New studies asses patient’s adherence to glaucoma medication

A new study reveals that a fairly large number of patients suffering from glaucoma did not regularly use their prescribed eye drops.

Image source: www.atlanticeyeinstitute.com

The research, which was conducted at university-based glaucoma clinic, recruited 407 patients who were undergoing treatment that required daily prostaglandin eye drops. Aimed to measure their medical adherence, the patients were given a container with an electronic cap that recorded each time it was opened.

It was revealed later on that 82.8 percent of the participants took their medication properly on at least 75 percent of days, while the remaining 17.2 percent were not able to adhere to their prescribed medication.

Image source: www.oregoneyecenter.com

Furthering the study, the researchers made their second intervention by including text or voice messages to assist the patients with their eye drop medication.

As the experiment concluded, the researchers found that the adherence rate among those who failed to take their medication in the first batch increased from 53 percent to 64 percent.

Although the barriers to patients’ medication adherence were considered complex, the researchers concluded that the inclusion of text or voice messages can help patients adhere to their eye drop medication.

Image source: www.glaucoma.org

Given these results, the researchers noted that telecommunication-based reminders can help patients and doctors track one’s daily glaucoma medications. They further stressed that this latest discovery is essential because it can potentially support today’s ophthalmology practice.

Dr. Hitesh K. Patel is an Edison, New Jersey-based ophthalmologist. Read more about glaucoma and other vision problems at www.pateleyeassociates.com.

REPOST: Off with your glasses: Visual crowding linked to retina, brain processing

Tel Aviv University researchers discovered a link between sharp vision and brain's processing speed. Find out how the brain integrate visual formation from this ScienceDaily.com article.

 

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Middle-aged adults who suddenly need reading glasses, patients with traumatic brain injuries, and people with visual disorders such as "lazy eye" may have one thing in common -- "visual crowding," an inability to recognize individual items surrounded by multiple objects. Visual crowding makes it impossible to read, as single letters within words are rendered illegible. And basic cognitive functions such as facial recognition can also be significantly hampered. Scientists and clinicians currently attribute crowding to a disorder in peripheral vision.


Image Source: en.wikipedia.org

Now Prof. Uri Polat, Maria Lev, and Dr. Oren Yehezkel of Tel Aviv University's Goldschleger Eye Research Institute at the Sackler Faculty of Medicine have discovered new evidence that correlates crowding in the fovea -- a small part of the retina responsible for sharp vision -- and the brain's processing speed. These findings, published in Nature's Scientific Reports, could greatly alter earlier models of visual crowding, which emphasized peripheral impairment exclusively. And for many adults lost without their reading glasses, this could improve their vision significantly.

"Current theories strongly stress that visual crowding does not exist in the fovea, that it's a phenomenon that exists only in peripheral visual fields," said Prof. Polat. "But our study points to another part of the eye altogether -- the fovea -- and contributes to a unified model for how the brain integrates visual information."

 A trained eye

According to Prof. Polat, vision is dynamic and changes rapidly, but it takes time for the brain to process this visual information. Rapidly moving tickers on TV, or traffic signs seen as the driver speeds past, are difficult for anyone to read. However, given enough time, someone with excellent vision can fully recognize the words. Those with slower processing speeds -- usually the result of poor perceptive development or age -- may not be able to decipher the tickers or the traffic signs. In the study, Prof. Polat employed his expertise in improving vision by retraining the brain and the foveal part of the eye, using exercises in which speed is a key element.

 
Image Source: flickr.com

"Training adults to reduce foveal crowding leads to improved vision. A similar training we conducted two years ago allowed adults to eliminate their use of reading glasses altogether, using a technology provided by the GlassesOff company. Other patients who had lost sharp vision for whatever reason were also able to benefit from the same training and improve their processing speed and visual capabilities," said Prof. Polat. Maria Lev, who performed the study as a part of her doctoral thesis, said one young subject had experienced significant limitations in school for years and had been unable to obtain a driver's license due to severe visual impairment from foveal crowding. After undergoing training that emphasized a foveal rather than a peripheral focus, he was able to overcome the handicap.

