Parkinson Drug May Prevent and Delay AMD

Newswise — RPB-supported researchers have made a significant discovery that might lead to the delay or prevention of the most common cause of blindness in the elderly: age-related macular degeneration (AMD).

Patients who take the drug L-DOPA (for Parkinson Disease, Restless Legs or other movement disorders) are significantly less likely to develop AMD and, if they do, it is at a significantly later age.

"There are only limited and highly invasive therapies for those with AMD and no known preventative treatment," said Brian S. McKay, PhD, Department of Ophthalmology and Vision Science, University of Arizona. "Our findings imply that L-DOPA may be repurposed to prevent or delay AMD."

Here's how the multi-institution team of scientists made the discovery.

The investigators had been conducting basic research into albinism, which causes profound vision loss and changes in the structure of the eye, especially the retina, and specifically the macula, the area of the retina that is associated with central vision lost in AMD.

The retina pigment epithelium is a critical support layer of tissue in the retina that fosters macula development and keeps it healthy through L-DOPA signaling. L-DOPA is made in pigmented tissues, and it has been known for a long time that lower risk for AMD is associated with darker pigmentation;

Blacks have a five-fold lower risk for AMD than Whites. The researchers postulated that signaling through the L-DOPA receptor may underlie racial disparities in AMD incidence.

To test this, they examined the health records of 37,000 patients at the Marshfield Clinic for individuals with AMD, or those taking L-DOPA, or those with both AMD and taking L-DOPA.

In patients who were given L-DOPA before being diagnosed with AMD, their AMD was diagnosed 8 years later than those not taking L-DOPA. These results were then confirmed in a much larger data set of 87 million patients, and the study was expanded to include prevention and delay of "wet" AMD, the most devastating form of the disease.

"Developing a new drug costs more than $2 billion and takes 13.5 years from discovery to market. Drug repositioning does not require anywhere near those costs," said lead author Murray Brilliant, PhD, Director at the Center for Human Genetics at the Marshfield Clinic Research Foundation.

"Our methods illustrate the power of precision medicine research -- using the electronic medical records of large numbers of patients -- to test unexpected drug interactions and find new uses for old drugs."

"The results suggest a new path forward in our fight against AMD that may even include a strategy to prevent those at risk of the disease from ever developing it," McKay said. "In the end, L-DOPA may not be the drug that ends the disease, but the pathway identified here is likely to be a key observation as the search for a cure continues."

This work was supported by Translational Sciences, The National Human Genome Research Institute, Research to Prevent Blindness, Bright Focus, The Edward N. & Della L. Thome Memorial Foundation, the Wisconsin Genomics Initiative, National Eye Institute, the Marshfield Clinic and the University of Arizona.

Falls and Brawls Top List of Causes for Eye Injuries in United States

Hospital costs for ocular trauma rise 62 percent over a decade, according to study presented at AAO 2015, the annual meeting of the American Academy of Ophthalmology

Newswise, November 16, 2015 – Falling and fighting top the list of major causes of eye injuries resulting in hospitalization over a 10-year period, according to research presented today at AAO 2015, the 119th Annual Meeting of the American Academy of Ophthalmology. 

Falling was the No. 1 cause of eye injuries overall and accounted for more than 8,425 hospitalizations. Researchers also found that the cost to treat eye injuries at hospitals rose by 62 percent during that period and now exceeds $20,000 per injury.

Serious ocular trauma injuries include orbital fractures and being pierced by objects. These injuries can be expensive to treat, and in many cases are preventable. 

With that in mind, researchers at Johns Hopkins University decided to identify the most common causes of eye injuries as well as the associated hospital costs so that prevention efforts could be better targeted. Such interventions could perhaps lower eye injury rates and overall health care costs for eye trauma inpatient visits.

They identified a sample of nearly 47,000 patients ages 0 to 80 diagnosed with ocular trauma from 2002 to 2011 using a national health care database. They examined the total cost of hospitalization, cause of injury, type of injury and length of hospital stay. The researchers then grouped injured people by age. 

Their findings include:

•Falls are the leading cause of eye injury: Most of the 8,425 falls recorded happened to those 60 and older. Among the types of falls, slipping caused nearly 3,000 eye injuries. Falling down stairs was cited as a cause of eye injury 900 times.
•Fighting was second most common cause of ocular trauma: In total, nearly 8,000 hospitalizations for eye injuries were caused by fighting and various types of assault. “Unarmed fight or brawl” came in at No. 2 overall among specific causes of eye injuries requiring hospitalization, but was the top cause reported for ages 10 to 59.
•Kids injured in accidents, vehicle collisions and by sharp objects: For children ages 10 and under, the leading cause of eye injury was being struck by accident by a person or object. Car crashes and accidentally being pierced or cut by a sharp object (such as scissors) were second and third on the list of causes.
•The median cost of treating these eye injuries shot up from $12,430 to $20,116 between the years 2002 to 2011, an increase of 62 percent. The researchers found costs to be higher at large hospitals and for older patients. Income did not correlate with costs. However, the Johns Hopkins team says that other factors not included in the study could play a role, too.

