Glaucoma

[Ms. Kathy]

Glaucoma is irreversible
Source Link: Kuensel Newspaper www.kuenselonline.com/modules.php?name=News&file=article&sid=8431

11 May, 2007 - The Thimphu National Referral Hospital treats about four cases of glaucoma every day, the third leading cause of blindness in the world.


[Photo at this link: www.kuenselonline.com/newspic07/07may9eye.jpg

Caption: A close up of an infected eye
And unlike cataract, glaucoma is irreversible.

According to eye specialists a high pressure in the eye, like blood pressure, results in glaucoma. When the pressure is more than 20mm of mercury then it was labeled as glaucoma.

When damage to the optic nerve fibers occurs, blind spots develop which usually go undetected until the optic nerve is significantly damaged resulting in blindness.

Blurred vision, severe eye pain, headache, rainbow coloured halos around lights, nausea and vomiting are the symptoms of glaucoma.

Tashi Zam, from Paro lost her right eye last year because of glaucoma. Her eye was removed after surgery. “All of a sudden, I started having severe pain in the eye, headache and couldn’t see anything,” she recalls.

Eye specialists explained that a clear liquid called the aqueous humor circulates inside the front portion of the eye. A small amount of fluid is produced constantly while an equal amount flows out of the eye through a microscopic drainage system to maintain a healthy level of pressure within the eye.

When the drainage area for the aqueous humor called the drainage angle is blocked, excess fluid cannot flow out of the eye. Fluid pressure within the eye increases, pushing against the optic nerve, which results in blindness.

There are two types of glaucoma, chronic open-angle glaucoma and closed-angle glaucoma. Doctors said that the open-angle glaucoma was more common since the symptoms appeared gradually.

“Since glaucoma cannot be reversed, eyedrops, laser surgery and surgery in the operating room are used to prevent further damage,” said an eye specialist.

The most important risk factors that could lead to glaucoma are age, family history of glaucoma, far sightedness or near sightedness, past eye injuries, systematic health problems including migraine headaches and diabetics, among others.

Eye specialists said that it was very important for people suffering from glaucoma to follow-up their medication, failing which could result in further complications.

There have been cases where infants suffer from glaucoma from birth but the risk of developing chronic open-angle glaucoma increases with age, which occurs mostly in adults beyond 40 years. “We check the eye pressure of all the patients above 40-years although the symptoms don’t develop,” said the eye specialist.

According to the World Health Organisation, Africans are more prone to chronic open-angle glaucoma and the disease is responsible for 15 percent of blindness worldwide.

By Kinga Dema
[e-mail]

[Ms. Kathy]

New Products Help Eyelash Growth
Source Link: ABC7/KGO-TV/DT SanFrancisco

May 14 - KGO - Remarkable advances have been made to improve our looks -- including lasers for skin resurfacing and Botox to prevent wrinkles. Now there may be something to enhance eye lashes. New eyelash products may actually help grow lashes, and it all started as side-effects from common prescription drugs.

Eyelashes have become one of the hottest trends in cosmetics, the longer and thicker-the better.

Carrie Maher, Eyelash Extensions Client: "Today I'm getting eyelash extensions because I like the way they look."

Eyelash extensions involve individual lashes glued one-by-one above the base of each lash. The cost: $300 dollars for the first session and fifty dollars every two weeks for a touch-up. Although the price is steep, business is booming.

Helen Woo, Aesthetician: "They look very, very natural, but besides that the eyes look bigger and the lashes look lots longer and it looks really beautiful."

But instead of gluing on lashes - fascinating new research suggests we may be able to "grow" our own long lashes. Surprisingly, it all started with these three glaucoma drugs - called prostaglandin analogs. These new treatments for glaucoma have an added benefit.

Andrew Iwach, M.D., Ophthalmologist: "All three of these can make eyelashes grow in certain patients."

Some doctors are even telling patients to put a drop of one of these glaucoma drugs on a cue tip and apply it to the base of their lashes to stimulate lash growth.

But San Francisco glaucoma specialist Dr. Andrew Iwach says these are drugs meant to be put into the eye and warns they have one very serious side-effect.

