NIH Roadmap will lead researchers into 21st century science, ARVO keynoter says

The annual research meeting drew attendees from around the world. Presentations covered all areas of ophthalmology.

FORT LAUDERDALE, Fla. – The National Institutes of Health has created a comprehensive plan to prepare the institutes for the challenges of 21st century science. A speaker here described the so-called NIH Roadmap Initiative, which involves restructuring the NIH and its 27 institutes, mixing researchers among disciplines to accelerate the pace of research and development and meeting the needs of the scientific community.

“Ultimately, we will create a new, more comprehensive discipline of clinical research,” said Steven E. Straus, MD, director of the National Center for Complementary and Alternative Medicine at the NIH, in his keynote speech at the Association for Research in Vision and Ophthalmology meeting. “We have developed the roadmap to accommodate the enormous strides that have occurred in biomedical research in the past few decades.”

The NIH Roadmap Initiative will provide funding, resources and manpower in several emerging areas of research: the Human Genome Project, with the development of a center for biomedical computing to accurately map genes; a national public database of the “small molecules” that are critical to exploring the functions of cells; the development of nanomedical institutions to study the possibility of engineering at the molecular level; and an initiative on protein research in an effort to predict the shape and function of proteins within cell membranes.

Dr. Straus said the significance of these research efforts on ophthalmology could be “groundbreaking” and could lead to the development of new drugs that target glaucoma, age-related macular degeneration, macular edema or optic neuropathies at the genetic or molecular levels.

“We are very excited to be living in a time of rapidly converging scientific discoveries,” said Paul A. Sieving, MD, PhD, director of the National Eye Institute, during the keynote symposium. “We have just passed through a decade of unprecedented genetic findings, and we are poised for more major breakthroughs.”

The following are highlights from the ARVO meeting.

Research inequities

Governmental regulation of scientific research affects scientific progress in some countries and limits cross-border collaboration, an international panel of researchers said at a workshop during the meeting.

In some countries, such as India and Australia, the regulatory climate favors scientific exploration, but global progress is inhibited by different situations in other countries, some participants said.

A German researcher noted that heterogeneous opinions on embryo research within the European Union have created divergent regulations that “seriously impede international scientific collaborations.” Stefan Lohwasser, MD, of the German Research Foundation, said scientists in the more liberal EU countries, such as the United Kingdom (one of the few EU countries with legislation that explicitly permits embryo research), are at an advantage compared to those in more restrictive countries, such as Germany.

“In the interest of scientific progress, harmonization of law should be a primary goal of the international scientific community,” Dr. Lohwasser said.

In the United States, the Bush administration has restricted stem-cell research. Under legislation passed in August 2001, federal funds cannot be used for research on any stem cell lines derived after that date.

With newer stem cell lines unavailable to researchers in the United States, these governmental restrictions mean that U.S. researchers are unable to take advantage of existing information, said Thomas F. Freddo, OD, PhD, a professor of ophthalmology, pathology and anatomy at Boston University School of Medicine.

“The most important thing I encourage each of you to do regarding these regulations is make sure to vote,” Dr. Freddo said.

Retina

PDT extension trials

Visual acuity remained stable or improved in patients with choroidal neovascularization due to pathologic myopia or histoplasmosis treated with verteporfin photodynamic therapy for up to 5 years, according to two studies presented here.

“This is good news for patients. Very few patients lost lines over time and most remained stable from baseline compared to patients who received placebo,” Gisele Soubrane, MD, told attendees.

Dr. Soubrane presented data from an open-label extension study of the Verteporfin in Photodynamic Therapy (VIP) trial. One-hundred twenty patients with subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia who were enrolled in the VIP trial continued in the extension study.

“We wanted to see if there was any benefit to a longer duration of therapy,” Dr. Soubrane said. Patients in the extension trial received standard verteporfin PDT at a mean of 0.4 treatments during the third year. Visual acuity remained stable for most patients at 5 years, as compared to a rapid decrease of vision seen in patients in the original trial treated with placebo at 6 and 24 months.

“Based on our results, photodynamic therapy will not be required for a lifetime,” Dr. Soubrane added.

A second extension study of 22 patients from the Verteporfin in Ocular Histoplasmosis Study, presented by Tim A. Aaberg, MD, also showed good outcomes. Patients with subfoveal CNV secondary to ocular histoplasmosis were followed for 48 months with standard verteporfin PDT. By the fourth year, 73% of patients gained five or more letters of visual acuity and 20% of patients lost less than 15 letters compared to baseline. A mean improvement of two lines of vision was noted.

