uv risk
Dr Margaret Kearns

UV risk to eye health an Australian Survey

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Survey: Australians lack awareness of UV risk to eye health

The mainstream media’s focus on blue light filters and consumer confusion may be contributing to Australian’s poor understanding of the risks associated with ultraviolet (UV) light exposure.

According to a national survey conducted by Carl Zeiss Australia, many Australians do not recognise the full effect UV light has on eyes.

In findings that the company described as “alarming”, its recently published MyEyeQ Report found that 73% of respondents were unaware most eye-related UV damage happened before the age of 18, and 45% were not aware of the level of UV protection their sunglasses provided.

Additionally, 71% of spectacle wearers did not know the level of UV protection their lenses offered.

According to Carl Zeiss Australia, unsubstantiated concerns about blue light risk and a lack of understanding regarding protection levels could be preventing consumers from fully comprehending the risks of UV light.

According to the survey results, 62% of parents found it difficult to understand the UV protection levels displayed on children’s sunglasses.

“To some degree, the blue light conversation has eclipsed UV concerns. While the media has latched on to blue light, there is no firm clinical evidence to suggest that blue light from digital devices poses a health risk anywhere close to that of UV,” Ms Hilke Fitzsimons, Carl Zeiss Australia general manager said.

“Australians recognise they need to protect their eyes, but they are underestimating the risks and are confused by what they see on the shelves and hear in the media.”Hilke Fitzsimons, Carl Zeiss Australia

“Australians recognise they need to protect their eyes, but they are underestimating the risks and are confused by what they see on the shelves and hear in the media. The industry has an important role to play in consumer education and purchase behaviour.”

Fitzsimons said that in some cases product labelling could be misleading. For example, some companies claim ‘full UV protection’ on lenses that only protect from light up to 380nm. To achieve full UV protection, lenses need to withstand up to 400nm.

“People are also confused by the distinction between things like UV protection and polarisation. Polarisation eliminates glare and can be more comfortable for the eyes but does not offer any additional UV protection,” she said.

The survey also stated that while 66% of Australians will develop skin cancer by the age of 70, some were not aware the eyelid region was one of the most common sites for non melanoma skin cancers.

Despite this risk, 33% of respondents indicated they were more concerned about protecting their skin from sun damage than their eyes, while almost half of Australians were only “somewhat concerned” about the risk of eye damage from UV light.

“We are fed so much information these days about skin anti-aging and sun damage, but it’s important people understand our eyes face the same risks, and the damage begins early,” Fitzsimons said.

“Photoaging of the skin around the eyes, several cancers on the skin around the eye and within the eye, cataracts, macular degeneration and preventable blindness are among the consequences of UV exposure. Consumers need to take this information very seriously.”

The survey involved 1,000 participants from across Australia.

Article appeared on Insight, 5th March 2019

VR Goggles
Dr Paula Berdoukas

VR Goggles for Glaucoma Diagnosis

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VR Goggles for Glaucoma Diagnosis

A wearable brain-based device called NGoggle that incorporates virtual reality (VR) could help improve glaucoma diagnosis and prevent vision loss. The device consists of head-mounted VR goggles that use light to stimulate targeted areas in a patient’s visual field. Its portability means it could be used in a variety of environments such as in an eye care professional’s office, community centre, or at home.

The VR goggles are integrated with wireless electroencephalography (EEG), a series of electrodes that adhere to the scalp to measure brain activity in response to signals received from the eyes. Within a few minutes, the NGoggle algorithm captures and analyses enough data to report how well each eye communicates with the brain across the patient’s field of vision. Diminished activity may indicate functional loss from glaucoma.

Dr Felipe Medeiros, a co-founder of NGoggle, Inc., and a professor of ophthalmology at Duke University School of Medicine, said the device’s VR capabilities can be greatly leveraged – people could be tested for glaucoma as they play a VR-based video game or explore a virtual art gallery for instance. 

“The possibilities are endless for making it an engaging experience, which would go a long way toward ensuring that people use it and receive the treatment they need,” he said.