 
Image Source: zmescience.com

 "He finally managed to learn to read properly and found his way forward," said Lev. "I'm proud to say that today he is not only eligible for a driver's license, he's also been able to earn his master's degree."  

Follow this Dr. Hitesh K. Patel Twitter page to get more updates on vision care.

REPOST: New eye layer has possible link to glaucoma, study shows

How will the new layer that's discovered in the human eye affect eye diseases like glaucoma? Read the answer from this ScienceDaily.com article.
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A new layer in the human cornea -- discovered by researchers at The University of Nottingham last year -- plays a vital role in the structure of the tissue that controls the flow of fluid from the eye, research has shown.

Image Source: foxnews.com

The findings, published in a paper in the British Journal of Ophthalmology, could shed new light on glaucoma, a devastating disease caused by defective drainage of fluid from the eye and the world's second leading cause of blindness.

The latest research shows that the new layer, dubbed Dua's Layer after the academic Professor Harminder Dua who discovered it, makes an important contribution to the sieve-like meshwork, the trabecular meshwork (TM), in the periphery of the cornea.

The TM is a wedge-shaped band of tissue that extends along the circumference of the angle of the anterior chamber of the eye. It is made of beams of collagen wrapped in a basement membrane to which trabecular cells and endothelial cells attach. The beams branch out randomly to form a 'meshwork'.

Pressure within the eye is maintained by the balance of aqueous fluid production by eye tissue called the ciliary body and drainage principally through the TM to the canal of Schlemm, a circular channel in the angle of the eye.

Defective drainage through the TM is an important cause of glaucoma, a condition that leads to raised pressure in the eye that can permanently affect sight. Around 1 to 2% of the world's population yearly have chronic glaucoma and globally around 45 million people have open angle glaucoma which can permanently damage the optic nerve -- 10% of whom are blind.

The latest research by Professor Dua and colleagues in Academic Ophthalmology at The University of Nottingham sheds new light on the basic anatomy of Dua's Layer, which is just 15 microns thick but incredibly tough. Comprised of thin plates of collagen, it sits at the back of the cornea between the corneal stroma and Descemet's membrane.

By examining human donor eyes using electron microscopy, the researchers were able to look at Dua's Layer beyond the central part of the cornea to shed more light on its features at the extreme periphery of the cornea. They discovered that the collagen fibres of Dua's Layer also branch out to form a meshwork and that the core of TM is in fact an extension of Dua's Layer.

It is hoped the discovery will offer new clues on why the drainage system malfunctions in the eyes of some people, leading to high pressure.

Professor Dua said: "Many surgeons who perform lamellar corneal transplant recognize this layer as an important part of the surgical anatomy of the cornea. This new finding resulting from a study of the microanatomy of the periphery of the layer could have significance beyond corneal surgery."

The breakthrough discovery of Dua's Layer was first revealed in a paper in the academic journal Ophthalmology in June last year and was widely covered by the world's scientific and lay media. The paper became the number one downloaded ophthalmology paper from the website ScienceDirect between July and September 2013 and was ranked the 11^th most downloaded from the website for the whole of medicine and dentistry.

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Dr. Hitesh K. Patel is the founder of the Edison-based eye center, Patel Eye Associates. Know more about him by following this Twitter account.

REPOST: Cause of destructive cascade of diabetic retinopathy

This MedicalNewsToday.com article discusses the roles  and effects of excessive ROS or reactive oxygen species in our body and how will it affect our vision.


The retina can be bombarded by reactive oxygen species in diabetes, prompting events that destroy healthy blood vessels, form leaky new ones and ruin vision.

Now researchers have learned that those chemically reactive molecules must come from both the bone marrow as well as the retinal cells themselves to cause such serious consequences.

"It's a cascade that requires two players to signal the next event that causes the damage," said Dr. Ruth Caldwell, cell biologist at the Vascular Biology Center at the Medical College of Georgia at Georgia Regents University.