Lucentis, anecortave acetate studies

Two promising drugs aimed at stopping the progression of neovascularization in age-related macular degeneration are currently recruiting for phase 3 trials, according to investigators.

Lucentis (ranibizumab, rhuFab V2, Genentech), an anti-VEGF monoclonal antibody injection, and anecortave acetate (Alcon), an angiostatic cortisene in depot formulation, completed phases 1 and 2 of their early trials with high safety profiles and significant improvements in visual acuity, presenters here told attendees.

“RhuFab continued to produce improvement in visual acuity when administered intravitreally once a month for 6 months,” said Jeffrey S. Heier, MD.

In a study of 64 patients with predominately classic, minimally classic or exudative AMD, Lucentis effectively treated the lesions by evidence of improved visual acuity. Eighty-one percent of patients gained lines of visual acuity at 6 months, Dr. Heier said.

Jason S. Slakter, MD, presented outcomes from phase 1 and 2 of the anecortave acetate studies. In a 24 month follow-up period, a 15-mg dose of the drug (administered every 6 months via juxtascleral depot) significantly reduced visual loss from baseline in patients with choroidal neovascularization when compared to placebo.

Patient enrollment for the phase 3 trials for both AMD drugs is under way. The anti-VEGF antibody for predominantly classic choroidal neovascularization (ANCHOR) trial, a randomized, multicenter study comparing 0.3-mg and 0.5-mg doses of Lucentis to verteporfin in photodynamic therapy, is currently accepting patients with predominately classic wet AMD. The anecortave acetate risk reduction (AART) study, a randomized trial evaluating anecortave acetate in high-risk non-exudative patients with AMD, is also accepting patients for its multicenter trial.

Visudyne in Japan

Photodynamic therapy has been safe and effective for 2 years in Japanese patients with subfoveal choroidal neovascularization due to age-related macular degeneration, according to Yasuo Tano, MD. He described 2-year results of the Japanese AMD Trial (JAT).

He said the results confirm previous observations from the 12-month data in the study and support the use of PDT over an extended time period.

The JAT study helped pave the way for last year’s approval of Visudyne (verteporfin for injection, Novartis) in Japan for all forms of CNV secondary to AMD. The Japanese government recently agreed to reimburse for Visudyne treatment, an announcement that Dr. Tano said was long awaited.

“These results confirm the safety and efficacy of this modality and are consistent with the efficacy observed in previous studies. These results have finally led to the approval of verteporfin therapy in all lesion compositions of CNV secondary to AMD in Japan,” he said.

Fifty-one patients were enrolled in the 24-month JAT study, out of the 61 patients who were enrolled in the 12-month phase. Those who enrolled in the trial extension received additional verteporfin therapy — a mean of 0.9 treatments during the second 12 months — through month 21 if fluorescein leakage from CNV was seen on angiography, according to Dr. Tano.

Forty-six patients (90%) completed the 24-month evaluation. Treatment was discontinued in five patients due to adverse events that were not considered related to the treatment, he said. At month 24, the mean visual acuity score in the study eye was 54.0, compared to 50.8 at baseline and 54.2 at 12 months. Dr. Tano said the score of 54.0 equated to about 20/80 in the scale used in the JAT study.

At the end of the study, six of 46 patients had lost 15 letters of visual acuity or more, and four of those six patients had lost 30 letters or more, Dr. Tano said.

Dr. Tano said he believes this approval of Visudyne will dramatically affect the way Japanese vitreoretinal specialists approach the treatment of CNV secondary to AMD.

“(PDT) is very beneficial to Asian populations. Currently, (transpupillary thermotherapy) is more heavily used in Japan that it is in the United States, but I believe that this will change,” he said.

Body fat and macular pigment

There is a significant inverse relationship between percentage of body fat and macular pigment optical density, according to a poster presentation.

The study, authored by Orla O’Donovan, MD, concluded that dietary and serum levels of lutein and zeaxanthin are significantly and positively related to macular pigment optical density but inversely related to body fat. The study claims that all results support the theory that a relative lack of macular pigment, or serum lutein and/or zeaxanthin, may underlie the increased risk of age-related maculopathy progression.

