A weekly e-journal
edited by Arthur B. Epstein, OD, FAAO

Volume 5, Number 18 Monday, May 9, 2005

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Off the Cuff: Solution Confusion--Here We Go Again!

With the long-awaited reintroduction of B&L’s PureVision, contact lens fitters have yet one more excellent lens in their silicone hydrogel armamentarium. As an early adopter of PureVision, I was pleased to see its return to the U.S. market. But while checking out the PureVision package insert, something caught my eye. It turns out that AMO UltraCare is contraindicated for use with the PureVision.

By itself, that would not be disturbing, but add to it CIBA Vision SOLO-Care Plus and Acuvue Advance incompatibility, earlier reports of clinically significant epithelial staining with the PureVision and ReNu MultiPlus and recent anecdotal reports concerning other silicone hydrogel lens care product related corneal staining, and you can see why I am concerned. You should be too.

Silicone hydrogels may be the future of contact lenses, but it is a future that can easily be derailed if these new and unique lenses are beset by constant lens care product incompatibilities. It is time that the FDA recognized that silicone hydrogels are different enough to be treated differently and that they require additional care product compatibility and safety testing.

Not all care products have silicone hydrogel compatibility issues, but until the FDA acts, we need to be vigilant and educate our silicone hydrogel patients to use only products that we know will not cause problems.


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Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com




HRT and Cataract

Hormone replacement therapy (HRT) may protect against the development of cataract, but epidemiological studies in humans have been inconclusive. The aim of this study was to assess the association between hormone replacement therapy and cataract. Participants were 10,000 women aged 45 years and older with cataract and 10,000 age-matched controls.

The association between cataract and use of estrogen-only HRT had an odds ratio of 1.13. This reduced to 0.81 after adjustment for examination frequency. Similarly, the odds ratio for the association between cataract and use of a HRT formulation containing estrogen and progesterone was 1.18, reducing to 0.86 after adjustment for examination frequency.

Estrogen-only and estrogen-progesterone hormone replacement therapies are associated with a small reduced risk of cataract. This data adds to the growing body of evidence on the systemic effects of HRT.

SOURCE: Aina FO, Smeeth L, Hubbard R, et al. Hormone replacement therapy and cataract: a population-based case-control study. Eye 2005;[Epub ahead of print].

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Combination of Bimatoprost and Latanoprost on IOP

This study evaluated the effect of combining bimatoprost and latanoprost on intraocular pressure (IOP) in primary open angle glaucoma (POAG). A randomized clinical trial was conducted on eighteen glaucoma patients. In the first four weeks, latanoprost 0.005% was prescribed for both eyes and any other anti-glaucoma medication was discontinued. In the next four weeks (Phase 1), bimatoprost 0.03% was combined with latanoprost in one randomly assigned eye (case eye) of each patient. In the following four weeks (Phase 2), bimatoprost was discontinued in the case eyes, while bimatoprost was substituted for latanoprost in the fellow eye (control eye). The IOP was measured at the end of the first four weeks (baseline measurement) and weekly during Phases 1 and 2.

In the case eyes, the mean IOP increased (1.8 mmHg) along Phase 1 (combined therapy) when compared to baseline measurements. The IOP returned to previous values after discontinuation of bimatoprost in Phase 2. In the control eyes, the mean IOP did not change throughout the study. The combination of bimatoprost and latanoprost in POAG increases the IOP and should not be considered as a therapeutic option.

SOURCE: Doi LM, Melo LA Jr., Prata JA Jr. Effects of the combination of bimatoprost and latanoprost on intraocular pressure in primary open angle glaucoma: a randomized clinical trial. Br J Ophthalmol 2005;89(5):547-9.

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Corneal Astigmatism in Graves’ Ophthalmopathy

One hundred-nine patients with inactive Graves' ophthalmopathy and 109 age- and gender-matched controls without Graves' ophthalmopathy were examined using manual corneal keratometry. In the Graves' patients, 52 percent had a CT scan available for review, and 41 percent underwent orbital, strabismus, and/or eyelid surgery with a follow-up of keratometry over a mean period of 1.7 years after surgery.

There was a statistically significant difference between the Graves' and control eyes at 3.00D to 3.25D in both eyes. The astigmatism was found to be steeper at 95 to 100 degrees and 105 degrees to 110 degrees in the right eyes only. In 10 Graves' patients, the astigmatism had caused newly acquired reduced visual acuity. A greater amount of astigmatism did not correlate with specific CT findings. Following orbital, strabismus and eyelid surgery, the diopters and meridians of the astigmatism did not change.

Graves' ophthalmopathy may be associated with greater with-the-rule corneal astigmatism, which overall is not influenced by orbital, strabismus or eyelid surgery. The astigmatism may possibly be caused by soft-tissue fibrosis in the superolateral orbital region.

