By Dr. Ari Weitzner

I remember this from about 10 years ago- these guys tried to create an anastomosis using a laser, by clipping the vein and breaking Bruch’s. It worked sometimes, but complications were high and results were unpredictable. But in Ophthalmology, I read that researchers recently had more success (75%), and they kept an eye on complications and treated neovascularization promptly.

By Dr. Ari Weitzner

A study in Ophthalmology noted a high correlation between those with facial rosacea and Demodex mites (and B oleronius, a bacteria associated with the mites). The authors suggest that lid scrubs with tree tea oil may be of benefit. I would imagine any patient with significant Meibomian gland disease who does not respond to typical Rx may benefit as well. The authors note that cylindrical dandruff along the base of the eyelash is pathognomonic for Demodex.

By Dr. Ari Weitzner

In the AJO, a study demonstrated no difference in visual acuity or corneal aberrations up to 36 months in patients who had LASIK with a blade versus all-laser LASIK with no blade. This confirms what was suggested earlier. It seems that bladeless LASIK is largely a marketing tool.

By Patient

A few weeks ago i went to my optician who gave me an eye exam. He asked me if i had any problems with my eyes and I said yes my left eye has felt like there is something in it,like a hair or a small object, near the tear duct area.

He checked and said there was nothing wrong. He gave me some Liposic (it has not helped at all) and sent me on my way. I have felt this object in my eye for months before. So I went to the doctor and told him. He didn’t check my eye. He just prescribed lacrisert. But when i went to get this medication the pharmacy told me it was 100’s of dollars and wasn’t covered on my medical coverage. 

The pharmacist then contacted the doctor who had prescribed Lacrisert inserts, and I was switched to refresh lacri-lube and refresh liquigel (drops)..is this for people with dry or watery eyes?..i dont have either,should go to another eye doctor at a hospital for a third opinion?…This is driving me bonkers.

By Dr. Randall Wong

There may be a new treatment regimen for patients with central retinal vein occlusions (CRVO).  The new regimen is actually of two previously described techniques; optic neurotomy combined with intraocular injection of steroid.

The study, described in a recent issue of Ophthalmic Surg lasers Imaging, compared the use of radial optic neurotomy (RON) plus intravitreal injection of steroid (triamcinolone) against four other arms;

• RON + Triamcinolone
• Triamcinolone Alone
• Internal Limiting Membrane Peel, RON and Triamcinolone
• RON Alone
• Observation only

The study results indicated the best improvement with the radial optic neurotomy when combined with the steroid injection.

What Does This Mean?  Radial optic neurotomy (RON) was popular for several years for the treatment of CRVO.  It has fallen out of favor, probably due to the lack of significant improvement (in my opinion).  While it was exciting to be able to offer hope to CRVO patients, the results were somewhat inconsistent and disappointing.

During that time, the use of intraviteal steroid injection was controversial.  By creating the radial neurotomy, basically making an incision on the edge of the nasal disc, penetrating choroid and lamina, the hope was to create an anastomosis with secondary neovascularization during the post-period.

The use of the steroid was feared to inhibit the neovascularization.

While any hope for this group of patients is welcomed, perhaps we need to revisit this procedure and the use of steroid.  With the introduction of Ozurdex, I wonder if used alone, or with RON, the visual prognosis may be brighter.

Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia

By Dr. Ari Weitzner

In Review of Ophthalmology, Dr. Asbell discusses some studies which suggest that contact lenses retard myopia compared to single-vision glasses. The theory is that contacts create less peripheral hyperopia. The study noted less axial length and less myopia in the contact lens wearers over a six-month period.

By Patient

I am 65 years old, I have Fuch’s Dystrophy, and I have had 2 surgeries for cataracts (on each eye).  I am also very nearsighted, with astigmatism.  Until the surgeries I was never bothered by Presbyopia (I could see all near things quite well, especially when I removed my glasses).  Before my surgery, I was told I could only receive the implant that corrects my nearsightedness, but I would be able to see far, or I could choose the option where they corrected my vision in 1 eye (but that 1 sounded very strange to me) so I opted for the cataract surgeries that would correct my nearsightedness.  What I didn’t know (until after the surgeries) was how bad my near vision would be affected. Now I cannot see or read anything that has any kind of small print on it (I can’t even see my cell phone displays).  I feel like my vision completely turned around and now I can see fairly well far away (about 20/30 or 20/40), but I cannot see a thing close up.

I feel like I sacrificed my near vision to be able to see far away better.  I know that my Fuch’s Dystrophy gets in the way, too, and that’s probably why I’m not seeing 20/20.  I also know that I couldn’t get the other implant option (because of my Fuch’s), which was a dual implant that corrected both near and far vision. 

What I would like to know is it common for people w/Fuch’s Dystrophy who get cataract surgery to lose near vision?  If anyone else has had an experience like mine, please comment, too.

By Dr. Randall Wong

As reported in OSN, a small study reports reduced recurrence of macular pucker when the ILM (internal limiting membrane) is safely removed.