The study looked at 100 healthy, white subjects between the ages of 22 and 60. Body fat composition was determined using dual energy X-ray absortiometry, calipers (skinfold thickness), bioelectric impedence absorptiometry and waist-hip ratio. In addition, patients were administered a food frequency questionnaire that assessed and quantified the dietary intake of lutein and zeaxanthin.

When adjusted for body fat, the association between macular pigment optical density and age was inverse and statistically significant.

Microchip for RP

A silicone retinal microchip was well tolerated in a 3.5-year study on patients with retinitis pigmentosa, according to a presenter here.

Y. Chow, MD, presented outcomes of a multicenter U.S. study of the subretinal Artificial Silicon Retina microchip (Optobionics, Naperville, Ill.).

Ten patients with retinitis pigmentosa were implanted with the 25-µm thick, 2-mm wide microchip under the retina, 20° below the macula. Over 42 months, retinal function was evaluated with high-contrast letters, OCT, fundus photography and automated visual field tests. Patients subjectively revealed their satisfaction with vision through interviews and questionnaires.

Dr. Chow said the microchip was well tolerated in the retina and continued its electrical functioning for the duration of the study.

Patients reported an improvement in light perception and contrast perception, he said. Researchers noted a mean improvement in optotype and grading acuity from baseline; however, a diminished effect was noted in one of three patients who were followed up to 3.5 years.

Further study is needed to determine the potential benefit of the subretinal microchip in patients with retinal pigmentosa, he said.

Cornea

Postmenopausal women, dry eye

A method of calculating the tear film’s protection of the ocular surface suggests that postmenopausal women are at greater risk for dry eye than premenopausal women, according to a poster presentation here.

K.A. Wilcox, MD, of the Schepens Eye Research Institute in Boston, and colleagues conducted a study in which they calculated the ocular protection index (OPI) of 58 women diagnosed with dry eye. Their study was described in a poster.

The OPI was calculated by dividing a subject’s tear breakup time by her interblink interval. An OPI of less than 1 indicated that the subject’s eye was unprotected by the tear film for at least some amount of time between each blink.

The subjects underwent ophthalmic examinations including visual acuity, blink rate, tear breakup time and fluorescein staining.

The OPI was determined for each patient and compared between the pre- and postmenopausal patients. The researchers found that the mean OPI in premenopausal subjects (n=20) was 1.29, and the mean OPI in postmenopausal subjects (n=38) was 0.69. The difference was statistically significant (P = .02.)

Environment and blink rate

Patients with dry eye show an increased blink rate in adverse environmental conditions, according to a poster.

J. Casavant, MD, and colleagues at Schepens Eye Research Institute studied 180 patients diagnosed with dry eye. All patients were exposed for 90 minutes to a controlled adverse environment (CAE) in which humidity, temperature and airflow were metered, and visual tasks were administered to them. Upon entering the CAE and every 5 minutes subsequently, ocular discomfort was evaluated. Before and after CAE exposure, blink rate, tear breakup time and fluorescein staining were assessed.

The mean blink rate at baseline was 19.61 blinks/minute, which increased to 22.77 blinks/minute after CAE exposure. An ocular discomfort level of 3 (on a scale to 6) was reported by the patients.

Protein chip for ocular surface

Biomarker profiles of tear proteins might be used to differentiate between patients with dry eye and those with healthy eyes, according to a presenter.

Researchers at the University of Mainz, Germany, found up to 14 proteins and peptides that were expressed differently in the tear film composition of dry eye patients than in healthy eyes.

These differences in tear film composition could help provide an alternative approach in the search for disease-specific biomarkers and, therefore, in the discovery of new diagnostic procedures and treatments for ocular surface diseases such as dry eye, the study concluded.

“We currently lack objective criteria for assessing the effectiveness of new treatment options for dry eye,” said A. Wirthlin, of the Baar, Switzerland-based company Proteognostics, which manufactures a new protein chip technology known as SELDI (surface enhanced laser desorption ionization).

“Existing clinical tests such as Schirmer and tear film breakup time do not correlate well to each other,” he said.

The SELDI technology is highly sensitive and well suited for mass screenings, the researchers said. It relies on a process called two-dimensional electrophoresis, and it detects biomarker profiles even when there is a very small sample volume, as is often the case in tears, without compromising its mass accuracy, Mr. Wirthlin said.

The next steps will be to extend the protein testing to a larger sample set and to identify the biomarkers with the best predictive power for dry eye or other ocular surface diseases, he said.

