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AOA Clinical Practice Guideline Receives National Recognition

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The American Optometric Association’s first evidence-based clinical practice guideline, Eye Care of the Patient with Diabetes Mellitus, is now posted to a professionally recognized clearinghouse for health care guidelines, the National Guideline Clearinghouse.

A database of clinical guidelines, the NGC is maintained by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. Guidelines must meet stringent standards to be accepted, and must provide evidence-based recommendations or action plans for patient care.

Posting to the clearinghouse means the diabetes guideline is publicly available for other health care professionals, institutions and agencies to reference with knowledge that it has met NGC standards, said Diane Adamczyk, O.D., chair of the AOA Evidence-Based Optometry (EBO) Committee, which released the guideline in February 2014.

“The rigorous process of developing this guideline has now met the high standards of the National Guideline Clearinghouse, which is truly a sentinel event,” Dr. Adamczyk said. 

Revised standards from the Institute of Medicine in 2011 called for new clinical guidelines to adhere to a stringent evidence-based approach to development. In context of the diabetes guideline, this included a cross-disciplinary review from top diabetes experts and specialists, and hundreds of scientific papers and studies over the course of two and a half years. 

The milestone 83-page diabetes guideline is a pertinent resource for optometrists, as nearly one-third of U.S. adults are estimated to have diabetes by 2050.

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In addition to a clinical breakdown of diabetes mellitus, prevention and diagnostic criteria, the guideline also assists doctors in achieving prescribed objectives in diabetes-related care, including: 

  • Identifying diabetes’ tell-tale markers, and reducing the risk of vision loss through timely diagnosis, intervention and action;
  • Improving the quality of care for people with diabetes;
  • Educating patients and care providers regarding ocular complications of diabetes, and the benefits of vision rehabilitation; and,
  • Suggesting vision rehabilitation services or referral of people with vision loss from diabetes.

Doctors also can use the diabetes quick-reference guide, a summary version of the guideline in a condensed, nine-page format for easy access.  

 

To view the guideline, please click here. If you’d like more information about the guideline, visit www.aoa.org/evidence or contact Danette Miller at (314) 9834155 or DMiller@aoa.org.

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First US Patient Gets Wireless Retinal Device Implant

It’s aimed at restoring partial sight to patients with advanced age-related macular degeneration.

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(PRESS RELEASE) PITTSBURGH – UPMC has implanted the first patient in the U.S. with a new wireless retinal device as part of a clinical trial aimed at restoring partial sight to patients with advanced age-related macular degeneration.

“Vision research has advanced dramatically in the recent past and UPMC is at the forefront of this revolution. This is the first of many such breakthroughs led by UPMC and Pitt that will benefit patients with vision loss in our community and around the world,” said José-Alain Sahel, MD, director of the UPMC Eye Center, Eye and Ear Foundation chair of ophthalmology and distinguished professor at the University of Pittsburgh School of Medicine who initiated the trial at UPMC. “We are proud to be the first center in the United States to test this next generation retinal implant that could help treat an incurable disease like AMD.”

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The system, called PRIMA, is designed to restore sight in patients blinded by retinal degeneration. It consists of a 2 millimeter-by-2 millimeter, 30-micron thick miniaturized wireless photovoltaic chip placed under the damaged retina. It works in tandem with augmented reality glasses that have a built-in miniaturized camera and infrared projector.

The chip acts like a tiny artificial retina, made up of 378 tiny electrodes that convert infrared light from the glasses to electrical signals that are carried by the optic nerve to the brain. After receiving the implant, patients undergo an intensive rehabilitation program that trains their brains to understand and interpret the signals from the implant in combination with their remaining natural vision. Compared to earlier-generation implants, PRIMA is wireless and has significantly more electrodes, which allows for the transmission of more visual information.

“This is an incredibly exciting first for us at UPMC and I’m honored to be a part of it,” said Joseph Martel, MD, the implanting surgeon at the UPMC Eye Center and the Pitt School of Medicine, and the principal investigator of the trial at UPMC. “I’m grateful to our patients who have volunteered to participate in this trial, without whom this would not be possible.”

AMD is the leading cause of vision loss in people older than 50. Today, it affects approximately 14 million people in the United States, and the prevalence is expected to rise as the baby boomers age. As AMD progresses, the center of vision becomes increasingly blurry. “Atrophic” AMD, which accounts for a large proportion of advanced cases, has no curative treatment available.

The UPMC feasibility trial is running in parallel with the first-in-human trial in France, which involves five patients with advanced AMD, who now have been followed for more than a year. The 12-month results from the French study demonstrated the ability of most patients to identify sequences of letters and there were no device-related serious adverse effects.