In a partnership with Duke University, a study is being conducted to validate the diagnostic accuracy and reproducibility of the device. In addition to comparing NGoggle to standard automated perimetry, they will look at how well NGoggle discriminates among different stages of disease by comparing its assessments of the neural damage in glaucoma with standard imaging techniques such as optical coherence tomography. The investigators also plan to conduct longitudinal investigations to validate the ability of the device to detect disease progression. Results will inform an application to the U.S. Food and Drug Administration to market the device.

Article appeared on mivision, February 28 2019

dry eye
Dr Richard Smith

From Gut to Eye: New Approaches to Dry Eye Disease

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From Gut to Eye: New Approaches to Dry Eye Disease

Scientists are embracing novel approaches to treating disease – the use of faecal implants and tablets to treat gut problems and serious conditions such as depression, Parkinson’s disease and multiple sclerosis, was one of the big medical stories in 2018. Now both the gut and ocular surface microbiomes are being explored by researchers chasing a cure for one of the most common and persistent eye conditions – dry eye.

Dr Judith Flanagan, Leader of Ocular Therapeutics at Brien Holden Vision Institute, says studies have demonstrated a link between the immune system and dry eye disease, prompting them to investigate whether probiotics taken orally will reestablish proper immune system function and combat the problem.

“There is substantial evidence associating the gut microbiome with systemic inflammation in disease states such as diabetes, irritable bowel syndrome and dermatitis,” she said. “It’s also been found that taking probiotics, which act to help restore a disrupted bacterial community in the gut, can have a positive effect on both systemic and localised immune system function.

(an) avenue being explored is the use of topical treatments at the ocular surface in an attempt to ‘rebalance’ the ocular microbiome

“So, working within an ecological framework, we’re investigating whether these probiotic supplements can reconstitute a healthy microbiome, either at the site of the disease or enterically, and act to reduce the severity of signs and symptoms of dry eye disease. Along these lines, another avenue being explored is the use of topical treatments at the ocular surface in an attempt to ‘rebalance’ the ocular microbiome.

“It’s possible that the microbial community on the eye’s surface plays a role in the development of meibomian gland dysfunction. A change to the balance of this commensal community may lead to eyelid inflammation, changes to the composition of the eye’s tears or to the quality of the meibomian lipids that form the upper most layer of the tear film.

Dr Flanagan said research has shown that low dose oral antibiotics are useful in treating meibomian gland dysfunction but the concentrations used are below levels needed to eliminate bacteria and the effects are instead, anti-inflammatory.

“Another benefit of low dose antimicrobials is that they inhibit bacterial lipase production, reducing the concentration in the tear film of these enzymes that can act to degrade the lipid layer of the tears.”

We’re currently recruiting participants for this trial of the topical ointment

However, with concerns that long term oral antibiotic use can diminish our bacterial communities, and that exposing bacteria to non-biocidal levels of these drugs can induce antibiotic resistance, the researchers are proposing an alternative approach.

“Rather than using antibiotics to target the lipase enzymes, we are developing a bacterial lipase inhibitor ointment derived from natural products (coconut oil) that can work to rebalance a healthy ocular microbiome and deliver increased ocular comfort and reduced dry eye disease,” said Dr Flanagan.

“We have already shown in the lab that our novel agent can inhibit production of bacterial lipase without being antimicrobial. It has also been shown by others that bacteria never develop resistance to this agent and that this lipase inhibitor does not affect the healthy bacteria that we need on the ocular surface. We hope, through a clinical trial, to provide initial evidence that this approach can reduce the signs and symptoms of dry eye disease by naturally allowing the bacterial community to find an ecological balance.

“We’re currently recruiting participants for this trial of the topical ointment (which is applied on the skin around the eye rather than in the eye) and planning for an oral probiotics study in the near future, so if there are optometrists working in the inner Sydney area who have patients that might be interested we would love to hear from them,” said Dr Flanagan.

Article appeared on mivision, 28th February 2019

laser eye surgery
Team Focus

Am I a Candidate for Refractive or Laser Eye Surgery?

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Refractive or laser eye surgery is not right for everyone. The qualifications of a good candidate for refractive or laser eye surgery generally include:

  • At least 18 years of age
  • Stable eyeglass and contact lens prescription for at least 2 to 3 years
  • Stable vision over at least the past year
  • No history or findings of active corneal disease
  • No significant medical or eye problems, such as previous corneal ulcers, keratoconus (a progressive thinning of the cornea), diabetic retinopathy, macular degeneration, or glaucoma
  • Not pregnant or nursing
  • Eyeglass prescription within certain limits set by your eye surgeon

A good candidate is also one who, despite expecting improved vision, will still be OK with the idea of having to wear glasses under certain situations, such as when driving at night.