The study’s co-authors, Norbert Pfeiffer, MD, and Franz H. Grus, MD, of the University of Mainz, said they have no commercial relationship with Proteognostics.

Moxifloxacin in children

Vigamox (0.5% moxifloxacin, Alcon) was as comfortable as a tear substitute in a normal pediatric population, according to a study presented here.

Researchers at centers in New Jersey, New York and Massachusetts tested 50 subjects, ages 7 to 17 years. At baseline the subjects received one drop of tear substitute in each eye. At least 1 hour later, they received one drop of moxifloxacin in each eye. Patients rated the comfort of the Vigamox drop immediately after instillation and again 1 minute and 3 minutes after instillation. They rated their comfort level from 0 to 10, with 0 being “very comfortable” and 10 being “severely bad pain.”

The mean comfort scores for the tear substitute and moxifloxacin were, respectively, 2.14 and 1.81 immediately after instillation, 0.71 and 0.84 at 1 minute after instillation, and 0.41 and 0.46 3 minutes after instillation.

The authors concluded that moxifloxacin was as comfortable as the tear substitute in the pediatric population. They attributed this to the fact that moxifloxacin does not contain benzalkonium chloride and has a near-neutral pH of 6.8.

Glaucoma

Poor communication

Sixty percent of glaucoma patients who switch ophthalmologists do so because of a breakdown in doctor-patient communication, according to a presentation here.

Results from the Glaucoma Research Foundation Patient Survey were presented in a poster by Jane N. Rollins, MSPH. While poor communication is the main reason for seeking care from a new physician, the majority of patients are happy with the care they receive from their ophthalmologist, she said.

A total of 4,310 patients responded to a questionnaire from the Glaucoma Research Foundation, she said. Patients answered a series of questions about glaucoma, their relationship with their current physician and their attitude toward side effects from medication.

Seventy-one percent of patients received care from the same ophthalmologist for the duration of their illness. Patients who switched physicians did so because of poor consultations regarding their illness and treatment regimen (60%), the desire to significantly lower their IOP (20%) or because they incurred side effects with their medication (6%).

Notably, most patients value efficacy in their therapeutic treatments, and 87% of patients reported that they would continue to comply with their treatment regardless of adverse reactions such as hyperemia or iris pigmentation.

5-FU and bleb needling

Needling of failed blebs with adjunctive 5-fluorouracil produced poor to moderate results at 5-year follow-up, according to Mark S. Juzych, MD. He presented the results of a chart review of 197 eyes of 197 patients who underwent bleb needling with 5-fluorouracil (5-FU) after trabeculectomy or phacotrabeculectomy.

“We analyzed the survival of the initial needling after a failed bleb,” Dr. Juzych said. The procedures were carried out between 1995 and 1998. Bleb needling was performed with a 28-gauge needle and 5 mg of 5-FU in 0.1 mL. Topical anesthesia was applied.

Outcomes were considered successful if IOP was lowered to 18 mm Hg from a preoperative IOP of 21 mm Hg or greater. If preoperative levels were below 21 mm Hg, a 20% reduction in IOP was considered successful.

The success rate of single application 5-FU needling at 1 year was 31%. At 2 years postoperatively, 22% of patients were successful. The success rate fell to 16% at 3 years, 14% at 4 years and 12% at 5 years after surgery. Patients with higher IOP measurements before needling were at a higher risk for failure.

Considering these results, Dr. Juzych said, other, more successful surgical strategies are needed for patients with failed blebs, especially in patients with high IOP.

RNFL thickness and the cornea

Ocular hypertensive patients with thinner-than-normal corneas also have thinner retinal nerve fiber layer measurements, a finding that may have implications for following glaucoma patients, according to a study in Brazil.

A study group from the University of São Paulo presented findings of a prospective study that included 65 eyes of 65 subjects (29 ocular hypertensive patients and 35 normal subjects). The Stratus OCT (Carl Zeiss Meditec, Calif.) optical coherence tomographer was used to measure peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters in all participants. The ocular hypertensive patients were divided into two subgroups based on their central corneal thickness measurements.

The study found that mean RNFL thickness was 98.27 ± 2.53 µm in the ocular hypertensive patients and 106.50 ± 2.28 µm in the control group. The difference between the groups was statistically significant.

The mean RNFL thickness in ocular hypertensive patients in the subgroup with a central corneal thickness of less than 540 µm was 92.98 ± 5.55 µm. In the subgroup with central corneal thickness of greater than 540 µm, the mean RNFL thickness was 101.77 ± 4.08 µm. Again, the differences between these two group were significant, according to the authors.