Andrew Iwach, M.D: "In some patients there can be a change in the color of the iris."

That's right, the iris color can actually darken or even change - especially in hazel eyes and the change is permanent.

It didn't take long for marketers to come up with seemingly less risky eyelash products that are applied topically - like eyeliner. So far there are two different brands - one even lists an ingredient very close to a prostaglandin analog compound. The other boldly claims to grow lashes. they're expensive at about $160 a tube, but they still cost less than $300 dollar eyelash extensions..."if" they work.

Pam Ferrell, a Corte Madera skin care specialist, was skeptical so she used herself as a guinea pig.

Pam Ferrell, Aesthetician: After about five weeks, I was really quite surprised, I noticed that when I used an eyelash curler that my lashes were extending beyond the silver bar in the eyelash curler. My lashes grew, I think about a quarter of an inch beyond the eyelash curler."

One of her clients, Joanne Cooper, tried it on her short, thin lashes applying it along the base of her lashes each night.

Joanne Cooper, Eyelash Eyelash Enhancer User: "In about a month, my eyelashes were getting so long that they were hitting my glasses when I was wearing my glasses, so it works.

Kim Nguyen tried it on her very thin lashes.

Kim Nguyen, Eyelash Enhancer User: "After a good 6 weeks my lashes all really full and nice looking, you know - with a little mascara on - it's perfect."

Heather Cooper tried the lash grower after she spontaneously lost half her lashes.

Heather Cooper Eyelash Enhancer User: I woke up and I had missing eyelashes exactly on the same a whole patch on both eyes.

Almost immediately after using the lash product, she says her lashes grew back longer than before. Amazing claims that may be true, but so far there is no real research to show safety or efficacy of either of these products so check with your eye doctor first.

To learn more about enhancing eye lashes, click here.: abclocal.go.com/kgo/story?section=drive_to_discover&id=5304948

[Ms. Kathy]

Rates of Glaucoma Medication Utilization Among Older Adults with Suspected Glaucoma, 1992 to 2002
Source Link: MDLinx.com--OphthoLinx Medical News www.mdlinx.com/OphthoLinx/xml-article.cfm/1837966

Joshua D. Stein, et al. - To determine rates of glaucoma medication utilization among glaucoma suspects in the Medicare Current Beneficiary Survey (MCBS) and identify recent utilization patterns for various hypotensive drug classes...Conclusion: This study identifies recent changes in patterns of glaucoma suspects’ use of hypotensive medications by using patient-reported information, thus avoiding reliance on third-party databases. Such trends over time are important to recognize, because they reflect variations in patient care and have economic and clinical implications [more. at www.mdlinx.com/readArticle.cfm?art_id=1837966].
American Journal of Ophthalmology, 05/14/07

[Ms. Kathy]

Glaucoma
New technologies may help in the early detection of glaucoma

Breaking News 5/16/2007

PARIS — New functional and structural tests can allow an earlier and more accurate diagnosis of glaucoma, helping prevent the silent progression of undetected glaucomatous damage, according to a specialist speaking here at the French Society of Ophthalmology annual meeting.

"We can now go beyond the limitations of standard automated perimetry and use more sensitive, sophisticated technologies," said E. Bluwol, MD, of the Hôpital Saint-Antoine, Paris.

Dr. Bluwol and colleagues conducted a prospective study including 84 patients with ocular hypertension and 51 patients with preperimetric glaucoma. In all cases, investigators performed Humphrey Matrix frequency doubling technology perimetry (Carl Zeiss Meditec), blue-yellow perimetry and retinal nerve fibers analysis with GDx VCC scanning laser perimetry (Carl Zeiss Meditec).

"Blue-yellow perimetry and FDT Matrix allowed an early differentiation between ocular hypertension and preperimetric glaucoma. The association with GDx VCC increased their diagnostic sensitivity. On the other hand, the association of FDT Matrix and GDx seemed to be the most effective in the early diagnosis of ocular hypertension," Dr. Bluwol said.