Article appeared on WebMD

glaucoma
Team Focus

Aussie Tech Could End Glaucoma Eye Drops

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Australian tech could end glaucoma eye drops

A clinical-stage Australian biotechnology company has begun recruiting glaucoma patients for a trial of a new implant that could end the need for daily eye drops.

PolyActiva has developed ocular implants that, when placed in the eye, provide sustained treatment over a six-month period, potentially removing the need for patients to manage their own treatment. Such a move could improve glaucoma outcomes, as several studies have demonstrated that up to 46% of patients don’t remember to use their drops or administer them poorly.

PolyActiva CEO Dr Russell Tait told Insight the technology had originally been developed for a different purpose, but its ability to carry a large amount of drugs in a small area and achieve zero order release, while maintaining separate control over the implant’s biodegradation made it ideal for delivering drugs to the eye.

“The implant is designed to deliver treatment for six months after which it will disappear without further intervention.”
Russell Tait, PolyActiva

“This product is designed to make the lives of glaucoma sufferers easier by removing the need for daily drop administration and thus improving treatment management,” Tait said.

“The implant is designed to deliver treatment for six months after which it will disappear without further intervention. We’re excited about starting our first clinical study and look forward to seeing how our lead candidate performs.”

According to Tait, the implant is capable of being administered in an ophthalmologist’s office under a slit-lamp using a custom-designed administration device.

“The implant itself is tiny – it’s about .2 mm in diameter and up to 4 mm in length, depending on the strength of the relevant product,” he explained.

“It sits in the lumen of a 27 gauge needle and it’s administered by clear corneal injection with a custom-built administration. For the glaucoma product it sits in the inferior angle of the interior chamber.”

The clinical trial will assess the safety and tolerance of the implant when administered to glaucoma patients and should be completed by the middle of 2019, with a view to eventually bringing the technology to market in around six years. Trials will initially be restricted to Australia, however as they progress Tait said the company would look to engage centres in the US as well.

“The major investors, MRCF [Medical Research Commercialisation Fund] and Yuuwa Capital, see this technology having a major potential impact on the lives of millions of glaucoma patients globally,” Dr Chris Nave, chairman of PolyActiva and CEO of the MRCF said.

“This innovative drug delivery technology has further potential applications, such as being used to administer other types of medication, including antibiotics and steroids for cataract surgery patients.”

PolyActiva’s first clinical candidate is designed to provide a constant daily therapeutic dose of latanoprost free acid for at least 26 weeks. Latanoprost is the active ingredient of a commonly prescribed glaucoma eye-drop treatment (Xalatan).

The Phase I clinical trial is being conducted under the Therapeutic Goods Administration Clinical Trial Notification (CTN) scheme at the Royal Victorian Eye and Ear Hospital in Melbourne, through the Centre of Eye Research Australia (CERA).

Article appeared on Insight

05/09/2018 • By Matthew Woodley

contact lens
Team Focus

A Warning for Contact Lens Wearers

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Warning for contact lens wearers as infection increases

Blinding Acanthamoeba keratitis infections are on the rise, according to a new study led by UNSW’s Dr Nicole Carnt.

The research, which was conducted at Moorfields Eye Hospital in the UK while Carnt was on an NHMRC CJ Martin Biomedical Early Career Fellowship, found a threefold increase in Acanthamoebakeratitis infections in Southeast England since 2011. However, while the study is based on data from the UK, Carnt said its findings were equally important in Australia.

“It is absolutely imperative that regulators and those working in the optical sector take the findings seriously, and use the recommendations to take immediate and urgent action on prevention,” Carnt said.

“Contact lenses are medical devices and should be supplied with warnings regarding safe use.”

“It is absolutely imperative that regulators and those working in the optical sector take the findings seriously.”
Nicole Carnt, UNSW

Carnt told Insight she has been working with the Cornea and Contact Lens Society Australia (CCLSA) to develop a website dedicated to healthy contact lens wear, along with other initiatives to raise awareness.