“This means that decreasing central corneal thickness may be an important risk factor in glaucoma,” Prof. Remo Susanna Jr., MD, one of the study authors, told Ocular Surgery News in an interview.

“It is important to follow up with patients to see if they continue to have decreasing thickness. You cannot make a diagnosis based on one machine, but OCT is clearly a plus,” Dr. Susanna said.

Physician resource site

Protect Vision, an interactive Web site and educational campaign for ophthalmologists who treat glaucoma, was launched during the meeting.

A joint initiative of Prevent Blindness America and Allergan Inc., www.protectvision.org is a resource for eye care professionals designed to provide patient materials and updated information on treatment, management and prevention of glaucoma.

“It provides critical, up-to-date information about glaucoma for practicing physicians and their patients in one simple location,” George A. Cioffi, MD, medical editor of www.protectvision.org, told Ocular Surgery News.

Downloadable, printable patient materials for physicians are a standout feature of the Web site, he said.

“Doctors can download a glaucoma checklist, a quiz to check for signs of the disease, a Medicare benefits leaflet, facts about glaucoma medications and a tip sheet to help patients remember when to take their eye drops,” Dr. Cioffi said.

By offering these free resources, Dr. Cioffi said, Prevent Blindness America and Allergan hope to increase awareness of the disease.

Compliance in Brazil

Brazilians with glaucoma are as compliant with their glaucoma treatment regimens as glaucoma patients in other countries, but higher adherence rates are needed for effective management of the disease. These are the conclusions of a study of glaucoma compliance in Brazil.

J.F. Lopes, MD, and colleagues at the University of São Paulo Medical School, presented a poster on the subject. Their cross-sectional study examined 199 patients diagnosed with primary open-angle glaucoma who were using topical glaucoma medications. Patients were given a structured questionnaire addressing sociodemographic aspects of the disease and its treatment. Those who claimed to have taken 100% of their prescribed eye drops in the previous 3 days were deemed adherent. Statistical analysis was used to associate noncompliance with a series of variables.

The researchers found that the prevalence of nonadherence was 32.2%. A statistically significant connection was shown in univariate analysis between adherence and number of prescribed doses (P < .001), pilocarpine prescription (P = .0028), self-reported “absolute” adherence (P = .001) and attitude toward taking eye drops (P < .001).

Driving and glaucoma

Older people with glaucoma are at least as safe on the road, if not safer, as elderly drivers without the disease, according to a study presented here.

The study, authored by C. Owsley, MD, and colleagues, compared 576 patients with glaucoma to 115 without glaucoma, all of whom were licensed drivers over the age of 55 years. Chart abstractions and patient interviews were used to discover demographic, clinical and driving habits. Information about motor vehicle collisions (MVC) was obtained from Department of Public Safety records.

Adjusting for visual acuity, medical and demographic characteristics, the study found that glaucoma patients had a lower MVC rate than patients without glaucoma. When at-fault crashes were isolated, there was no difference between MVC rates for glaucoma patients and those without glaucoma. Glaucoma patients had substantially higher levels of self-reported caution in challenging driving situations such as at night, in fog, in rain, in rush hour, on the highway and in high-density areas, Dr. Owsley said.

The study concluded that drivers with glaucoma may restrict their own driving activities due to their disease, but a determination could not be made as to whether the reduced crash rate is entirely explained by this self-limiting behavior.

Refractive surgery

Quest for super-vision

The pursuit of optical perfection in refractive surgery may be misguided, according to a speaker here. Correction of higher-order optical aberrations might be more valuable for improving diagnostic instrumentation than for correcting a patient’s refractive error, suggested Lawrence Thibos, OD.

At a symposium on optical aberrations, Dr. Thibos raised doubts over the wisdom and appropriateness of the use of super-vision as a standard for visual performance.

Dr. Thibos said some optical aberrations are not only acceptable but even desirable. He said the emphasis that has been placed on achieving perfect optics in refractive surgery might be misguided.

“Aberrations are not all bad,” he said. “For people with pathological (optical) aberrations, just to be ‘normal’ would be like having super-vision to them. Wouldn’t it be better to put our efforts into helping those who are truly needing to achieve ‘normal’ optical quality instead?”

Dr. Thibos said the correction of optical aberrations may be most beneficial for the development of diagnostic instrumentation.