“While we have some clues, we still can’t be certain why it’s more expensive to get treated for an eye injury now than before,” said Christina Prescott, M.D., Ph.D., the study’s lead researcher and an ophthalmology professor at the Wilmer Eye Institute at Johns Hopkins University. 

“It could be related to drug prices or administrative costs. Either way, it’s clear we need more targeted interventions to help reduce these types of injuries, many of which are preventable.”

Members of the media who would like a copy of the poster or wish to speak to an expert about the findings should contact the American Academy of Ophthalmology Public Relations Department at media@aao.org.

Economic Trends in Eye-Related Hospitalizations (PO118) was presented at AAO 2015, the 119th annual meeting of the American Academy of Ophthalmology. 

Known as the place "Where all of Ophthalmology Meets,"™ the Academy’s annual meeting takes place Nov. 13-17 at the Sands Expo/Venetian in Las Vegas. It is the largest ophthalmology conference in the world. For more information, see AAO 2015 highlights.

About the American Academy of Ophthalmology

The American Academy of Ophthalmology, headquartered in San Francisco, is the world's largest association of eye physicians and surgeons, serving more than 32,000 members worldwide. 

The Academy’s mission is to advance the lifelong learning and professional interests of ophthalmologists to ensure that the public can obtain the best possible eye care. For more information, visit http://www.aao.org.

The Academy is also a leading provider of eye care information to the public. The Academy's EyeSmart® program educates the public about the importance of eye health and empowers them to preserve healthy vision. EyeSmart provides the most trusted and medically accurate information about eye diseases, conditions and injuries. OjosSanos™ is the Spanish-language version of the program.

Visit http://www.geteyesmart.org or http://www.ojossanos.org to learn more.

Restoring Vision with Stem Cells

 Researchers have succeed in producing photoreceptors from human embryonic stem cells

Newswise, October 6, 2015--Age-related macular degeneration (AMRD) could be treated by transplanting photoreceptors produced by the directed differentiation of stem cells, thanks to findings published today by Professor Gilbert Bernier of the University of Montreal and its affiliated Maisonneuve-Rosemont Hospital.

ARMD is a common eye problem caused by the loss of cones. Bernier’s team has developed a highly effective in vitro technique for producing light sensitive retina cells from human embryonic stem cells.

“Our method has the capacity to differentiate 80% of the stem cells into pure cones,” Professor Gilbert explained. “Within 45 days, the cones that we allowed to grow towards confluence spontaneously formed organised retinal tissue that was 150 microns thick. This has never been achieved before.”

In order to verify the technique, Bernier injected clusters of retinal cells into the eyes of healthy mice. The transplanted photoreceptors migrated naturally within the retina of their host.

“Cone transplant represents a therapeutic solution for retinal pathologies caused by the degeneration of photoreceptor cells,” Bernier explained.

“To date, it has been difficult to obtain great quantities of human cones.” His discovery offers a way to overcome this problem, offering hope that treatments may be developed for currently non-curable degenerative diseases, like Stargardt disease and ARMD.

“Researchers have been trying to achieve this kind of trial for years,” he said. “Thanks to our simple and effective approach, any laboratory in the world will now be able to create masses of photoreceptors.

“Even if there’s a long way to go before launching clinical trials, this means, in theory, that will be eventually be able to treat countless patients.”

The findings are particularly significant in the light of improving life expectancies and the associated increase in cases of ARMD. ARMD is in fact the greatest cause of blindness amongst people over the age of 50 and affects millions of people worldwide.

And as we age, it is more and more difficult to avoid – amongst people over 80, this accelerated aging of the retina affects nearly one in four. People with ARMD gradually lose their perception of colours and details to the point that they can no longer read, write, watch television or even recognize a face.

ARMD is due to the degeneration of the macula, which is the central part of the retina that enables the majority of eyesight.

This degeneration is caused by the destruction of the cones and cells in the retinal pigment epithelium (RPE), a tissue that is responsible for the reparation of the visual cells in the retina and for the elimination of cells that are too worn out.

However, there is only so much reparation that can be done as we are born with a fixed number of cones. They therefore cannot naturally be replaced. Moreover, as we age, the RPE’s maintenance is less and less effective – waste accumulates, forming deposits.

“Differentiating RPE cells is quite easy. But in order to undertake a complete therapy, we need neuronal tissue that links all RPE cells to the cones. That is much more complex to develop,” Bernier explains, noting nonetheless that he believes his research team is up to the challenge.

Bernier has been interested in the genes that code and enable the induction of the retina during embryonic development since completing his PhD in Molecular Biology in 1997.

“During my post-doc at the Max-Planck Institute in Germany, I developed the idea that there was a natural molecule that must exist and be capable of forcing embryonic stem cells into becoming cones,” he said.

Indeed, bioinformatic analysis led him to predict the existence of a mysterious protein: COCO, a “recombinational” human molecule that is normally expressed within photoreceptors during their development.

In 2001, he launched his laboratory at Maisonneuve-Rosemont Hospital and immediately isolated the molecule.