The authors studied 65 eyes that underwent sutureless vitrectomy (25 or 23-gauge), no ICG dye staining and removal of the ILM.  The results showed an improvement of vision in 25% of patients.  The improvement in vision was both stable and statistically significant.

What Does This Mean?  The authors note that while there is visual improvement, the amount of improvement is limited.  They conclude that earlier vitrectomy is warranted to “save” further vision loss.

I agree that patients should consider vitrectomy as soon as they are aware of some non-correctable vision change due to macular pucker.  This can be either distortion and/or decreased vision.  In other words, a patient may be 20/20, but complaining of distortion.  Either can be a reason for operating.

The techniques have improved that given proper surgical technique, vision loss from this common macular disorder.

Randall V. Wong, M.D.

Retina Specialist
Fairfax, Virginia

By Dr. Randall Wong

Jancevski, MD and colleagues report on the safety of “Retisert” for patients with intermediate or posterior uveitis.  Their study involved 64 eyes of 51 patients.

Retisert (Bausch and Lomb) is an intraocular delivery device that releases a steroid (fluocinolone).  The device is implanted in the posterior segment and is anchored by scleral sutures.  It does not dissolve.

In their retrospective study, most patients had an elevation of IOP.  Half required topical therapy, 14 required laser, trabeculectomy or shunt.  11 of 14 phakic eyes needed cataract surgery.

Vitreous hemorrhage, retinal detachment endophthalmitis and blebitis were other complications.

What Does This Mean? At first glance, Retisert for the management of posterior or intermediate uveitis  does not seem a viable treatment.  The rise of IOP and complications seem high.

Now consider the ramifications of reducing systemic immunotherapy.  The study found that some patients were able to reduce or discontinue immunotherapy. This was noted in 9 patients.

My point is that there seems to be a place for Retisert given the complications of systemic immunosuppressive therapy.  For patients not tolerating systemic therapy, local implantation, despite the side effects, may be appropriate.

In the future, with more and more steroid delivery systems emerging (e.g. Iluvien, Ozurdex), the treatment of intermediate uveitis may become more straightforward.

Randall V. Wong, M.D.

Retina Specialist
Fairfax, Virginia

By Irv Arons

A new company, a spin-off from another of Dr. Robert Langer’s MIT companies, has just come out of stealth mode and released details of its potentially breakthrough approach to delivering drugs on demand to the back of the eye. The new company, On Demand Therapeutics, has disclosed a laser activatable drug reservoir that can deliver a drug such as Avastin, for treating neovascular AMD, as needed to treat that disease. At least, that is the concept.

To read more about this potential breakthrough in on-demand drug delivery, please see my writeup on the company, including illustrations of the concept, along with several questions I have.

Robotic surgical technology with its three-dimensional, high-definition view gives surgeons the sensation of touch, even as they operate from a remote console. A new study describes the phenomenon, called intersensory integration, and reports that surgical outcomes for prostate cancer surgery using minimally invasive robotic technology compare favorably with traditional invasive surgery.

Contralateral prophylactic mastectomy, a preventive procedure to remove the unaffected breast in patients with disease in one breast, may only offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor negative, according to researchers.

A research team that conducted the gene therapy trial for an inherited blindness reports that a study in animals has shown that a second injection of genes into the opposite, previously untreated eye is safe and effective, with no signs of interference from unwanted immune reactions following the earlier injection. These new findings suggest that patients who benefit from gene therapy in one eye may experience similar benefits from treatment in the other eye.

Scientists recently assessed the light emitted by a home-use intense-pulsed light (IPL) hair reduction system and confirmed that it is safe. This confirmation is important, as IPL devices must meet the necessary safety guidelines, to ensure users are protected in the case of accidental exposure to the human eye.

An eight-year prospective study of more than 30,000 postmenopausal Swedish women found that those who were using or had used HRT had significantly higher rates of cataract removal, compared with women who had never used HRT. Alcohol consumption seemed to increase HRT's harmful effect.

Senior eye doctors are warning people to keep liquid capsules for fabric detergents out of the reach of children after a wave of eye injuries in young children at their hospital.

In an eye-opening editorial, a leading expert urges the medical community to use ultrasound instead of computed tomography as the first-line imaging test for better diagnosis capability in the evaluation of acute female pelvic and lower abdominal conditions.

Researchers are now a step closer to deciphering a leading cause of blindness in the United States -- glaucoma. They found that the first sign of injury in glaucoma actually occurs in the brain. The findings show that glaucoma is very much like other neurodegenerative central nervous system diseases.

Researchers have determined that regular use of aspirin, acetaminophen and non-steroidal anti-inflammatory drugs increases the risk of hearing loss in men, particularly in younger men, below age 60.

Researchers have developed a new assessment tool to measure the severity of symptoms that can complicate stem cell transplantation. The tool assesses symptoms resulting from chronic graft-vs.-host disease (cGVHD).