Online AMD Toolkit

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A global coalition of patient organisations concerned with vision health, ageing and avoidable blindness has launched an online toolkit to improve understanding of Macular Degeneration (MD) - www.Retina-AMD.org.

Retina International, the coalition leader, state that "although awareness has improved over the last decade, the various stages and complexity of the disease are not well understood. Early, intermediate and late stage MD are conditions with differing signs and symptoms."

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Early diagnosis is critical to detect and treat the first signs of MD successfully and to give everyone access to aids and rehabilitation services that can improve quality of life.

Scientific research into MD is leading to better understanding. However it is important that up-to-date information is delivered through a trusted source.

Dry Eye Update - Layering Eye Drops

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We categorise Dry Eye as Evaporative Dry Eye (EDE) or Aqueous Deficient Dry Eye (ADDE). And many people suffering dry eye have a combination of the two!

Treatment needs to be specific depending on whether the aqueous part of the tear layer needs boosting, or the oily top coat is not working. Most of the eye drops available target ADDE but novel NovaTears,  provides a unique relief for EDE.

Nova tears is water free, so it can be used after opening for around six months with no need for preservatives. It spreads easily and feels good in the eye. Nova Tears spreads across the eye to reconstitute the lipid layer, slow evaporation, and allow natural regeneration of the tear film. 

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While Nova Tears can be used by itself, I can strongly recommend layering. As a Dry Eye sufferer  I can share my recipe for relief.

  • Lacritec Omega-3 2 capsules
  • One drop Hylo Fresh, wait 5 minutes (brush your teeth, other bathroom routines)
  • One drop Nova Tears (This drops spreads so beautifully it feels like it is literally running off the eye)

My personal experience is the addition of Nova Tears keeps me symptom free for most of the day. If you need any advice or are suffering with dry eye, contact us or book a dry eye assessment.

By Claire McDonald, Optometrist

Stem Cells Restore Sight to Macular Degeneration Patients

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Patients with wet age-related macular degeneration (AMD) received a new treatment derived from stem cells and have regained reading vision. 
The study is a major milestone for the London Project to Cure Blindness (a partnership between Moorfields Eye Hospital NHS Foundation Trust, the UCL Institute of Ophthalmology and the National Institute for Health Research). Professor Pete Coffey from UCL said the research may lead to “an affordable 'off-the-shelf' therapy… within the next five years”. However, Macular Degeneration New Zealand, and Macular Disease Foundation Australia have advised caution, more work is needed before this can occur. 

Published in Nature Biotech, the study described the implantation of a specially engineered patch of retinal pigment epithelium cells derived from embryonic stem cells to treat people with sudden severe sight loss from wet AMD. It may also help treat dry AMD in the future. This is the first description of a complete engineered tissue successfully used in this way. 

Two patients underwent the procedure; a woman in her early 60s and a man in his 80s with severe wet AMD. 

 The purpose-built introducer tool

The purpose-built introducer tool

The study investigated whether the diseased cells at the back of the patients' affected eyes could be replenished using the stem cell based patch. A specially engineered surgical tool was used to insert the patch under the retina in the affected eye of each patient in an operation lasting one to two hours. 

After 12 months, these two patients who were previously not able to read at all, even with glasses, were reading 60-80 words per minute with normal reading glasses. 

The trial results are very encouraging, but the reality of this as a routine treatment is still many years away and we can't draw too many conclusions from two patients over only 1 year. Much more research is needed to confirm safety, long term efficacy and to determine the most appropriate time to treat. Equally important is to determine whether this type of treatment could be of benefit for people with late dry AMD (geographic atrophy) where there is currently no treatment available.

Potential for Vitamin B3 in Glaucoma Treatment

Researchers from the Centre for Eye Research Australia (CERA) in Melbourne are conducting a world-first human trial of an over-the-counter vitamin supplement to treat glaucoma, a disease of the optic nerve which affects 60 million people worldwide.

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Professor Jonathan Crowston is the lead investigator of the study and Dr. Flora Hui is the Research Fellow conducting the six-month clinical trial. They hope to prove that therapeutic use of high dosage vitamin B3 (nicotinamide) could be used to support existing glaucoma treatments, such as eye drops.

“Imagine your car’s engine is running a bit rough and as a result, the car doesn’t drive smoothly. If you top up the engine with oil, the car runs better, even though you haven’t fixed the underlying problem,” explains Dr. Hui.

“Our study hopes to confirm that vitamin B3 can protect nerve cells from dying, in a similar way that adding oil to a faulty car engine can still allow it to run more smoothly,” she concludes.

Professor Jonathan Crowston leads the Glaucoma Research and is Managing Director of the Centre for Eye Research Australia. “Glaucoma currently has no cure and vision loss is generally thought to be irreversible,” he said.

“We have recently discovered that in the early stages after an injury, visual function can in fact recover, but the ability to recover diminishes with increasing age. We have developed clinical tests that now allow us to look for visual recovery and we are beginning to look at treatment that could boost recovery. Our premise is that if you can improve optic nerve recovery after an injury that we could reduce the risk of glaucoma progressing,” said Prof. Crowston.