But it took several years of research to demystify the molecular pathways involved in the photoreceptors development mechanism. His latest research shows that in order to create cones, COCO can systematically block all the signalling pathways leading to the differentiation of the other retinal cells in the eye.

It’s by uncovering this molecular process that Bernier was able to produce photoreceptors. More specifically, he has produced S-cones, which are photoreceptor prototypes that are found in the most primitive organisms.

Beyond the clinical applications, Professor Bernier’s findings could enable the modelling of human retinal degenerative diseases through the use of induced pluripotent stem cells, offering the possibility of directly testing potential avenues for therapy on the patient’s own tissues.

About this study:

Shufeng Zhou, Anthony Flamier, Mohamed Abdouh, Nicolas Tétreault, Andrea Barabino, Shashi Wadhwa and Gilbert Bernier published “Differentiation of human embryonic stem cells into cone photoreceptors through simultaneous inhibition of BMP, TGFβ and Wnt signaling” in Development on October 6, 2015. DOI: 10.1242/dev.125385

Gilbert Bernier is director of the Stem Cell and Developmental Biology Laboratory at Maisonneuve-Rosemont Hospital and a professor with the Department of Neuroscience and the Department of Opthalmology at the University of Montreal.

This work was supported by grants from the Foundation Fighting Blindness Canada, Turmel Family Foundation for Macular Degeneration Research, Canadian Stem Cell Network, C. Durand Foundation, the GO Foundation, and Natural Science and Engineering Research Council of Canada [grant #250970-2012].

Professor Bernier was supported by the Fonds de recherche du Québec – Santé.

The University of Montreal is officially known as Université de Montréal. Maisonneuve Rosemont Hospital is part of Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal.

Protect Vision from Digital Devices

(Family Features), October 2, 2015-- Digital communication has become an integral part of daily life. Smartphones and tablets are pocket-sized personal assistants with appointment reminders, news and a means of keeping in touch with family and friends. Living multi-screen lives may aide productivity, but eye health professionals are increasingly worried about the consequences of “digital vision.”

Over the past two years, time spent with digital devices has increased 49 percent, according to data from online measurement firm comScore. Handheld devices are leading the way: time using smartphones jumped 90 percent and tablets surged 64 percent.

However, some studies suggest all that time squinting at the phone may cause users to squint at everything else. Research housed through the Vision Impact Institute has shown that myopia (nearsightedness) is rapidly rising in East Asia, Europe and the United States, especially among younger people. Research is pointing to factors other than genetics, such as behavior and environment, as the cause of this epidemic of shortsightedness. The common denominator among these populations seems to be time spent using digital devices.

While not seeing distances clearly can be frustrating, even dangerous when driving, it can be corrected with eyeglasses, contact lenses and refractive surgery. However, high myopia has been associated with a greater risk for ocular disorders, including retinal detachment, glaucoma and cataracts. 

“We’re good about getting the annual physical and dental check-up, but often we aren’t as diligent about seeing the eye doctor once a year, 

”“As we turn more and more of our daily routines over to digital devices, we need to place a greater emphasis on scheduling regular eye exams to correct problems such as myopia and monitor for associated risks,”  said Maureen Cavanagh, president of the Vision Impact Institute.

In addition, Cavanagh points to several small steps all digital users can take to make their devices healthier for their eyes:

·        Make sure the settings are adequate – increase screen font size and improve the contrast. Always use good lighting but avoid glare on small screens.

·        Exercise your eyes just as you exercise your body. Every few minutes, look up from the screen and focus on something in the distance. This exercise helps prevent eye strain and uses more of your ocular muscles. And don’t forget to take breaks occasionally.

·        Get outside. Sunshine can be the antidote to digital vision, according to some research. While the sun’s role isn’t completely understood, an Australian study showed that children who spent more time outside playing in natural light had a lower rate of myopia. In China, schools are experimenting with classrooms made of transparent materials to help stem the nation’s epidemic of shortsightedness in young people.

Regardless of your age or how many digital devices you have, taking care of your eyes helps prevent vision problems and protects your overall eye health. Learn more at visionimpactinstitute.org.

Do Patients with Age-Related Macular Degeneration Have Trouble with Touch Screens?

Newswise, September 25, 2015– Older adults with central vision loss caused by age-related macular degeneration (AMD) have no problem with accuracy in performing touch screen tasks, according to a study in the October issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Wolters Kluwer.

But their performance is slower—especially during the initial "exploration" phase of touch screen tasks, according to the new research by Quentin Lenoble, PhD, of Université Lille Nord de France and colleagues. 

The study provides initial insights into the best ways of adapting touch screen applications for use by the millions of people affected by AMD.

People with AMD Are Accurate, But Slower, in Using Touch Screens

Age-related macular degeneration is the leading cause of vision loss in older adults, causing serious impairment in driving, reading, and other daily tasks. 

"The advent of digital displays and use of computer screens has opened up many new possibilities for reading activities and travel aids for AMD sufferers," comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science.

Dr. Lenoble and colleagues designed an experiment to see how AMD affected performance on a simple touch screen task. Twenty-four older adults with AMD were asked to explore scenes presented on a touch screen, and then to drag pictured objects to the corresponding scene—for example, matching a fish to the sea.

