the Cuff: No Comment
For the first time in several years, Optometric Physician will not be endorsing a candidate for the AOA Board of Trustees. You may wonder why. It is not for lack of qualifications. As is typically the case, all of this year’s candidates are quality, dedicated colleagues with a long history of service to the profession. Several are friends that I hold in high regard, and all possess skills that will serve the board well.
The reason for my silence is the candidates' own silence. Although I did eventually speak with every candidate, none chose to voluntarily supply information that I requested in an editorial several months back. My goal was to help readers better understand the political process and make informed choices. So for yet another year, the few who represent the rest of us will be selected by a tiny fraction of our profession with little, if any, involvement from the rank and file.
Involvement of every one of us in selecting those who represent our profession is ever more important. As optometry advances, so too do our challenges. Before next year’s AOA Congress, Optometric Physician will initiate a novel experiment that will mix organizational democracy with 21st-century technology. We will endorse a candidate (or candidates) in 2008 while creating a opportunity for the rest of you to have your say. Stay tuned....
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24-Hour Efficacy of the Brimonidine/Timolol Fixed Combination
This study evaluated the 24-hour intraocular pressure (IOP) control of brimonidine/timolol fixed combination (BTFC) vs. the unfixed combination of its individual components dosed twice daily in patients with primary open-angle glaucoma or ocular hypertension. Following a six-week medicine-free period, patients were randomized to BTFC or to the unfixed combination of brimonidine and timolol for three months. Patients then were crossed over to the opposite treatment for another three months. At the end of the medicine-free period and each treatment period, patients underwent 24-hour IOP measurements at 0600, 1000, 1400, 1800, 2200 and 0200 hours.
Twenty-eight patients completed this study. Both BTFC and the unfixed components showed a significant IOP reduction from untreated baseline and were statistically equal when compared directly for each individual time point and for the 24-hour IOP curve. The mean 24-hour IOP was 24.6 +/- 1.9 for baseline, 19.2 +/- 1.9 for BTFC and 19.2 +/- 1.6 mm Hg for the unfixed components. Four patients were discontinued due to side effects. The most common ocular adverse event was ocular hyperemia (three patients with BTFC and five with the unfixed components), and systemic adverse events were rare.
This study suggests that both BTFC and the unfixed components of brimonidine and timolol provide a significant 24-hour IOP reduction from untreated baseline and statistically equal control when compared directly at each time point and for the 24-hour pressure curve.
SOURCE: Konstas AG, Katsimpris IE, Kaltsos K, et al. Twenty-four-hour efficacy of the brimonidine/timolol fixed combination versus therapy with the unfixed components. Eye 2007; Jun 15 [Epub ahead of print].
Left-Sided Duane's Syndrome and Retinal Coloboma Associated with Contralateral Microphthalmia
A 15-year-old girl presented with a left-sided Duane's retraction syndrome (DURS) in combination with ipsilateral retinal coloboma and contralateral microphthalmia. Abduction limitation and narrowing of the palpebral fissure and globe retraction during attempted adduction (type I DURS) was demonstrated in the left eye. Additionally, a retinal coloboma was observed in the nasal inferior quadrant of the left eye. No other somatic or developmental abnormalities were observed, and karyotypic analysis was normal.
This is the first case of non-syndromic unilateral DURS associated with a contralateral major ocular malformation. This unusual clinical combination probably arose from the embryonic action of an eye-specific disruptor.
SOURCE: Garnica-Hayashi RE, Vargas-Ortega J, Zenteno JC. Left-sided Duane's syndrome and retinal coloboma associated with contralateral microphthalmia. Strabismus 2007;15(2):113-7.
Avastin for Radiation Retinopathy
After plaque radiation therapy, six patients developed radiation retinopathy (retinal edema, hemorrhages, microangiopathy and neovascularization). Intravitreal bevacizumab (Avastin 1.25 mg in 0.05 mL) was periodically injected (every 6 to 8 weeks). Ophthalmic evaluations included visual acuity, ophthalmic examination, fundus photography, fluorescein angiography and optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO) imaging.
