Off the Cuff: Around the World

Back just a week from a whirlwind lecture tour of Hong Kong and Singapore, I am still a bit jet lagged. While abroad, I had the pleasure of meeting a number of optometrists from around Asia. I met with leaders of the Hong Kong Society of Professional Optometrists, the Hong Kong Association of Private Practice Optometrists, the Singapore Optometry Association and the Singapore Contact Lens Society. Much like my experience in the U.S., Australia and Europe, I find optometrists have much in common regardless of where they live or practice.

Worldwide, optometrists face many of the same challenges and share common interests. Although optometric education and legislation are both still evolving rapidly in Asia, many Asian optometrists seem as interested in the latest science and clinical developments as ODs in the U.S. are. Contact lenses and corneal reshaping in particular are of tremendous interest in Asia. Silicone hydrogel lenses still represent a small segment of the soft lens market, but there is tremendous interest in new lens materials and developments in lens care.

We need to keep in mind that optometry is an international profession with roots that extend deeply in many countries. Planning for our profession’s future should involve our international colleagues, especially as the push for primary care optometry spreads throughout the world. Special and warm thanks to all of my colleagues and friends who made this visit such a memorable one.

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

The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Publishing or any other entities or individuals.

A 66-year-old man underwent surgery for benign prostatic hyperplasia. The preoperative blood pressure was 140/85 mmHg, hemoglobin 15.9 g/dL and hematocrit 48.6 percent. Two hours postoperatively, the blood pressure, hemoglobin and hematocrit dropped dramatically. One day later, transient horizontal diplopia developed. Funduscopy showed a congenitally small cup-to-disc ratio without papillary edema. Other ocular findings were unremarkable. By four days postoperatively, sudden and painless amaurosis bilaterally developed when the patient awoke with nausea and vomiting. Visual acuity was no light perception bilaterally. The optic discs were swollen with small hemorrhages. Scans of the head and orbits and electrolyte levels were normal. There were no responses on visual evoked potentials bilaterally. The patient’s blood pressure was 90/50 mmHg, the hemoglobin 7.0 g/dL and the hematocrit 22.9 percent, necessitating infusion of three units of packed red blood cells. The blood pressure, hematocrit and hemoglobin increased to normal levels. Three months later, the visual acuity remained no light perception. The pupils were unreactive, and there was marked optic disc atrophy bilaterally.

Bilateral and simultaneous acute ischemic optic neuropathy is be a rare but devastating surgical complication. The combination of anemia and hypotension may increase the risk of anterior ischemic optic neuropathy postoperatively after transurethral prostatic resection.

SOURCE: Sadaba LM, Garcia-Layana A, Maldonado MJ, Berian JM. Bilateral ischemic optic neuropathy after transurethral prostatic resection: a case report. BMC Ophthalmol 2006;6(1):32.

This study assessed the association between age-related vision and hearing impairments and whether combined sensory losses magnify effects on health-related quality of life. Seventy-five percent of survivors (2,334 participants) were reexamined at Blue Mountains Eye Study five-year examinations and 86.3 percent (2,015) attended hearing assessments. Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB (500 to 4000 Hz in the better ear).

Participants with visual impairment compared with those without visual impairment had lower mean audiometric thresholds across all frequencies. For each one-line (five-letter) reduction in best-corrected visual acuity and presenting visual acuity, hearing loss prevalence increased by 18 percent or 13 percent, respectively. Cataract and age-related maculopathy were also associated with hearing loss. The association between age-related maculopathy and hearing loss was stronger at younger ages (younger than 70 years). Combined impairments were associated with poorer health-related quality of life than were single impairments.

Older participants with visual impairment were also more likely to have hearing loss, which suggests that these sensory impairments could share common risk factors or biologic aging markers. Combined sensory impairments also cumulatively affect health-related quality of life.

SOURCE: Chia EM, Mitchell P, Rochtchina E, et al. Association between vision and hearing impairments and their combined effects on quality of life. Arch Ophthalmol 2006;124(10):1465-70.

Factors Predicting IOP Control After Phaco in Angle-Closure Glaucoma

This study investigated whether the presence of glaucomatous optic neuropathy affects the reduction of intraocular pressure (IOP) after phacoemulsification in postiridotomy eyes with primary narrow angles and to evaluate the preoperative factors associated with postoperative IOP control in primary angle-closure glaucoma (PACG).

Patients with PACG undergoing phacoemulsification were prospectively enrolled and received a complete ophthalmic examination. Diurnal IOP was measured one day before and three months after surgery. For comparison, patients with primary angle closure or angle closure suspect (PAC/S) undergoing phacoemulsification were also enrolled.