Their performance was compared with that of older adults without AMD, as well as young adults with normal vision. All three groups were highly accurate in matching the objects to the corresponding scene, with correct response rates of about 99 percent.

However, there were significant differences in the initial "exploration phase"—when participants were visually exploring the scenes presented on the touch screen. 

Average exploration time was about four seconds for AMD patients, compared to three seconds for older subjects with normal vision. For younger subjects, exploration time was significantly shorter: less than one second.

The younger participants also had shorter touch screen movement times. However, the two groups of older adults had similar movement speeds, whether or not they had AMD.

"This study shows that people with AMD are able to perform a task on a touch screen," Dr. Lenoble and coauthors write. 

"They were slower during the exploration phase, but accuracy was not affected." Based on this finding, the researchers suggest, "AMD impaired the perceptual but not the motor performance of the patients in this task."

The authors note some limitations of their study—including the fact that it was performed using large, desktop-sized touch screen monitors. It's unclear how AMD patients would be able to see and navigate the images presented on smaller screens, such as smartphones and global positioning systems.

But the results are an informative first step toward adapting touch screen applications for patients with AMD, and possibly with other visual impairments as well. 

"The advent of digital displays and use of computer screens has opened up many new possibilities for reading activities and travel aids for AMD sufferers," says Dr. Adams. 

"This study suggests that there can be new strategies in making touch screen scenes and materials more identifiable to the many people with low vision caused by AMD."

Click here to read "Categorization Task over a Touch Screen in Age-Related Macular Degeneration."

Article: "Categorization Task over a Touch Screen in Age-Related Macular Degeneration" (doi: 10.1097/OPX.0000000000000694)

About Optometry and Vision Science

Optometry and Vision Science, official journal of theAmerican Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer reported 2014 annual revenues of €3.7 billion. The group serves customers in over 170 countries, and employs over 19,000 people worldwide. 

The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on NYSE Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).

Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit www.wolterskluwerhealth.com, follow@WKHealth or @Wolters_Kluwer on Twitter, like us onFacebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.

Study Finds Cataract Surgery Leaves Patients Satisfied

(Family Features) September 10, 2015-- By 2030, 38 million Americans will suffer from cataracts, a number that will increase to 50 million by 2050, according to the National Eye Institute of the National Institutes of Health. The most common treatment for cataracts is surgery, and new research suggests its benefits are strong.

A study of patient satisfaction surveys revealed that almost all patients who undergo cataract surgery are satisfied with their vision and quality of life post-surgery. The study, from the Accreditation Association for Ambulatory Health Care (AAAHC) Institute for Quality Improvement, showed that 99.7 percent of patients would recommend the procedure to friends or relatives suffering from cataracts. Ninety-six percent of patients reported that their vision was better post-surgery, and 98 percent said they were comfortable during the procedure and post-discharge. What’s more, 96 percent returned to normal activities of daily living within one week of the procedure.

“The data clearly shows that patients find value in cataract surgery and are generally very pleased with the outcomes of the procedure,” said Naomi Kuznets, Ph.D., vice president and senior director for the AAAHC Institute for Quality Improvement.

Cataracts occur when protein builds up on the lens of an eye, making the person’s vision cloudy. According to experts at the Mayo Clinic, common symptoms of cataracts include clouded, blurred or dimmed vision, increasing difficulty with vision at night and sensitivity to light or glare. Individuals experiencing these symptoms should consult an ophthalmologist to see if they are candidates for cataract surgery.

“The satisfaction numbers in this study show how worthwhile cataract surgery is for so many individuals,” said Kris Kilgore, R.N., AAAHC Institute board member and administrative director of Grand Rapids Ophthalmology Surgical Care Center in Grand Rapids, Michigan. “Every day we hear from patients who have improved quality of life thanks to this procedure. This study bears out empirically the wonderful anecdotes we hear from patients every day.”

Cataract surgery is an outpatient procedure, meaning it requires no overnight hospital stay. During cataract surgery, a surgeon makes a small incision to remove the cloudy lens, and then replaces it with a clear, manmade lens. To reduce the costs of the procedure and for patients’ convenience, surgeons commonly schedule cataract procedures at surgery centers, which are small surgical facilities that may be on a hospital campus or offsite.

The safety of these facilities is overseen by government regulators and by accrediting bodies such as AAAHC. During an accreditation evaluation by AAAHC, a trained medical professional visits a surgical facility to personally verify its adherence to patient safety, quality care and value standards.

If you are a candidate for cataract surgery, visit www.aaahc.org to find a local AAAHC-accredited facility.

Fight Against Age-Related Vision Loss

Sept. 9, 2015 /PRNewswire-USNewswire/ -- It's commonplace for many people to take steps to fight common signs of aging. Americans spend billions of dollars each year to improve the way they look.  

Far too many, however, forget about the steps they should take to protect how they see. The American Academy of Ophthalmology is reminding adults to start the fight against age-related vision loss early – long before they reach the golden years.

