Eyedolatry

Marsala Pantone Color of the Year 2015

2015 eyewear fashion trends 4:33 PM

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CooperVision Discontinues Several Hydrogel Contact Lenses

The world is moving to either single use or silicone hydrogel contact lenses, and CooperVision acknowledged that trend recently by announcing plans to discontinue some of its older hydrogel contact lens options. They cited a major movement in contact lens fitting trends in the first few months of 2014: 44% of hydrogel lens wearers were refit to silicone hydrogel lenses and 44% of multiple wear lens wearers were refit into daily disposables (data from CooperVision). With so many options for better health and better comfort, the days of old hydrogrel lenses seem to be numbered with multiple companies restructuring their product lineups to ditch old materials in favor of healthier options.

I was surprised to see Proclear EP as a discontinued lens since I do find it effective for very early presbyopia, but full multifocal contact lenses are getting better at limiting distance distortion, and using a silicone hydrogel lens like Biofinity MF with low adds will give the added benefit of monthly lens wear and higher oxygen transmissibility. via

The three lenses that are being discontinued are Biomedics 55 UV, Biomedics 38, and Proclear EP. As of 12/31/2014 trial lenses will no longer be available for order, and no boxes will be available to purchase in any of these lens products as of 10/31/2015. Here are the recommended refit options for the products being discontinued:

Biomedics 55 UV and Biomedics 38 (also called Sofmed or Ultraflex):

to keep with 2 week disposal, refit to Avaira
to change to monthly disposal, refit to Biofinity
upgrade to daily disposable

Proclear EP (also called Biomedics EP):

change to monthly replacement Biofinity MF with low add
upgrade to daily disposable multifocal in low add

Lenses that are not included in the slated discontinuation plans include Biomedics XC, Vertex Toric, and Frequency 55 (Encore Premium). These hydrogel lenses will likely have a limited future based on the trends CooperVision is citing as the cause of their decision since these lenses are also older hydrogel materials. Additionally all of those above products are not even listed on the CooperVision website as current products except by going to an "additional lenses" section. It's not a bad idea to consider refitting patients wearing CooperVision's other older hydrogel lens materials as well to be proactive to possible changes in the near future. If you have a patient with silicone hydrogel intolerance, Proclear Compatibles and Proclear 1-Day offer great alternatives (and they are listed on CooperVision's site as part of their product family which makes me feel comfortable that there are no plans to remove these lenses in the near future).

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Update on Gene Therapies for Leber's Congenital Amaurosis

gene therapy for blindness 7:00 AM

Leber's Congenital Amaurosis results in photoreceptor death and significant
visual loss in childhood. via

If you know someone affected by the blinding genetic condition, Leber's Congenital Amaurosis (LCA), then the recent studies on gene therapies have been giving us a reason to hope. LCA is a rare genetic condition that results in significant vision loss during childhood due to death of the photoreceptor rods and cones that detect and process light information. There are several genetic variants of the disease, and one (LCA2) has been isolated to a mutation in the RPE65 gene. Isolating a disease to one gene mutation makes for an exciting option: the ability to replace that gene into the body with gene therapy!

The RPE65 gene codes for a protein essential in the way the retinal pigment epithelium supports the photoreceptor rods and cones and uses vitamin A to detect light. When the mutation was identified, LCA2 became a prime target for genetic therapy treatment because it required just one snippet of code to be replaced. Scientists can use virus vectors to insert the correct RPE65 gene directly into the eye (via intravitreal injection), with the hopes that the treated person will begin making the corrected protein, and regain that lost visual function. Some of the first studies from the University of Pennsylvania and University of Florida were published in 2009 and showed improvement in visual function.

Now a few years into these studies, new reports are coming in. Gene replacement treatment in these patients has been safe, but it appears that the retinal photoreceptors have continued to degenerate despite the gene therapy. OCT scans show retinal thinning occurring at the same rate in both treated and untreated eyes even years after original therapy. It appears that gene therapy can improve vision for a period of time (how many years, we do not know), but the photoreceptors may still lose function long term. Childhood treatment can help improve visual function but may not be enough to erase the damage during that early development. Early intervention appears to be key, but in humans LCA destruction is beginning even during development of the ocular tissue in the womb, so our capabilities for delivering this early treatment are limited.

Right now there are several Phase 3 clinical trials being run to assess long term benefit of RPE65 gene replacement therapy in LCA2, and the results look promising that vision can be improved at least temporarily. To this point the published results have not shown any study participants suffering from vision loss, despite the progression to their retinal thinning, so it is too early to tell how long their visual improvements from gene therapy will last. Trying to find a way to treat patients with gene therapy before they suffer retinal photoreceptor damage may be difficult, so scientists are looking at somehow combining gene therapy with other therapeutic treatment that may help stabilize retinal photoreceptor cells. As of right now, no such medical treatment exists but eyes are on the use of LINGO-1 as a possible neuro-regenerator. The science is new and innovative and sure to meet many hurdles along the way, but we are living in an exciting world of possibilities!