“We are trying to encourage optometrists to talk about water related risks, as often they tend to skip over it as in the too hard basket or the risk too low to enforce the message,” she said.

“Yes, contact lenses are a lifestyle option and we don’t want people to be restricted but we do want them to be aware of the risks and take precautions where needed. Our message is to choose healthy contact lens wear.”

While the infection is quite rare, usually affecting 2.5 in 100,000 contact lens users per year, one in four people affected will need a corneal transplant to treat the disease and restore vision.

A member of the Acanthamoeba Keratitis Patient Support Group in the UK led by Carnt, Ms Irenie Ekkeshis, says more needs to be done to prevent new cases.

“This research confirms what those of us affected by Acanthamoeba keratitis have suspected for some time: that incidences of this awful, life-changing infection are on the increase,” Ekkeshis said.

“There’s more that should be done to prevent people from losing their sight to Acanthamoeba keratitis.”

The microorganism responsible for the infection can often be found in bodies of water such as lakes, oceans and rivers, as well as domestic tap water, swimming pools, hot tubs, soil and air. As such, Carnt said contact lens wearers needed to be aware of the risks associated with use around water.

“Acanthamoeba keratitis is a largely preventable disease. People who wear reusable contact lenses need to make sure they thoroughly wash and dry their hands before handling contact lenses, and avoid wearing them while swimming, face washing or bathing,” she said.

“Daily disposable lenses, which eliminate the need for contact lens cases or solutions, may be safer and we are currently analysing our data to establish the risk factors for these.”

The study was published in the British Journal of Ophthalmology.

Article appeared on Insight

26/09/2018 • By Matthew Woodley

 

istent
Team Focus

iStent Significantly Reduces Unmedicated IOP in Glaucoma

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iStent Significantly Reduces Unmedicated IOP in Glaucoma

Glaukos’ iStent inject trabecular micro-bypass system achieved a statistically significant reduction in unmedicated diurnal intraocular pressure (IOP) in patients undergoing cataract surgery, according to results from a two-year U.S. Investigational Device Exemption (IDE) pivotal trial data.

Results of the iStent inject prospective, randomised, multicenter clinical trial, which included 41 investigational sites and 505 open-angle glaucoma (OAG) subjects, were presented at the American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting by Dr. Thomas W. Samuelson, an ophthalmic surgeon at Minnesota Eye Consultants. In the study, 387 subjects were randomised to iStent inject in combination with cataract surgery and 118 subjects were randomised to cataract surgery only. Subjects were followed through 24 months with annual medication washouts.

The iStent inject met the study’s primary and secondary effectiveness endpoints as follows:

  • At 24 months, 75.3 per cent of the iStent inject cohort achieved a 20 per cent or greater reduction in unmedicated IOP, compared to 61.9 per cent for the cataract-only cohort.
  • At 24 months, the mean unmedicated IOP reduction was 6.9 mmHg for the iStent inject cohort, compared to 5.4 mmHg for the cataract-only cohort.
  • Through 24 months, the overall rate of adverse events for the iStent inject, in combination with cataract surgery, was similar to cataract surgery only.

Additional Findings

While not part of the effectiveness claims being pursued by the company, additional key findings include:

At 24 months, observed data show that the iStent inject cohort achieved a 31 per cent mean reduction in unmedicated (post-washout) IOP to 17.1 mmHg from an unmedicated (post-washout) mean baseline IOP of 24.8 mmHg.

At 24 months, observed data show that 62.6 per cent of the iStent inject cohort achieved unmedicated mean IOP at or below 18 mmHg, compared to 49.2 per cent for the cataract-only cohort.

At 23 months, observed data show that the iStent inject cohort achieved a 75 per cent reduction in the mean number of medications, compared to 47 per cent for the cataract-only cohort.

The iStent inject is designed to improve aqueous humor outflow into Schlemm’s canal and reduce IOP in mild-to-moderate Open Angle Glaucoma (OAG) patients undergoing cataract surgery. It includes two heparin-coated titanium stents preloaded into an auto-injection system that allows the surgeon to inject stents into multiple trabecular meshwork locations through a single corneal entry point.