An estimated 43 million Americans will face vision loss or blindness from age-related eye diseases by 2020.[1] During September, the National Eye Institute and the Academy are recognizing Healthy Aging Month by bringing eye-healthy tips to the public. Ophthalmologists, the medical doctors who treat eye diseases and conditions, recommend that adults following these sight-saving habits:

It's all about the baseline

Get a baseline comprehensive eye exam, ideally when you turn 40. This is when age-related eye changes often begin to occur. During this medical eye exam, your ophthalmologist will check more than how well you see. He or she will also check for signs of common age-related eye diseases such as glaucoma and macular degeneration. None of these conditions have noticeable symptoms early on. If a disease is identified, an ophthalmologist can track it and provide treatment to help prevent it from getting worse.

After the baseline exam, adults should have comprehensive exams:

Every two to four years until age 54

Every one to three years until age 64

By age 65, every one to two years, or as recommended by your ophthalmologist.

Keep an Eye on Family History

Age-related macular degeneration (AMD), glaucoma, cataracts and other eye diseases can be inherited. If you have a close relative with AMD, you have a 50 percent chance of developing the condition. A family history of glaucoma increases your chances by four to nine times. So, you should inform your eye care professional about your family's eye health history. This can help him or her make an earlier diagnosis and save your vision.

No more Butts

Quitting smoking is one of the best investments you can make in your eye health. Smoking increases your risk for developing cataracts and age-related macular degeneration. It also raises the risks for cardiovascular diseases that indirectly influence your eyes' health. And, as an irritant, it worsens dry eye. The American Cancer Society has resources to help people who want to quit: www.cancer.org.

Eat for Your Eyes

Studies have shown that some foods are good for eye health as well as general health. These foods include citrus fruits, vegetable oils, dark green leafy greens and cold water fish such as salmon and tuna. So pile them on!

Know (and Control) Your Numbers

High blood pressure, cholesterol and blood glucose (sugar) levels all increase the risk of vision loss from an eye disease. Watch these numbers and try to keep them under control. This will not only help your eyes, but also your overall health.

"Adults should know that recent advances in eye care have made it more possible than ever to have good vision in your senior years," said Rebecca Taylor, M.D., clinical spokesperson for the Academy and comprehensive ophthalmologist. "But, to achieve this, you'll need to adopt some healthy habits early on, and see an ophthalmologist at points along the way."

To learn more about how to care for aging eyes, visit the Academy's public information website at www.eyesmart.org. Seniors concerned about the cost of caring for their eyes may be eligible for a comprehensive eye exam and up to one year of treatment at no out-of-pocket cost through EyeCare America (www.eyecareamerica.org), a public service program of the Foundation of the American Academy of Ophthalmology.

About the American Academy of Ophthalmology

The American Academy of Ophthalmology, headquartered in San Francisco, is the world's largest association of eye physicians and surgeons, serving more than 32,000 members worldwide. The Academy's mission is to advance the lifelong learning and professional interests of ophthalmologists to ensure that the public can obtain the best possible eye care. For more information, visit www.aao.org.

The Academy is also a leading provider of eye care information to the public. The Academy's EyeSmart® program educates the public about the importance of eye health and empowers them to preserve healthy vision. EyeSmart provides the most trusted and medically accurate information about eye diseases, conditions and injuries. OjosSanos™ is the Spanish-language version of the program. Visit www.geteyesmart.org or www.ojossanos.org to learn more.

About EyeCare America

Established in 1985, EyeCare America, a public service program of the Foundation of the American Academy of Ophthalmology, is committed to the preservation of sight, accomplishing its mission through public service and education. EyeCare America provides year-round eye care services to medically underserved seniors and those at increased risk for eye disease. 

More than 90 percent of the care made available is provided at no out-of-pocket cost to the patients. EyeCare America is co-sponsored by the Knights Templar Eye Foundation Inc., with additional support provided by Alcon and Genentech. More information can be found at www.eyecareamerica.org .

Driving with Central Visual Field Loss II: How Scotomas Affect Hazard Detection in a Driving Simulator

Newswise, September 3, 2015-- Vision researchers in Boston have published the second paper of a study designed to determine if a driver who suffers from loss of central vision is able to detect pedestrians in a timely manner when driving. 

Central visual field loss, a scotoma or blind area in central vision, is found most commonly in patients with age-related macular degeneration (AMD). Patients with AMD may drive provided their visual acuity at least meets the requirements for a restricted license. 

However, the size and location of the blind area are usually not considered when making licensing decisions. The purpose of the study was to evaluate how much these blind areas delayed responses to pedestrian hazards in the safe environment of a driving simulator.

This study was conducted with participants with AMD who drove in a state-of-the-art driving simulator at the Schepens Eye Research Institute of Mass. Eye and Ear. The research was led by Alex Bowers, Ph.D., Eli Peli, O.D. M.Sc., and P. Matthew Bronstad, Ph.D..

The study’s first phase, documented in JAMA Ophthalmology, Mar. 2013 showed that patients with blind areas to the side of where they typically look tend to miss pedestrians coming from that side. 

The results of the current study showed that a blind area located above or below the center of interest will still likely block or delay a driver’s ability to detect pedestrians entering the field of vision from the side of the road. 