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This One's For the Guys

clubmaster trend 2014/2015 7:00 AM

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New Daily Disposable Contact Lens: Clariti 1-Day

clariti 1 day parameters 7:00 AM

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New Implantable Telescope Brings Better Vision to those with Advanced Macular Degeneration

Age Related Macular Degeneration 8:33 PM

Age Related Macular Degeneration with advanced
central vision disruption
image credit to eyedolatry.blogspot.com

Imagine a world where your central vision was nothing but a blur or distortion. Any time you try look at something straight on, you can only see the periphery of the object you are trying to see. Try recognizing faces or reading your cell phone or a book with nothing but peripheral vision. This is what the world looks like for the millions of people worldwide that have advanced macular degeneration. There is no cure for this devastating visual condition, but a new implantable telescopic device can help restore some of that central vision zone for the first time ever.

The CentraSight implantable telescope is made by VisionCare Ophthalmics, and is a vision enhancing device that can improve central vision range when placed inside the eye. Traditionally, patients with central vision loss had to rely on handheld or spectacle mounted telescopes to try to enhance their central vision. These devices were bulky and distracting, not to mention their limited visual potential (about 10 degrees of field is all they can provide!). The CentraSight implantable telescope is just over 4 mm in size and sits discretely in the eye, making it less obvious to those around you that you are using a low vision device, and also freeing up your hands that would have otherwise had to hold the magnifying lens up to the eye whenever you wanted to use it. Because the telescopic optics are inside your eye, there is the added benefit of a much larger observable field of view, between 20 and 24 degrees of gained central vision area is attainable with the implant/

Enlarged view of the CentraSight implantable telescope. This is actually under 5 mm in size via

Implant inside the eye. It is placed in the same place that a post-cataract surgery implant
would traditionally be inserted via

Who Qualifies?
In October the FDA updated the candidacy needs for patients interested in the CentraSight implant to offer younger patients the opportunity to pursue the implant. The new requirements are:

1) Bilateral Central Vision Loss due to Age Related Macular Degeneration

If one eye is damaged with macular degeneration but the other still has great preserved central vision, then the patient is not a candidate. The implant needs to be placed on the better seeing eye in order to provide of any improvement in perceived vision. If the implant is put in the bad eye, then the brain will just suppress the bad eye's image and use the good eye only like it was doing before surgery. You would have just had a very expensive surgery without any visual benefit. In order for the telescope to work, your brain has to want to process its image, and that is why it must be placed on the eye with better vision to achieve the best effect.

2) Best Corrected Vision between 20/160 and 20/800

This telescopic implant will only be beneficial if the patient has advanced vision loss, so vision must be poor in order for the telescopic implant to make sense. The reason that poor vision is so important to achieve success with this surgery is that by putting in the telescope, you are sacrificing all peripheral vision out of the eye with the implant. To give up all of that visual field, you have to have a true need for central vision to make the sacrifice worth it.

3) No prior history of cataract surgery

When you have cataracts removed, the surgeon places a clear, plastic implant inside your eye to help correct post-operative vision. The telescopic implant is placed inside the eye in very much the same way. The telescope sits inside of the posterior capsule, just like a standard IOL. Once you have a post-cataract implant in place, there are many risks in removing it, so at this time the telescope implant must only be placed in people that have not had cataract surgery and can be fit with the telescopic implant from the very first.

4) At Least 65 years old

This age limit was just decreased by the FDA (previously the limit was age 75). Since the study results published show that the implant is both safe and effective, the age has been lowered to allow more people suffering from devastating vision loss to benefit.

Some Basics on What to Expect

Before the surgery takes place, your surgeon is going to refer you to a low vision specialist to help you prepare for the type of vision this telescopic implant can provide. The world is going to look quite different after surgery because with the telescope in place, one eye will be responsible for central vision and the other will do all of the peripheral vision tasks. The telescope creates a type of monovision if you think of it in that light. Once the telescope is in your eye, you can't see anything but that central 20 to 24 degrees of field because the telescope is converting all of your available retinal photoreceptors into central vision processing centers. The patient will need practice and coaching to get used to having their eyes see so differently, and before and after implantation there is going to be a learning curve to get comfortable with the new vision provided.

Very little can be done with modern medicine to return lost vision to someone with macular degeneration, but the reason that the CentraSight telescope has been so popular in the news lately is because studies show such promising vision improvement. In the course of one year after telescopic implantation in the better seeing eye, 90.1% of 206 participants had gained 2 lines of letters on a visual acuity test, and 66.6% achieved 3 lines of visual improvement. This improvement in vision can mean the difference in recognizing faces, or living more independently. You aren't going to be driving or reading small font books, but it can make navigating every day tasks much easier and safer.

Dr. Isaac Porter explains the telescopic implant in the video above.

Are you interested in learning if you or a loved one could benefit from the CentraSight implantable telescope? Please head to this website to find a provider in your area, or ask your local eye doctor for a referral to specialist that offers this treatment!

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