In 2017, a US research team led by Prof Simon W.M. John and Dr. Pete Williams from the JAX laboratories in the USA, found that vitamin B3 given to glaucoma-prone mice prevented optic nerve degeneration and glaucoma. In fact, this treatment also reversed the negative effects of ageing in the mouse eye. “We were very excited by these findings and are now looking at the effect of vitamin B3 in glaucoma patients,” said Prof. Crowston.

New Research: Exercise May Reduce the Risk of Glaucoma

People who are doing moderate to vigorous physical activity may significantly lower their risk of glaucoma, according to research presented at the 121st Annual Meeting of the American Academy of Ophthalmology (AAO). Tseng et al from the University of California, Los Angeles (UCLA) reported a 73% lower incidence of glaucoma among the most physically active study participants, compared with the least active. 

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The researchers reviewed survey and pedometer readings from the National Health and Nutrition Examination Survey (NHANES), which has tracked the health and nutritional status of over 70 million adults in the United States since the 1960s. For each 10-minute increase in moderate-to-vigorous activity per week, glaucoma risk decreased 25 per cent.(1) This suggests that exercise plays a protective role, where people who exercise at a higher intensity (speed and steps) may decrease their glaucoma risk more, compared to people exercising at a lower intensity. 

These results correlate with a study showing reduced self-reported glaucoma incidence with each kilometer (km) per day run and with each incremental increase in speed in a 10-km footrace among 29,854 male runners followed for 7.7 years. (2)

However there are studies which contradict these results. A South Korean study of 11,247 people,  showed increased glaucoma prevalence for participants doing high intensity activity versus moderate activity.(3) South Korea does have a high proportion of normal tension glaucoma, where there may be a lower threshold for glaucomatous damage due to exercise-induced changes in eye pressure.

Care should be taken when interpreting these new findings until they are published in a peer reviewed journal. However the emergence of exercise as a potential modifiable risk factor in glaucoma is exciting, because most other risk factors are outside an indiviual's control. Moderate intensity exercise appears to be safe and likely beneficial for most people,(10) including glaucoma patients.

People with glaucoma, especially normal tension glaucoma, or advanced disease, should discuss exercise with their Eye Specialist. 

References:

1. Tseng, V., F. Yu, and A.L. Coleman, Exercise Intensity and Risk of Glaucoma in the National Health and Nutrition Examination Survey, in American Academy of Ophthalmology. 2017: New Orleans, USA.

2. Williams, P.T., Relationship of incident glaucoma versus physical activity and fitness in male runners. Med Sci Sports Exerc, 2009. 41(8): p. 1566-72.

3. Lin, S.C., et al., The relation between exercise and glaucoma in a South Korean population-based sample. PLoS One, 2017. 12(2): p. e0171441.

4. Society, A.P.G., Asia Pacific Glaucoma Guidelines. 2016, Kugler Publications: Amsterdam, The Netherlands.

5. Qureshi, I.A., The effects of mild, moderate, and severe exercise on intraocular pressure in glaucoma patients. Jpn J Physiol, 1995. 45(4): p. 561-9.

6. Wylegala, A., The Effects of Physical Exercises on Ocular Physiology: A Review. J Glaucoma, 2016. 25(10): p. e843-e849.

7. Natsis, K., et al., Aerobic exercise and intraocular pressure in normotensive and glaucoma patients. BMC Ophthalmol, 2009. 9: p. 6.

8. McMonnies, C.W., Intraocular pressure and glaucoma: Is physical exercise beneficial or a risk? J Optom, 2016. 9(3): p. 139-47.

9. Susanna, R., Jr., et al., Applications of the water drinking test in glaucoma management. Clin Exp Ophthalmol, 2017. 45(6): p. 625-631.

10. Garber, C.E., et al., American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 2011. 43(7): p. 1334-59.

Dry Eye Assessment

Dry Eye occurs when there is inadequate tear film to protect the ocular surface. Symptoms include scratchy, gritty irritated eyes. Life expectancy, longer working careers, increased screen time, low humidity, metropolitan environment and diet are increasing the incidence of dry eye. Diabetes, smoking, contact lenses, eye surgery and medications can exacerbate symptoms. Mild dry eye can be annoyingly uncomfortable, and severe symptoms can limit activities such as work, socialising or travel, significantly reducing quality of life.

 Medmont Video Tear Film Analysis

Medmont Video Tear Film Analysis

Dry eye science is a growing area. New methods to diagnose the different types of dry eye, (Aqueous Deficient Dry Eye or Evaporative Dry Eye) are being developed, along with new treatments. We now have specialised tests and offer in-practice treatments. If you have dry eye symptoms we may be able to help you.

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Here is what a Dry Eye Assessment involves. We start with a questionnaire on your symptoms. This gives insights into your dry eye, and helps us measure improvements. Diagnostic tests include video Tear Film Surface Quality analysis. We use staining techniques for a microscope evaluation which includes assessment of the oil glands and eye lids. Blephasteam Heat goggle treatment is followed by lower lid margin cleaning and oil gland clearing.

At your appointment we will create a treatment plan for ongoing relief. This will often include drops and ointments, Omega-3 supplements and eyelid hygiene treatment.

If you have dry eye, or dry eye symptoms, please book an appointment to see us.