The good news is the finding also provides two new points for intervention, said Dr. Modesto Rojas, MCG postdoctoral fellow and first author of the study in the journal PLOS ONE.

Excessive glucose in the blood prompts excessive production of reactive oxygen species, or ROS, and the light-sensitive retina is particularly vulnerable. Caldwell's research team had previously documented that ROS from white blood cells produced by the bone marrow as well as from retinal cells were the major instigators in diabetic retinopathy, a leading cause of blindness worldwide. But they weren't sure which mattered most.

So they looked as several different scenarios, including mice lacking the ability to produce ROS by either the retinal or white blood cells, and found that if either were lacking, future damage was essentially eliminated. "One alone can't do it," said Caldwell, the study's corresponding author. "They did not develop the early signs of diabetic retinopathy that we were measuring."

While blocking ROS production by retinal cells could be difficult, drugs already exist that reduce activation of white blood cells. Those cells not only make ROS, but also adhere to blood vessel walls in the retina that become sticky in diabetes, Rojas said. In fact, a study published in October 2013 in PLOS ONEshowed that neutrophil inhibitory factor could block the vascular lesions that are a hallmark of diabetic retinopathy without hurting the immunity of diabetic mice. The MCG scientists note that decreased activation does not impact the immune protection white blood cells also provide.

Next steps include studying those drugs in their animal models and learning more about how ROS causes the collateral damage that can destroy vision. "All of this is some sort of wound-healing response gone wrong," Caldwell said.

ROS, a natural byproduct of the body's use of oxygen, has healthy roles in the body, including cell signaling, but is destructive at high levels that result from disease states such as diabetes.



Dr. Hitesh K. Patel, an ophthalmologist, serves Edison, New Brunswick and all areas of Middlesex County, NJ. LASIK surgery is one of his specializations.Get more updates by following this Twitter page.

Research: Birth control use could increase risk factor for glaucoma

Research shows that long-term birth control use could be a risk factor for glaucoma, a blindness-causing ocular disorder that affects nearly 60 million people worldwide. The study, which was conducted by University of California, San Francisco, Duke University School of Medicine and Third Affiliated Hospital of Nanchang University, Nanchang, China, reveals that females who had used any kind of oral contraceptives for longer than three years are twice as likely to suffer glaucoma.

Image Source: nymag.com

The research is the first to establish a connection between long-term birth control use and increased risk of glaucoma. Researchers surveyed 3,406 female participants aged 40 years and older from across the United States using a vision and reproductive health questionnaire and eye exams.

Image Source: jama.com

The researchers advise gynecologists and ophthalmologists to be conscious that oral contraceptives might be a contributing factor in glaucomatous diseases, and that they should inform their patients to have their eyes screened for the blindness-causing disease if have other risk factors. Considered one of the leading causes of blindness, glaucoma is a condition that brings damage to a person’s optic nerve and gets worse over time. It is often associated with a buildup of pressure inside the eye and usually occurs in adults over age 40, but it can also manifest in young adults, children, and even infants.

Image Source: glenmorevisioncenter.com

Ophthalmologist Dr. Hitesh K. Patel of Edison, New Jersey is the founder of Patel Eye Associates, an eye care center that provides treatment and diagnosis of various vision problems such as cataracts, nearsightedness, and astigmatism. Know more about his expertise by visiting this website.

REPOST: Climate may play a role in the distribution and prevalence of trachoma

According to researchers, climate change can influence the transmission of the active stages of trachoma. This MedicalNewsToday shares the findings.

High temperatures and low rainfall are important factors which influence the occurrence and severity of the active stages of trachoma - the most common cause of infectious blindness - according to a new study published in PLOS Neglected Tropical Diseases.

Researchers from the London School of Hygiene & Tropical Medicine and Sightsavers carried out the first systematic review to explore links between climate and trachoma. They found temperature and rainfall appear to influence the transmission of the infection in Africa, possibly because the eye-seeking flies which spread trachoma are more active at higher temperatures and are more abundant in areas with low rainfall.