SOURCE: Mombaerts I, Vandelanotte S, Koornneef L. Corneal astigmatism in Graves' ophthalmopathy. Eye 2005;[Epub ahead of print].

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NEWS & NOTES

DEADLINES APPROACHING FOR AAO 2005, SAN DIEGO. The American Academy of Optometry (AAO) is holding its annual meeting from December 8 to 11, 2005, at the Convention Center in San Diego. Deadline for awards nominations is May 16; the Call for Abstracts dates are June 15 to August 1. Meeting registration begins on July 6, 2005 and applications for AAO Student Travel Fellowships must be submitted by October 1. To learn more about Academy 2005, go to www.aaopt.org/meetings/meeting5.

AMO TO ACQUIRE QUEST VISION TECHNOLOGIES. Advanced Medical Optics, Inc. (AMO) has exercised its option to acquire Quest Vision Technologies, Inc. Financial terms were not disclosed. The companies entered into a one-year research and evaluation licensing agreement in May 2004 to develop accommodating intraocular lens (IOL) technologies and designs to address presbyopia. At the time, AMO was given the option to acquire Quest Vision after one year. The accommodating IOL being designed through an AMO and Quest Vision collaboration provides accommodation by altering the shape of the optic with or without axial movement. AMO’s acquisition gives it access to novel accommodating IOL technologies that the company hopes will add breadth to its growing refractive IOL offering, which currently includes the ReZoom multifocal lens, which gained FDA approval in March 2005; the Verisyse phakic IOL; and the Tecnis multifocal IOL. ReZoom and Tecnis multifocal IOLs have CE Mark approval in Europe for treatment of presbyopia. For more information, go to www.amo-inc.com.

TWO-YEAR CLINICAL TRIAL DATA RELEASED FOR B&L’S RETISERT FOR POSTERIOR UVEITIS. The results of a two-year Phase IIb/III clinical trial of Bausch & Lomb’s Retisert (fluocinolone acetonide intravitreal implant) for the treatment of chronic, noninfectious uveitis affecting the posterior segment of the eye have been released. The trial, conducted at 26 centers in the United States and one center in Singapore, included 278 people with noninfectious posterior uveitis randomized to receive either a 0.59-mg or 2.1-mg implant in the affected eye, or in bilateral cases, in the more severely afflicted eye; the fellow eye was implant free. Results showed a statistically significant lower rate of disease recurrence in eyes with Retisert (11.2 percent) after two years, compared to the recurrence rate in the year prior to enrollment (59.7 percent) and compared to the rate in the fellow eyes (50.0 percent) after two years. There were also statistically significant decreases in systemic use of immunomodulatory therapy and in periocular corticosteroid injections after implantation. In the eyes with Retisert, a statistically significant improvement in visual acuity occurred after two years as well. The most common adverse events included cataract progression and increased IOP, which were anticipated given the nature of the disease and the type of drug used. They were managed by conventional means, including cataract surgery and the use of eye drops or filtering surgery to lower IOP. Patients in the study will be followed for an additional year. Bausch & Lomb aims to make Retisert available in mid-2005.

FOR ODS SPECIALIZING IN GERIATRIC EYECARE: WHITE HOUSE HOLDS CONFERENCE ON AGING. Optometrists with an interest in geriatric eyecare are invited to attend the 2005 White House Conference on Aging (WHCoA), October 23 to 26, 2005, at the Hyatt Regency Washington on Capitol Hill. The theme of the conference is "The Booming Dynamics of Aging: From Awareness to Action." The conference will include gerontology scholars, leading advocates from senior organizations and key healthcare providers--including doctors of optometry--to focus on aging issues. Their common mission is to help shape national policy that better meets the needs of current and future senior citizens. About 1,200 WHCoA delegates are expected to make recommendations to President George W. Bush and the U.S. Congress aimed at improving the physical and psychological health of aging individuals and enhancing their social and economic security. Interested optometrists can seek to be appointed a delegate to the convention by their state governor or state’s U.S. senators or representative, or they may seek appointment by a national organization interested in aging issues. They might also participate in state "listening sessions" or organize and host their own WHCoA-approved and designated event. Additional, provisional conference attendee slots will be available via an online application/nomination process. For more information, go to www.whcoa.gov.

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Optometric PhysicianTM Editorial Board

Chief Medical Editor
Arthur B. Epstein, OD, FAAO


Art/Production Director

Joe Morris

Circulation Director
Janice Miller

Journal Reviews
Shannon Steinhäuser, OD, FAAO

CIP Team
• Alan G. Kabat, OD, FAAO
• Joseph Sowka, OD, FAAO
• Andrew Gurwood, OD, FAAO

Section Editors

• Murray Fingeret, OD, FAAO
• William Jones, OD, FAAO
• Paul Karpecki, OD, FAAO
• Ron Melton, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO
• Randall Thomas, OD, MPH, FAAO


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