Measuring corneal hysteresis using the Reichert Ocular Response Analyzer can also provide useful diagnostic data for the early detection of glaucoma, according to a study presented by N. Fayol, MD, of the Fondation Rothschild, Paris.

"We have compared the corneal hysteresis and corneal pachymetry data of 192 normal eyes, 43 ocular hypertension eyes and 119 glaucoma eyes," he said. "We have found that corneal hysteresis was significantly different in the three groups. It was lower in the eyes with ocular hypertension and even [lower] in glaucomatous eyes than in normal eyes. Pachymetry data were not equally significant in discriminating between the three groups."

Source Link: OSN SuperSite www.osnsupersite.com/view.asp?rID=21920

[Ms. Kathy]

Israeli company develops new technology able to make complex eye-surgery commonplace

24 Sep 2007
An Israeli specialist in complex eye surgery for glaucoma patients has developed a new laser technology that promises to transform the difficult and rarely done surgery into a commonplace procedure that can be carried out by regular eye surgeons all over the world.

By Karin Kloosterman Israel 21C

Glaucoma, like hearing loss, is one of those terrible inevitabilities of ageing. Nicknamed "the silent sight thief", glaucoma is the second leading cause of blindness in the US, afflicting an estimated three million Americans aged 40 and over. Over 15 million more are at risk - especially those of African and Mexican-American descent.

There is no easy cure for the condition; current medical and surgical treatments are either risky or inadequate. But a breakthrough treatment for glaucoma may be waiting at the end of the tunnel, courtesy of Israeli startup IOPtima.

The company's technology comes in the form of a laser known as the OT134, a medical device based on carbon dioxide laser technology - similar to laser technology used on the skin.

According to its developers, the OT134 device enables an eye surgeon with little expertise to easily operate on the eyes of a glaucoma patient, making the formerly complex operation as simple as going for a cataract operation.

While eye surgeons today are using laser treatment extensively, they apply it to correcting vision and not for treating physical abnormalities of the eye, explains IOPtima's CEO Joshua Degani.

"Our application for treating the envelope of the eye itself is very original," he told ISRAEL21c.

The idea of a carbon dioxide laser for treating glaucoma was originally devised by Prof. Ehud Assia, a professor at the Sackler Faculty of Medicine at Tel Aviv University, and director of the Ophthalmology Department at the Meir Medical Center in Kfar Saba.

Glaucoma is caused by excessive pressure in the eye, often brought on with age. The clear liquid that bathes the eye's optic nerves flows through a meshwork, like a drain, in order to pass out of the eye. But as we get older, the fluid gets clogged in the meshwork and a pressure builds up. It can be so strong that it presses on the optic nerve causing extensive damage over time.
Only a small percentage of eye surgeons around the world have obtained the painstaking know-how required to relieve pressure from the eye with a surgical approach. The most efficient surgical technique is known as Trabeculectomy Non-Penetrating Deep Sclerectomy (TNPDS).

And Assia is one of the few eye surgeons in the world who can perform the procedure. It requires a surgeon to scrape off a thin layer of the wall of the eye, leaving only a razor thin layer (5%) intact. This layer has to be thin enough for the excess liquid to drain out of the eye and thick enough that the eye remains protected.

Performing such a surgery is like balancing on a tightrope: It is both difficult and extremely risky if something should go wrong. Eyes collapse, infections, cataract formations and more. That is why few choose to operate and opt to prescribe a long-term, but less-effective, drug alternative instead.

That's where IOPtima's lasers come in. Assia's device will make it possible for eye-surgeons everywhere to become instant experts in a surgical technique that was once performed by a select few. It enables surgeons who aren't trained in performing TSPDS to perform the procedure with ease.

Using the IOPtima device, the laser switches off the moment before the eye membrane is perforated - at exactly the same time when the liquid is able to pass through the membrane, but when the membrane is thick enough to keep the eye protected.

"It occurred to me that this would be a perfect fit for non-penetrating surgery, because the moment the CO2 laser came in contact with the intra-ocular liquid of the eye it would automatically shut off, and therefore prevent any serious damage," says Assia.

After having his 'Eureka' moment, Assia developed the device and then took it to the boardroom, where he partnered with Bio-Light Life Science Investments to form IOPtima.