These late reactions usually occurred because the pedestrians were entirely or partially obscured by the blind area after the drivers noticed the pedestrian using their peripheral vision, and then tried to look at them directly, causing the blind area to obscure the pedestrian.

Taken together, the results of the two papers suggest that that any binocular central field loss might delay a driver’s ability to detect moving hazards in time for the driver to take safe, corrective action.

“If you are a low-vision patient, you should understand how the condition affects and perhaps limits your ability to drive safely,” said Dr. Bronstad. 

“These data should prove useful to clinicians in advising patients about whether they should continue driving, and may even become a consideration for state agencies responsible for licensing drivers.”

About Massachusetts Eye and Ear and Schepens Eye Research Institute
Mass. Eye and Ear clinicians and scientists are driven by a mission to find cures for blindness, deafness and diseases of the head and neck. 

Now united with Schepens Eye Research Institute, Mass. Eye and Ear is the world's largest vision and hearing research center, developing new treatments and cures through discovery and innovation. 

Mass. Eye and Ear is a Harvard Medical School teaching hospital and trains future medical leaders in ophthalmology and otolaryngology, through residency as well as clinical and research fellowships. Internationally acclaimed since its founding in 1824, Mass. Eye and Ear employs full-time, board-certified physicians who offer high-quality and affordable specialty care that ranges from the routine to the very complex. 

U.S. News & World Report’s “Best Hospitals Survey” has consistently ranked the Mass. Eye and Ear Departments of Otolaryngology and Ophthalmology as top in the nation. For more information about life-changing care and research, or to learn how you can help, please visit MassEyeAndEar.org.

About Harvard Medical School Department of Ophthalmology
The Harvard Medical School (HMS) Department of Ophthalmology (eye.hms.harvard.edu) is one of the leading and largest academic departments of ophthalmology in the nation. 

More than 350 full-time faculty and trainees work at nine HMS affiliate institutions, including Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, Brigham and Women's Hospital, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Joslin Diabetes Center/Beetham Eye Institute, Veterans Affairs Boston Healthcare System, VA Maine Healthcare System, and Cambridge Health Alliance. 

Formally established in 1871, the department has been built upon a strong and rich foundation in medical education, research, and clinical care. 

Through the years, faculty and alumni have profoundly influenced ophthalmic science, medicine, and literature-helping to transform the field of ophthalmology from a branch of surgery into an independent medical specialty at the forefront of science.

Vitamin D May Play Key Role in Preventing Macular Degeneration

 University at Buffalo research shows women with two risk alleles and low D status are more likely to have the disease

Newswise, August 31, 2015– Vitamin D has been studied extensively in relation to bone health as well as cancer. Now, a team led by a researcher at the University at Buffalo has discovered that vitamin D may play a significant role in eye health, specifically in the possible prevention of age-related macular degeneration, or AMD, among women who are more genetically prone to developing the sight-damaging disease.

In a paper published today (Aug. 27) in JAMA Ophthalmology online, Amy Millen, associate professor of epidemiology and environmental health in UB’s School of Public Health and Health Professions, and her team found that women who are deficient in vitamin D and have a specific high-risk genotype are 6.7 times more likely to develop AMD than women with sufficient vitamin D status and no high risk genotype.

“Most people have heard that you should eat carrots to help your vision. However, there appear to be many other ways that adequate nutrition can support eye health. Having adequate vitamin D status may be one of them,” says Millen, PhD, the study’s lead author. 

“This is not a study that can, alone, prove a causal association, but it does suggest that if you’re at high genetic risk for AMD, having a sufficient vitamin D status might help reduce your risk.”

“To our knowledge, this is the first study that’s looked at the interaction between genetic risk and vitamin D status in the context of age-related eye disease,” adds Millen.

Macular degeneration is characterized by the deterioration of the macula, a small part of the central retina where the eye’s photoreceptors (rods and cones) are most highly concentrated. 

The leading cause of legal blindness, macular degeneration affects more than 10 million Americans — more than cataracts and glaucoma combined — according to the American Macular Degeneration Foundation. The disease affects a person’s central vision, which is needed for common tasks such as reading and driving. The effect is similar to that of a rain drop on the center of a camera lens.

Researchers analyzed data compiled on 1,230 women ages 54 to 74 who participated in the Carotenoids in Age-related Eye Disease Study (CAREDS), which is an ancillary study of the Women’s Health Initiative (WHI) Observational Study (OS). 

The WHI OS is a major National Institutes of Health-funded research program aimed at addressing the most common causes of death, disability and poor quality of life in postmenopausal women. UB is one of 40 WHI centers nationally. 

CAREDS was conducted among participants at three of the centers: University of Wisconsin (Madison), the University of Iowa (Iowa City) and the Kaiser Center for Health Research (Portland, Oregon).

Researchers were able to determine participants’ vitamin D status by analyzing serum samples for a vitamin D biomarker, 25-hydroxyvitamin D [25(OH)D], which provided a glimpse into vitamin D intake through all sources: diet, supplements and sunlight.