“The primary barrier to high-quality fundus imaging is the poor quality of the patient’s eye. I think that improving the quality of this instrumentation should have a major benefit to patient health in the long run,” he said.

Refractive surgery, Army

A 3-year study of U.S. Army soldiers found excellent clinical outcomes of refractive surgery and substantial improvement in “soldier readiness” as a result, according to M.D. Hammond, MD.

“This study came about through recognition of the tremendous importance of vision to our soldiers,” said Dr. Hammond, of the Walter Reed Army Medical Center in Washington. “Battlefield conditions put extreme stress on the soldier and their vision.”

The Army Warfighter Refractive Eye Surgery Program (WRESP) was designed with the intention of decreasing the limitations posed by corrective eyewear on combat soldiers.

Monthly reports gathered from seven WRESP laser centers detailed the numbers and types of procedures performed, uncorrected visual acuity, best corrected visual acuity and significant intraoperative or postop complications.

A total of 25,642 eyes of 16,091 servicemen and women were treated in WRESP between May 2000 and October 2003. PRK was performed in 60% of eyes, LASIK in 32% and LASEK in 8%. Postop UCVA was 20/20 in 85.6%, 20/25 in 91.8% and 20/40 in 98.1% of eyes with at least 3 months follow-up. No more than one line of BCVA was lost in any eye at 3 months or longer postop.

As another part of the study, soldiers with previous refractive surgery who were returning from deployment completed a questionnaire about their vision. These soldiers rated the effects of refractive surgery on their ability to perform tasks such as night operations, weapons sighting, operations in extreme environmental conditions and the ability to use personal protective equipment. The scale was from 1 (much worse) to 5 (much better).

In the surveys, 90.2% of patients rated their overall readiness as better or much better after surgery. The score for overall soldier readiness was 4.69; night vision, 4.41; weapons sighting, 4.65; and environmental conditions, 4.1.

Two survey respondents claimed to have worse or much worse night operations skills postop, and two reported difficulty with adverse conditions such as heat, dust and dryness. None of the patients reported worse overall readiness after surgery.

“The WRESP program has provided excellent results,” Dr. Hammond said. “It was not uncommon to go through those questionnaires and see comments like ‘This was the best thing the military ever did for me.’”

Cataract

Endophthalmitis prophylaxis

Topical antibiotics applied before cataract surgery helped prevent endophthalmitis in a large series of cases, according to a presentation here.

D.A. Hollander, MD, and colleagues evaluated the role of preoperative topical antibiotics in the prophylaxis of bacterial endophthalmitis after cataract surgery. They reviewed 2,718 patients who underwent cataract surgery performed by residents between 1984 and 2002 at San Francisco General Hospital.

In 60% of cases, the patients applied antibiotic ointment to the ocular surface for 3 days before cataract surgery. The other 40% of patients did not apply preoperative antibiotics. All patients were prepped with povidone-iodine before surgery.

Three cases of postoperative bacterial endophthalmitis were seen in the patients who did not receive preoperative topical antibiotic treatment. Two cases were acute, presenting within 5 days of surgery, and both acute cases involved posterior capsular rupture and required anterior vitrectomy. No patients in the antibiotic treatment group developed endophthalmitis.

Dr. Hollander suggested that preoperative topical antibiotics may play a role in the prophylaxis of endophthalmitis, particularly in longer, complicated cases involving the disruption of the posterior capsule.

Diabetes and cataract

The quality of life for patients with diabetes notably improved after phacoemulsification and IOL implantation, according to a poster presentation.

Typically, surgeons are hesitant to perform phacoemulsification on patients with diabetes because of the increased risk of macular edema and diabetic retinopathy. However, S.B. Patel, MD, found that the benefit to quality of life after phacoemulsification outweighed the risks of complications.

Twenty-four diabetic patients who underwent phacoemulsification and IOL implantation reported being satisfied with their level of achievement in vision-dependent activities 52 days after cataract surgery. Visual acuity improved from a mean 0.61 preoperatively to 0.29 postoperatively. No significant correlation between improved VA and vision-dependent activities scores was found.

An increase in retinal thickness after the surgery is a risk factor for macular edema. Dr. Patel suggested that patients with diabetes who undergo cataract surgery should be closely monitored for any early signs of macular edema.

Uveitis and cataract

Cataract surgery has the potential to significantly improve visual acuity in children with chronic uveitis, according to a poster.