Now the company's chief scientist, Assia and his team have conducted successful pre-clinical trials on 23 human patients in Israel. The initial results have been the talk of the town among eye surgeons worldwide, and some are using their clout to help organize human clinical trials in the United States, Canada and Europe. Among the collaborators are Prof. Mark Sherwoods from the University of Florida, as well Prof. Graham Trope from the University of Toronto.

On a more local level, IOPtima has consulted with such Israeli experts as medical laser specialist Prof. Abraham Katzir from the School of Physics and Astronomy at Tel Aviv University.

"Our system offers better efficacy and safety advantages, as well as the risk of far fewer complications over traditional drug and surgery therapies for glaucoma," says CEO Degani, who brings with him personal insight on laser technology through extensive work in the field and a PhD in the area from Jerusalem's Hebrew University.

Healthcare providers are likely to also welcome the IOPtima treatment. Medication against glaucoma amounts to $2-3 billion spent globally each year; it often fails because of low patient compliance and because in many cases it has limited long-term efficacy.

IOPtima's treatment will also open up possibilities for glaucoma surgery not only in the US but in developing countries as well, especially where the costly prolonged treatments of eye drops are not possible.

"For them, yes, this would be a major achievement," said Degani. "I think that the nicest thing about this is that it is going to make eye surgeries an appealing procedure both for patients and eye surgeons.

"In the past it was very difficult for eye surgeons to conduct such a surgery, and with great risks. Our laser will make it easy for glaucoma surgery to be done in a fast, convenient, effective and safe way."
Source Link: Israel Ministry of Foreign Affairs www.mfa.gov.il/MFA/Israel+beyond+politics/Israeli+company+develops+new++technology++that+makes+complex+eye-surgery+commonplace+24-Sep-2007.htm

[Ms. Kathy]

Glaucoma Research Foundation Earns Better Business Bureau Seal Of Approval04 Oct 2007

Glaucoma Research Foundation, a nonprofit organization dedicated to finding a cure for glaucoma, announced that it has met the Standards for Charity Accountability of the Better Business Bureau (BBB). As a result, GRF has earned the right to feature the BBB Wise Giving Alliance Seal on its website and printed materials.

"At GRF, we believe strongly in organizational transparency," said President and CEO Thomas M. Brunner. "We are proud to display the Better Business Bureau seal to let our donors and the community know we meet these rigorous standards of charity accountability."

The Standards for Charity Accountability were developed to assist donors in making informed giving decisions and to encourage public confidence in nonprofit organizations. To display the seal, an organization must qualify by completing a comprehensive evaluation by the BBB Wise Giving Alliance, the nation's most experienced charity evaluator. GRF's finances, governance, effectiveness, solicitations, and informational materials were all carefully reviewed as part of the evaluation process.

"GRF's historically demonstrated financial prudence, combined with thoughtful governance, has earned recognition from the nation's leading and toughest monitor of non-profit giving," said Brunner. "We want our donors to know, so we are proudly displaying the BBB Wise Giving Alliance seal on the home page of our website."

www.glaucoma.org
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Article URL: www.medicalnewstoday.com/articles/84592.php

[Ms. Kathy]

Mother vows to fight abuse, drug charges
Brad Williams, [e-mail]
Source Link:Knoxville News Sentinel www.knoxnews.com/news/2007/nov/05/mother-vows-fight-abuse-drug-charges/
Monday, November 5, 2007

Clay Owen

Suzette Evans and her son Jesse Johnson, 15, are shown in their home in Rutledge. Evans, who has used marijuana medicinally to fight a rare form of glaucoma, is waging a battle with authorities in Rutledge and Grainger County. [Photo Link: media.knoxnews.com/kns/content/img/photos/2007/11/04/1105pot1_t220.jpg]


Young scientist at ORNL gets presidential award
Forestry crews continue to monitor wildfire in Blount County
Creek and Y-12's relationship still flows
If Suzette Evans lived in North Carolina, where marijuana possession is decriminalized, it's unlikely she'd have gotten more than a $50 citation when police found a pipe in her home.

