earlier study of all patients who underwent surgical repair for a primary RRD in the Netherlands during 2009 and compared them with those for 2016. The data for this was provided by all vitreoretinal surgeons in the Netherlands, using the same definitions and the same inclusion and exclusion criteria as in the earlier study.
Furthermore, the team also assessed data from the prospective population-based Rotterdam Study in which participants had to undergo an extensive ophthalmological examination. This was done to find out if there was any change in the prevalence of myopia. This cohort of close to 15,000 people, they revealed, was typically of the middle-aged and elderly population of the Netherlands.
The study findings showed that there was an overall annual incidence of 18.2 per 100,000 person-years in the 2009 study of 3000 patients who underwent surgery for RRD as against an overall annual incidence rate of 26.2 per 100,000 person-years for the corresponding number of patients in 2016 even though the population increased only by 3% in the intervening years, thus signifying an increase of 44%.
Within the same duration, there was also a relative increase of 15.6% of low myopia in people aged 55 to 75 years. For medium and high myopia, the corresponding relative increases were 20.3% and 26.9%. The researchers concluded that the difference in primary RRD incidence could be due to increase in myopia prevalence.
In an ongoing research, Jesse L. Berry, MD, of USC Roski Eye Institute, and colleagues have found that aqueous humor, obtained safely, can possibly be used as a means for diagnosing retinoblastoma, prognosing and monitoring therapeutic response. At present, retinoblastoma, a rare type of eye cancer that usually develops in early childhood, is diagnosed clinically, without biopsy, to by-pass the need for extraocular tumor seeding.
“Retinoblastoma is the most common ocular tumor in children, but it is thankfully a rare disease,” says Berry. “We know that those cancers start with genetic mutation but require other chromosomal alterations to grow and thrive. For most cancers, you see something, you biopsy it, you get some molecular information that helps with diagnosis, prognosis and sometimes treatment. But for retinal blastoma, the diagnosis is made on clinical features alone,” she clarified.
According to Jesse Berry, the classification can also be done clinically, but around 80% of patients usually present with more serious classifications, wherein there is only a 50% chance of saving the eye with treatment.
She further informs that retinoblastoma can be diagnosed without biopsy. However, lack of biopsy implies that there is no eye-specific diagnostic and prognostic molecular biomarkers, no personalised treatment plan and limited understanding of “in vivo” tumorigenesis, meaning no identification of new mutations and chromosomal alterations that develop.
With safe access to aqueous humor, however, there is a means of using the liquid biopsy as a surrogate to biopsy retinoblastoma.
“If a tumor biopsy can give you a snapshot into what’s going on at the level of the cancer, a liquid biopsy gives you a more comprehensive picture of the entire tumor, because the entire tumor, all the forms of that tumor, are shedding into that liquid,” she said. “And a longitudinal liquid biopsy can actually show you how that tumor is evolving over time.”
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