The iStent inject relies on the same fluidic method of action as Glaukos’ first-generation iStent trabecular micro-bypass stent, which was approved by the U.S. Food and Drug Administration (FDA) in 2012 and has been shown to lower IOP in adult cataract patients with mild-to-moderate OAG. Each iStent inject stent is approximately 0.23 mm x 0.36 mm, or about one-third the size of iStent, which the company believes is the smallest medical device ever approved by the FDA.

The iStent inject is commercially available in the European Union, Armenia, Australia, Brazil, Canada, Hong Kong, Singapore and South Africa. The iStent inject is not approved for use in the U.S. Glaukos submitted a pre-market approval application for the iStent inject to the FDA in December 2017

Glaukos is also currently pursuing FDA approval for four additional MIGS surgical and sustained pharmaceutical therapy pipeline products, all of which are investigational in the U.S.:

  • iStent SA trabecular micro-bypass system, which is a standalone, two-stent procedure that is similar to the iStent inject and designed to reduce IOP in pseudophakic, mild-to-moderate OAG eyes.
  • iStent infinite trabecular micro-bypass system, which is a standalone, three-stent procedure, designed to reduce IOP in refractory OAG patients.
  • iStent supra suprachoroidal micro-bypass stent, which is designed to reduce IOP in mild-to-moderate OAG subjects undergoing cataract surgery by accessing the eye’s suprachoroidal space. This device is approved in the European Union.
  • iDose travoprost, which is an implant containing a special formulation of travoprost, a prostaglandin analog used to reduce IOP. Implanted during a micro-invasive procedure, the iDose travoprost is designed to continuously elute therapeutic levels of the medication from within the eye for extended periods of time.

Published by mivision | 9 May 2018

We Love Lasers – CPD evening

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On Tuesday the 25th of August, Focus Laser Eye Centre hosted a 6pt CPD evening for optometrists with the theme We Love Lasers. With 5 talks presented by our leading Laser Surgeons, the evening was very rewarding.

Nigel Whittle of MTH Clinic says:

I’d like to thank you for a great educational experience tonight.

The venue, the practice, was transformed into an environment where I think we all felt comfortable and relaxed. That being, it provided a platform for easy understanding and information absorption from expert and dedicated surgeon specialists.

The topics covered were done so in a professional yet down-to-earth manner. I love lasers more now too!!

The catering was exceptional….. I suspect you had a hand in that yourself, so thanks there also.

Please pass on my sincere thanks to Dr’s Margaret and Richard and their associates.

 

Dr Richard Smith

Lessons Learned With Electronic Health Records ( EHR )

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By Dr Richard Smith, MBBS, BSc, DO, FRCS, FRACS, FRANZCO
Published in Cataract & Refractive Surgery Today Europe’s (CRST) – June edition.

Transitioning to electronic health records involves a learning curve but can lead to increased efficiency and cost containment.

AT A GLANCE

  • The elimination of paper charts can yield savings in time, space, and money and increase access to patient data.
  • An Electronic Health Records ( EHR ) system can help provide a practice with a more modern style of patient consulting and facilitate patient education.
  • For some practices, adopting Electronic Health Records ( EHRs ) is one step toward a larger goal of transitioning to a paperless environment in which other processes, such as accounting and staff management, can be digitised as well.

Read Article in full

Download PDF

fasting before cataract eye surgery
Team Focus

Why is fasting before cataract eye surgery important ?

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Sometimes, even though patients know they will have intravenous sedation, they still do not understand why fasting before cataract eye surgery is necessary. On occasion a patient arrives for cataract surgery having eaten breakfast and unfortunately in these cases surgery has to be postponed, which can be very inconvenient for patients and doctors alike.

So why do you need to fast?

Fasting before cataract eye surgery reduces the risk of stomach contents/acid going the wrong way down into your lungs while you are asleep. Stomach acid can cause lung damage.

What is the correct way for fasting before cataract surgery?

  • NO solid food is to be eaten for at least 6 hours prior to your admission time.
  • NO fluids (except water, black tea or black coffee) are to be taken for at least 2 hours before your admission time.

Your regular medications may be taken at their usual time with a sip of water.

This is prepared by Anaesthetist
Dr Joanne Silverton