Human skin can synthesize vitamin D when exposed to ultraviolet light, Millen explains. However, for many people, 15 to 30 minutes a day with 10 percent of their skin exposed might be sufficient. 

In winter months, when there is a lower solar angle, sun exposure may not be not sufficient to maintain blood level for people who live north of a line from about Washington, D.C., to Los Angeles. 

At these times and locations, dietary intake may be needed. Dietary sources of vitamin D include fortified foods such as milk and foods that naturally contain vitamin D such as fatty fish like salmon and mackerel.

“Macular degeneration has been found to be strongly associated with genetic risk,” Millen says. 

Among many genes linked to AMD, one of the strongest is a specific genetic variant (Y402H) in the complement factor H gene, called CFH for short. This gene codes for the CFH protein that is involved in the body’s immune response to destroy bacteria and viruses.

Inflammation is believed to be involved in the development of macular degeneration.

“People who have early stage AMD develop drusen, lipid and protein deposits that build up in the eye. Your body sees this drusen as a foreign substance and attacks it, in part via the complement cascade response,” explains Millen. 

“CFH is one of the proteins involved in this response. We see more AMD in people who have certain variants in the gene which encodes a form of this CFH protein that is associated with a more aggressive immune response.”

Vitamin D shows promise for protecting against macular degeneration because of its anti-inflammatory and antiangiogenic properties; antiangiogenic refers to slowing the growth of new blood vessels, often seen in late stages of AMD.

“Our thinking was, if a person’s vitamin D status is better, would it reduce the immune response to drusen? We wanted to understand if the association between vitamin D and AMD differed depending on a person’s genetic risk for AMD,” says Millen. 

“Our study suggests that being deficient for vitamin D may increase one’s risk for AMD, and that this increased risk may be most profound in those with the highest genetic risk for this specific variant in the CFH protein.”

The study results, however, shouldn’t prompt people to run to the nearest grocery store to purchase vitamin D supplements.

“Our message is not that achieving really high levels of vitamin D are good for the eye, but that having deficient vitamin D levels may be unhealthy for your eyes,” Millen says.

Although the odds of having AMD was higher in women who were deficient for vitamin D, with 25(OH)D levels below 12 ng/mL (30 nmol/L), increasing vitamin D levels beyond 12 ng/mL did not further lower the odds of AMD to any meaningful extent, she explains.

“This study supports a role for vitamin D in eye health. That’s significant because when the Institute of Medicine’s report on the dietary reference intakes for vitamin D and calcium were released in 2011, the committee could only make conclusions about D related to bone health,” says Millen. 

“There wasn’t enough evidence at that time to make any recommendation based on D status and other outcomes beyond bone health.”

Millen’s co-authors on the paper, titled “Association between vitamin D status and age-related macular degeneration by genetic risk,” include researchers from the University of Wisconsin-Madison, University of Iowa, Case Western Reserve University, Kaiser Permanente Center for Health Research and Fred Hutchinson Cancer Research Center. The study was funded by the National Eye Institute of the National Institutes of Health.

The Amazing Adaptability of the Brain’s Vision Center

Researchers uncover for the first time how and when the visual cortex of blind children adapts to respond to spoken language, sound, music 

Newswise, August 19, 2015 — By early childhood, the sight regions of a blind person’s brain respond to sound, especially spoken language, a Johns Hopkins University neuroscientist has found.

The results, published this week in The Journal of Neuroscience, suggest that a young, developing brain has a striking capacity for functional adaptation.

“The traditional view is that cortical function is rigidly constrained by evolution. We found in childhood, the human cortex is remarkably flexible,” said Johns Hopkins cognitive neuroscientist Marina Bedny, who conducted the research while at Massachusetts Institute of Technology. “And experience has a much bigger role in shaping the brain than we thought.”

Bedny, an assistant professor in the Department of Psychological and Brain Sciences, studied 19 blind and 40 sighted children, ages 4 to 17, along with Massachusetts Institute of Technology cognitive scientists Hilary Richardson and Rebecca Saxe. 

All but one of the blind children were blind since birth.

They monitored the children’s brain activity with functional magnetic resonance imaging while the children listened to stories, music or the sound of someone speaking an unfamiliar language. 

The blind children’s vision portion of the brain, the left lateral occipital area, responded to spoken language, music and foreign speech — but most strongly to stories they could understand. In sighted children and sighted children wearing blindfolds, that same area of the brain didn’t respond.

The researchers concluded that blind children’s ‘visual’ cortex is involved in understanding language.

Working with individuals who are blind offers cognitive researchers an opportunity to discover how nature and nurture, or a person’s genes and their experience, sculpt brain function.

Though scientists have shown that occipital cortexes of congenitally blind adults can respond to language and sound, this study offers the first look at how and when the change in brain function occurs.

The team found the blind children’s occipital cortex response to stories reached adult levels by age 4. Because spoken language had colonized the brain’s visual region so early in the children’s development, the team realized the brain adaptation had nothing to do with a child’s proficiency in Braille. Scientists had previously guessed that brain plasticity for spoken language in blind people had something to do with Braille.

Blind children’s occipital reaction to the other sounds, music and foreign speech, did increase as they aged.