Trachoma affects more than 40 million people, but it is estimated that 1.2 billion people worldwide live in areas where trachoma is found and are at risk of going blind. The bacterial infection is either passed from person to person by contact with infected secretions from the eyes or nose on hands and clothing, or by flies that land around children's eyes. Repeated infection in childhood can lead to blindness later in life.

The World Health Organization has resolved to eliminate blinding trachoma by 2020 and is working with governments and partners to roll out the SAFE strategy*, which includes surgery to distorted eyelids, antibiotics for active infection, facial cleanliness and environmental improvement to reduce the spread of the infection.

However to ensure the disease can be eliminated on schedule, a greater understanding of all factors that affect the incidence of the disease is needed. This study brings together the evidence on the role climate factors have to play for the first time.

Study co-author Dr Sari Kovats, Senior Lecturer at the London School of Hygiene & Tropical Medicine, said: "Our findings will assist international efforts to map where trachoma occurs as we now have a clearer understanding of the role that altitude, temperature and rainfall can play. We need to increase research on the environmental determinants of blinding trachoma in order to make control measures more effective now and in the future."

Dominic Haslam, Director of Policy at Sightsavers and co-author of the study, said: "This review underlines the urgent need for organizations such as Sightsavers to step-up global efforts to eliminate trachoma, before regional climate shifts make the current situation worse. The blinding disease already causes devastating suffering to millions around the world, and yet we know that by promoting face washing, better hygiene and sanitation, we can help manage the spread of trachoma in endemic communities."

Founder of the Patel Eye Associates and Patel Eye Care and Rehabilitation Foundation, Dr. Hitesh K. Patel has served countless of clients in Edison, New Jersey, and beyond. Visit this Facebook page for more updates.

REPOST: New Laser Provides Cutting-Edge Treatment for Diabetes, Retinal Diseases

This ScienceDaily.com article shares the new laser, named Supra Scan Multi-spot Laser, which is said to prevent blindness for patients with severe conditions.


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A new laser is helping experts at the Truhlsen Eye Institute at the University of Nebraska Medical Center provide better treatment for eye diseases. This advanced laser can prevent blindness for some patients with serious conditions.

"This new laser with yellow light is currently the only one of its caliber in the U.S., and there's only one other being used in the world right now," said Quan Dong Nguyen, M.D., the McGaw Memorial Endowed Chair in Ophthalmology and director of the Eye Institute.

On July 22, the first patient received treatment from the laser for proliferative diabetic retinopathy, the most severe stage of eye disease caused by diabetes.

"This laser is the most cutting-edge laser device available today," said Diana Do, M.D., associate professor of ophthalmology and director of the Carl Camras Center for Innovative Clinical Research at the Truhlsen Eye Institute and the retina specialist who performed the first treatment.

"It allows us to apply a large number of laser spots in a variety of patterns," Dr. Do said. "Overall, it is more effective, efficient and may be safer than traditional lasers."

Traditional lasers are limited in the number of patterns and pulsing they can accommodate, whereas the new laser allows for more nuanced and problem-specific targeting, Dr. Do said.

The laser provides treatment for various rare eye diseases, including retinal vein occlusion, neovascular glaucoma, and retinal tears. In addition, with micropulse application capability, it also can be combined with other therapies to treat diabetic macular edema, the most common cause of moderate vision loss for diabetes patients.

"With diabetes rates on the rise nationally and in Nebraska, more and more patients will be able to benefit from the superior treatment that new technology like this can bring," Dr. Do said.

The full name of the laser is the Supra Scan Multi-spot Laser. It is manufactured by Quantel Medical, which is headquartered in Paris, France.

The Truhlsen Eye Institute, which opened in two months ago at 3902 Leavenworth St., is the newest building on UNMC's campus and offers state-of-the-art eye care in many eye subspecialties as well as routine prescription and optical shop services.

To make an appointment at the Truhlsen Eye Institute, please call 402-559-2020.

Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.

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This Dr. Hitesh K. Patel blog site contains more articles on the latest on eye care.