Alla Y. Hynes, MD, reviewed the charts of 25 patients with uveitis between the ages of 4 and 17. All had undergone cataract surgery with or without additional procedures between 1994 and 2002. The patients had been diagnosed with juvenile idiopathic arthritis-associated uveitis, idiopathic pars planitis, idiopathic panuveitis, idiopathic granulomatous uveitis, herpetic keratouveitis, idiopathic anterior uveitis or sarcoid uveitis.

Mean preoperative visual acuity was 20/155, with eight patients having a VA worse than 20/400. One week postoperatively, mean VA was 20/113, with nine patients having a VA worse than 20/400. At 1-year postop, mean VA was 20/90; two patients had VA of less than 20/400, and IOP was under control in all patients.

Early postop complications included hyphema, vitreous damage, iris bombey and giant cells on IOL implant. Late postop complications included glaucoma, posterior capsular opacity and one localized retinal detachment.

ARVO awards, announcements

Surgeons honored

A retinal specialist from Zurich and an ocular oncologist from New York were honored with awards from ARVO.

Charlotte E. Remé, MD, of the University Eye Clinic in Zurich, and David H. Abramson, MD, of Cornell University Medical College in New York, captured the prizes and drew several hundred ARVO participants to hear them speak.

As the recipient of the Proctor Medal, Dr. Remé gave a lecture titled “The dark side of light: the silent death of vision.”

Dr. Remé, who established the Laboratory of Retinal Cell Biology in 1976 in Zurich, is credited with helping to establish limits of bright light treatments of patients with seasonal affective disorder. She also determined that lithium exacerbated light-induced damage in rats, a finding that led her to the discovery that patients with manic depressive disorder who were treated with lithium exhibited changes in their visual performance.

“Obviously light is necessary for almost all life on earth. But it can also threaten visual health,” said Dr. Remé. She pointed out that light is used to treat winter depression and plays an essential role in regulating circadian rhythms, which are mediated by the eyes. However, light also has such a dramatic effect on photoreceptors that it can lead to cell death, she said.

“In other words, here we have the good and the bad of light,” she said. Dr. Remé also elaborated on the role of rhodopsin in light-induced apoptosis.

Dr. Abramson, who was presented with the Weisenfeld Award, is internationally known for his contributions to the study of ocular oncology. In his lecture “Retinoblastoma 2004: a triumph in ophthalmology,” Dr. Abramson outlined how treatments for retinoblastoma in children have improved to the point where the cure rate has reached nearly 100%.

“Indeed, retinoblastoma is a great success story,” he said.

He referred to the “evolution of understanding” over the past century that led to the very high success rate in treating pediatric retinoblastoma. A century ago, the only option for treatment was enucleation. Now surgeons routinely employ external beam radiation, radioactive applicators, photocoagulation, cryotherapy and chemotherapy, he said.

Dr. Abramson said he recently accepted a new position as the chief of ophthalmic oncology at Memorial Sloan Kettering Cancer Hospital in New York.

“This is creating a new service that has not existed previously,” he said. “In combination with the departments of pediatrics, surgery, radiation oncology, we … hope to expand ophthalmic oncology and to offer patients with ophthalmic oncology problems the same that all other cancer patients are being offered in terms of patient care, support, psychological support, long-term care, social work and basic molecular research.”

ARVO/Pfizer program

ARVO will partner with Pfizer Ophthalmics, following a $500,000 grant from the company, to create the ARVO/Pfizer Ophthalmics Research Institute, a think tank for vision research. The partnership was announced at the meeting.

The ARVO/Pfizer Ophthalmics Research Institute will organize an intensive 2-day conference each year before the annual meeting here that will bring together experts in the fields of basic science, ophthalmology, genetics, bioengineering and other specialties to collaborate on vision research, with a focus on glaucoma and retinal disease.

The invitation-only conference, to begin in 2005, will be open to ARVO members and key representatives from other scientific disciplines.

The grant will promote “interdisciplinary work among a small group of the brightest minds whose research in this large scientific area will have a global reach,” said Paul Kaufman, MD, executive vice president of ARVO, in a press release. The conferences will help to bridge the gap between research in ophthalmology and in other fields of medicine.

The grant will also fund the ARVO/Pfizer Ophthalmics Translational Research Awards. These awards, to be presented at each annual ARVO meeting, will honor ARVO scientists who exhibit excellence in “translational” research — basic research with clinical applications.