No bevacizumab-related ocular or systemic adverse effects occurred within the first 8 months of therapy. Progressive reductions in retinal hemorrhages, exudates, cotton-wool spots and microangiopathy were documented by photography, angiography and OCT/SLO imaging. Decreased macular edema was the most common finding. Improvement or stabilization of visual acuity was noted in all cases.
Intravitreal bevacizumab was tolerated, improved or maintained vision and reduced hemorrhage and retinal edema (angiographic leakage). This study should lead to additional and longer-term studies of humanized monoclonal anti-vascular endothelial growth factor antibody therapy for radiation retinopathy.
SOURCE: Finger PT, Chin K. Anti-vascular endothelial growth factor bevacizumab (Avastin) for radiation retinopathy. Arch Ophthalmol 2007;125(6):751-6.
Retained Nail with Perforating Injury of the Eye
A 26-year-old construction worker was injured by a nail while using a nail gun at work. The iron nail was inadvertently stabbed into the left eye from the upper eyelid and superonasal sclera to temporal sclera with lens involvement. His visual acuity was counting fingers in the left eye. Primary suture, removal of a retained iron nail, pars plana vitrectomy and lensectomy and laser photocoagulation were performed. Three months later, an intraocular lens was implanted in the ciliary sulcus. During postoperative six-month follow-up, final best-corrected visual acuity was 20/20 without complication.
As most eye injuries are preventable, proper training of nail-gun operators and use of safety equipment could reduce the incidence of ocular injuries. Expeditious removal of nails and repair of the lacerations can prevent the complications and achieve good final visual outcomes.
SOURCE: Chen KJ, Sun MH, Hou CH, Chen TL. Retained large nail with perforating injury of the eye. Graefes Arch Clin Exp Ophthalmol 2007; Jun 12 [Epub ahead of print].
HIGH-TENSION OPEN-ANGLE GLAUCOMA MAY BE LINKED WITH ARTERIAL PULSE PRESSURE. Individuals with a high pulse pressure (the difference between the systolic and diastolic blood pressure) may have a higher risk for high-tension open-angle glaucoma (OAG) than those without high pulse pressure, according to a report by researchers in the Netherlands. Investigators analyzed data from 5,317 individuals, 215 of whom had definite or probable OAG. At the beginning of the study (1990 to 1993), participants received eye examinations and their blood pressure was measured. During the third phase of the study (1997 to 1999), arterial stiffness was also measured. Based on their IOPs, subjects with glaucoma were classified into high-tension OAG (pressure greater than 21 mm Hg) and normal-tension OAG (21 mm Hg or lower). Results showed that high-tension OAG was associated with high pulse pressure, possibly with increased carotid arterial stiffness and, only in those treated for systemic hypertension, with low diastolic perfusion pressure. In the latter group, normal-tension OAG was associated with high diastolic blood pressure, whereas the association between normal-tension OAG and low diastolic perfusion pressure was inverted. The investigators stress that their findings need to be confirmed in other population-based studies, but they believe that their results suggest the mechanisms involved in the etiology of high-tension OAG may be different from those in normal-tension OAG.
AOA SUPPORTS VISION CARE FOR KIDS ACT OF 2007. With the support of the St. Louis-based branch of the AOA, the Vision Council of America and other leading eyecare groups, Sen. Kit Bond of Missouri has introduced the Vision Care for Kids Act of 2007 (S. 1117), highlighting the national need for better eye health care for children. S. 1117 would establish a federal grant program focused on treatment to bolster state initiatives for treating and improving children's vision; it would also encourage children's vision partnerships with non-profit entities. Nearly 25 percent of school-age children have vision problems, according to a federal study and vision disorders constitute the fourth most-common disability in the United States. According to Vision Council of America's 2005 study, "Making the Grade: An Analysis of State and Federal Children's Vision Care Policy," 32 states require vision screenings for students, but 29 of them do not require children who fail the screening to have a comprehensive eye examination. Because up to two-thirds of children who fail vision screenings do not comply with recommended eye exams, many children enter school with uncorrected vision problems. "This important legislation will improve vision care for children to better equip them to succeed in school and in life," Sen. Bond says of S. 1117.