Bedny believes her findings could one day lead to improved therapies for people with brain damage. If someone had a damaged part of the brain, she said it could be possible to train another part of the brain do the damaged part’s work.

“Early in development, the human cortex can take on a strikingly wide range of functions,” Bedny said. “We should think of the brain like a computer, with a hard drive ready to be programmed and reprogrammed to do what we want.”

This research was supported by the David and Lucile Packard Foundation and the Harvard/MIT Joint Research Grants Program in Basic Neuroscience.

Scientists find the brain works to minimize loss of vision, other functions

Newswise, August 17, 2015 – A new study may have unlocked understanding of a mysterious part of the brain — with implications for neurodegenerative conditions such as Alzheimer’s. The results, published in Translational Vision Science & Technology (TVST), open up new areas of research in the pursuit of neuroprotective therapies.

Glaucoma is a neurodegenerative disease where patients lose seemingly random patches of vision in each eye. This random pattern of vision loss is in stark contrast to loss from a brain tumor or stroke, which causes both eyes to develop blind spots in the same location. Scientists have long thought that glaucoma’s progression is independent of – or uncontrolled by – the brain.

Last year, researchers found evidence that the progression of glaucoma is not random and that the brain may be involved after all. Specifically, they found patients with moderate to severe glaucoma maintained vision in one eye where it was lost in the other — like two puzzle pieces fitting together (a “Jigsaw Effect”). 

“This suggests some communication between the eyes must be going on and that can only happen in the brain,” explains the study’s lead author, William Eric Sponsel, MD, of the University of Texas at San Antonio, Department of Biomedical Engineering.

In the latest TVST paper, Refined Frequency Doubling Perimetry Analysis Reaffirms Central Nervous System Control of Chronic Glaucomatous Neurodegeneration, Sponsel and his research team found that the Jigsaw Effect begins at the earliest stages of glaucoma and discovered clues as to which part of the brain is responsible for optimizing vision in the face of glaucoma’s slow destruction of sight.

However, these findings, which challenge longstanding assumptions about glaucoma, have been met with skepticism. Other glaucoma experts challenged the results in a letter to the TVST editor. 

“If the brain controls the distribution of vision loss in glaucoma, then a patient’s vision with their two eyes should be better than if you simply ‘mix and match’ the vision of right and left eyes from different patients,” explained letter co-author Paul Artes, PhD, of Plymouth University, Department of Eye and Visual Sciences. Along with co-author Jonathan Denniss, PhD, University of Nottingham, Visual Neuroscience Group, their letter analyzed a new cohort of glaucoma patients in which “that’s essentially what we did. And we did not find any visual advantage in a patient’s own eyes versus the combined vision in eyes from different patients; indeed we found the opposite effect.”

Sponsel and co-authors responded to the letter to the editor with their own. 

“Our analysis of the data [Artes and Denniss] introduced demonstrated conclusively that the ‘Jigsaw Effect’ was indisputably present in patients we had never even seen. Moreover, we were able to confirm that the alternative analytical method they proposed could not reliably detect very obvious computer-generated complementary visual field pairs,” like a left and right eye that could only see opposite halves of their normal field of vision, says Sponsel.

 “The problem with their approach was their assumption that a single brain could somehow combine information from the eyes of different human beings. We studied individual people with naturally paired eyeballs connected to a single brain.”

The key to finding where the brain coordinates vision loss was found in small-scale, arc-shaped patterns of vision displayed by patients. Co-author Ted Maddess, PhD, of the Australian National University, Center of Excellence in Vision Science, explains that these patterns mimic structures found at the very back of the brain, known as ocular dominance columns. While their function is not completely understood, what is known is that some ocular dominance columns are associated with the left eye and other columns with the right.

The new paper suggests that the narrow spaces between ocular dominance columns associated with the left and right eye are where the brain coordinates each eye’s working field of vision. Depending on what the brain needs, those narrow spaces can function with either eye “much like a bilingual person living near the border of two countries,” explains Sponsel.

The progression of Alzheimer’s and Parkinson’s diseases, which have neurodegenerative biology similar to glaucoma, may also be actively mediated by the brain. 

“Our work has illustrated that the brain will not let us lose control of the same function on both sides of the brain if that can be avoided. It seems likely that the same kind of protective mechanism will be at work with other neurodegenerative disorders,” he says.

The investigative team believes that if the brain regulates neurodegeneration – that if the brain controls how it loses control – then researchers will now be able to look into largely unexplored regulatory processes for opportunities to slow or stop the progression of these diseases.

“We’ve opened up this beautiful new world; there is so much to discover here,” says Sponsel.

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The ARVO journal Translational Vision Science & Technology, is an online only, peer-reviewed journal emphasizing multidisciplinary research that bridges the gap between basic research and clinical care, available at www.tvstjournal.org.

The Association for Research in Vision and Ophthalmology (ARVO) is the largest eye and vision research organization in the world. Members include nearly 12,000 eye and vision researchers from over 75 countries. ARVO advances research worldwide into understanding the visual system and preventing, treating and curing its disorders.