“We are working with a great sense of urgency because the aging population of the United States, especially the western Pennsylvania region we live in, will see a significant rise in the number of patients at risk for vision loss through diseases like age-related macular degeneration, glaucoma and vascular eye disease, as well as earlier onset genetic conditions such as retinitis pigmentosa,” said Sahel. “This is why our physicians and researchers at UPMC and Pitt, in collaboration with our U.S. and international colleagues — especially at the Paris Vision Institute at Sorbonne University — are taking a multi-pronged effort to treat and rehabilitate patients with vision impairments.”

In March 2019, UPMC broke ground on the UPMC Vision and Rehabilitation Tower at UPMC Mercy, which when completed, will provide advanced specialty clinical care and innovative programs for visually impaired patients. It also will be the home for the vision research program at Pitt and UPMC.

The PRIMA implant was invented by Daniel Palanker, professor of ophthalmology at Stanford University, and licensed and developed by Pixium Vision, a spin-off from the Paris Vision Institute. Sahel is a co-founder of Pixium and holds shares in the company.

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There Might Be a Faster and Cheaper Way to Test for Myopia

The research comes from Flinders University in Australia.

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(PRESS RELEASE) Myopia could become significantly easier to assess, according to a group of scientists.

Progressive research at Flinders University in Australia has identified a new method to measure how it affects the eye, a new article in PLOS ONE reveals.

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The work was based on testing of 70 volunteers, with the Flinders ophthalmology and medical device research institute experts taking a novel approach with optical coherence tomography (OCT), a device already available in most optometric and all ophthalmic practices.

“Our work uses the OCT and finds irregularities at this scale that correlate with the size of the eye, and therefore the degree of myopia,” says eye specialist Dr. Stewart Lake, from Flinders University.

“This may help monitor, measure, and explore the effects of myopia and how it leads to vision loss,” he says, adding that further development could make the system suitable for use in regular clinical practice.

Prior research elsewhere with MRI scanning has demonstrated large scale irregularities in the eyeball in highly myopic eyes.

OCT can sample the shape of the eye on a much smaller scale than MRI. The OCT testing will be far cheaper, is more readily available and repeatable as a test, researchers say in the article.

Myopia (short or near-sightedness) is for many an inconvenience requiring glasses or contact lens to correct. However, globally it is an epidemic and a major cause of vision loss and sometimes blindness.

Myopia is defined practically by the strength of lens required to correct eyesight. It was already known that myopia relates strongly to the size/length of the eyeball.

Global estimates forecast up to 5 billion people will have myopia and 1 billion people could suffer with high myopia by 2050, placing a significant burden on health systems to manage and prevent myopia-related ocular complications and vision loss.

This seven-fold increase, between 2000 and 2050, would make myopia the leading cause of permanent blindness worldwide.

High myopia increases the risk of pathological ocular changes such as cataract, glaucoma, retinal detachment and myopic macular degeneration, all of which cause irreversible vision loss

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Prevent Blindness Promotes Glaucoma Awareness This Month

More than 3.2 million Americans ages 40 and over have the condition.

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(PRESS RELEASE) CHICAGO – According to estimates from the Prevent Blindness report “Future of Vision: Forecasting the Prevalence and Costs of Vision Problems,” more than 3.2 million Americans ages 40 and over have glaucoma in the year 2020. The number is expected to increase as the population ages. Glaucoma, often referred to as the “the sneak thief of sight,” is a leading cause of vision loss that damages the optic nerve. Although symptoms may not be noticeable at first, glaucoma slowly diminishes peripheral vision, making activities such as driving increasingly difficult.

January is National Glaucoma Awareness Month and Prevent Blindness, the nation’s oldest volunteer eye health and safety nonprofit organization, seeks to educate the public on the disease, including risk factors, types of glaucoma, treatment options and more. Prevent Blindness offers a dedicated web page providing patients and their caregivers with free information at https://www.preventblindness.org/glaucoma or its online resource, Living Well with Low Vision at https://lowvision.preventblindness.org.

More women than men have glaucoma. Risk factors for glaucoma also include:

  • Age – The older you are, the greater you are at risk (especially those more than 60 years old).
  • Race – African-Americans age 40 and over are 4-5 times more likely to have glaucoma than others. Hispanics are also at increased risk for glaucoma as they age. Those of Asian and Native American descent are at increased risk for angle closure glaucoma.
  • Family History – If you have a direct relative with glaucoma, you are more likely to get glaucoma. If you are diagnosed with glaucoma, strongly encourage your family members to get complete eye exams.
  • Medical History – You are at higher risk if you have a history of high pressure in the eyes, previous eye injury, long term steroid use, or are farsighted or nearsighted.

The American Academy of Ophthalmology (AAO) also states that those with diabetes, migraines, high blood pressure, poor blood circulation or other health problems affecting the whole body are at increased risk of glaucoma.

“The year 2020 is an ideal reminder for all of us to make the resolution today to save our vision for tomorrow,” said Jeff Todd, president and CEO of Prevent Blindness. “By detecting vision problems and treating them early, including those from glaucoma, we can help to avoid significant vision impairment.”

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