Postoperative reduction of IOP was significant in the PACG group (29 patients) and in the PAC/S group (28 patients), with no significant difference between the groups. The number of glaucoma medications used decreased in both groups. Multiple regression analysis for the PACG group showed a positive correlation between postoperative IOP and preoperative factors of mean IOP and the anterior chamber depth.

The reduction of IOP three months after phacoemulsification is significant and is similar in extent in postiridotomy eyes with and without glaucomatous optic neuropathy. A higher postoperative IOP in PACG is associated with a higher preoperative IOP and with a deeper preoperative anterior chamber depth.

SOURCE: Liu CJ, Cheng CY, Wu CW, et al. Factors predicting intraocular pressure control after phacoemulsification in angle-closure glaucoma. Arch Ophthalmol 2006;124(10):1390-4.

Dry Eye in Women on Hormone Replacement Therapy

Forty post-menopausal women with dry eye (20 patients, Group 1) and without dry eye (20 patients, Group 2), all planning to receive hormone replacement therapy (HRT, estrogen plus progesterone), were recruited as study groups. Forty age-matched untreated women were enrolled as controls (Group 3 with dry eye: 5 patients; Group 4 without dry eye: 35 patients). Patients having at least one of the symptoms (dryness, itching, photophobia, foreign body sensation and tearing) together with two of the tests with positive results for dry eye (tear film break-up time [BUT], fluorescein staining of the cornea, analysis of the meibomian gland and Schirmer I test) in both eyes were considered dry eye positive. Hormonal assay for follicle stimulating hormone, luteinizing hormone, estradiol and free testosterone was performed. Dry eye statuses in the groups were evaluated statistically.

Four patients with incomplete follow-up data were excluded. HRT use increased estradiol levels in the groups. Mean ages of patients (50.2 and 50.7 years, and 50.0 and 53.0 years) were similar. Duration of menopause in Groups 1 and 2 (3.2 and 1.4 years), and in Groups 3 and 4 (3.0 and 1.7 years) were different. At the third-month examinations, all 20 patients in Group 1 and 11 patients (61.1 percent) in Group 2 had dry eye.

Duration of menopause and use of HRT may increase the incidence of dry eye in post-menopausal woman.

SOURCE: Erdem U, Ozdegirmenci O, Sobaci E, et al. Dry eye in post-menopausal women using hormone replacement therapy. Maturitas 2006; Oct. 7 [Epub ahead of print].

NEWS & NOTES

	PROTEIN DISCOVERY MAY BE KEY TO TREATING AMD. A protein that prevents blood vessels from forming in the cornea could form the basis for new age-related macular degeneration (AMD) and cancer and treatments, according to the group of international scientists at the University of Kentucky who discovered it. The researchers identified a protein, sVEGFR-1, that at sufficient levels appears to prevent vessel formation in the eye--and is likely the reason why the cornea is without blood vessels. The cornea contains large amounts of the chemical VEGF-A, which promotes blood vessel growth, yet it has been a mystery as to why blood vessels do not form there. The newly discovered protein is likely to be the answer. Produced in the cornea, sVEGFR-1 acts as a "mop" to absorb VEGF-A. The researchers are now concentrating on understanding how the body produces sVEGFR-1; they have already conducted small studies on animals with the goal of developing a synthesized version of the protein that can be administered via eye drops.
	PNT GLAUCOMA TREATMENT MAY SOON BE MARKETED IN CHINA. Ophthalmic International, a wholly owned subsidiary of Coronado Industries, has made marked progress toward completing registration of its Pneumatic Trabeculoplasty (PNT) glaucoma treatment within the People’s Republic of China. Beijing Vision World Trading, the company’s marketing partners in China, has informed Coronado that it is nearing the end of the regulatory process required to gain approval for PNT to be marketed in that country. The process has advanced faster than originally planned; the Chinese marketing partners now anticipate market approval within the next quarter. For more information about Coronado Industries, go to www.coronadoindustries.com.
	SWEDISH BIOPHARM FIRM INITIATES PHASE II CLINICAL STUDY OF NOVEL TREATMENT FOR GLAUCOMA. Sweden-based biopharmaceutical company Biovitrum has initiated a clinical Phase II study of candidate drug BVT.28949, a 5-HT2A antagonist for treating glaucoma. The company’s first clinical safety study of the drug, launched in September 2005, included 64 healthy volunteers and had positive results. The present placebo-controlled Phase II study includes 150 patients with elevated intraocular pressure (IOP) and will be conducted at several clinics in Sweden and the Ukraine. It is believed that BVT.28949 reduces IOP by stimulating the outflow of aqueous humor through a mechanism different from that of presently available products. Results of the study are expected to be available in mid-2007.

 

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