In Grainger County, however, like most of Tennessee, possession of a marijuana pipe can cost nearly $1,000 - and your children.

Evans' 15-year-old son was taken away from her the night of Aug. 10, to remain in protective custody for 34 days. They are reunited now, after a special meeting with the Department of Children's Services, but a hearing set for Nov. 16 will determine whether Evans' medicinal use of marijuana constitutes child abuse, neglect or endangerment.

"I have narrow-angle glaucoma," Evans said. It is a rare condition even among those with glaucoma.

Though Evans admits she recreationally used marijuana when she was younger, she says she resumed smoking small amounts to help her eyes.

"I come from an old hippie family," Evans said. "Do I agree with the abuse? No."

Allen St. Pierre, executive director of the National Organization for the Reform of Marijuana Laws, said uncontested medical research dating far back has shown that marijuana smoking reduces intraocular pressure with the first inhale to combat glaucoma, one of a number of illnesses marijuana is used to treat.

St. Pierre said a man in 1976 successfully sued the government to get medical marijuana.

"The disparity of how marijuana is treated in our society is terrific," St. Pierre said. "Twelve (states) have actually decriminalized the possession of marijuana," usually less than 1 ounce. Marijuana can be legally medically used in 12 states as well.

"Tennessee is a state which has no accommodations for people who use cannabis for medical purposes or nonmedical purposes," St. Pierre said. "The Southeast Untied States really yields no quarter to marijuana smokers."

He said in California, for example, people can medically smoke marijuana on the street in accordance with state law.

"It's night and day between what's happening in eastern Tennessee and the entire Western United States," he said. "This woman is a victim of geography."

Evans has produced medical records showing she is being treated for narrow-angle glaucoma. The records show a decrease to an all-time low intraocular pressure during the time she says she was using cannabis, and an increase after she quit using it.

She quit when Rutledge police officer Adam Morgan found her pipe July 24 during a search Evans consented to. No marijuana was found.

Evans said her son did not know she used marijuana until her pipe was found, and he had not been exposed to it.

She had a court date set for the charge, and thought that was the end of the matter.

On Aug. 10, Evans and her son, Jesse Johnson, got into an argument and Evans called the police, as she had done before.

"My son has a history of mental, emotional and behavioral problems. He has been in treatment since the age of 7," Evans said. She said they've had arguments before and she's called the police.

"They've always been courteous, professional … (they've) handled us with great respect," Evans said of the Rutledge Police Department.

Officer Richard McGinnis responded to her call on Aug. 10 and took her son into protective custody. Evans and her son allege that he began asking Jesse questions only about Evans' use of marijuana.

"All of it" was because of the standing marijuana charge, Evans said. "That officer knew that I had not been sentenced yet."

The charge against her now is child abuse and child neglect or endangerment, for admitting to smoking marijuana in her home, which the warrant says "exposed her 15-year-old son to illegal drugs."

"If the mother is using marijuana in front of the child, does the child have accessibility to the illegal drug, too?" McGinnis said.

McGinnis said at the time he took Johnson into protective custody, he had no knowledge of the marijuana charge, that he made the decision because of the nature of the domestic dispute. He said there were other factors in the case which he could not yet comment on. He also made the decision because the police chief had been out to the house the previous night.

"I thought there needed to be a separation between the two individuals," he said. "(Evans) was irrational, would not speak with me."

DCS took action from there, and the formal charge was decided later.

Evans said she will fight back in civil court over a host of issues and is thinking of starting her own National Organization for the Reform of Marijuana Laws chapter, since the only two in Tennessee are university affiliated. In the meantime, she says she is no longer smoking or receiving other glaucoma treatments, because of concerns about side effects.

"I have stopped all conventional treatment … for this rare form of glaucoma, and I realize I'm jeopardizing my quality of life. But if that's what I have to do to make a stand, (I will)," she said.

She also said she will not go to a state with medical-use laws.

"Why should I be forced to move from a state that I've lived in for 10 years?"

Brad Williams may be reached at 865-342-6432.

© 2007, Knoxville News Sentinel Co.

[Ms. Kathy]

Johnson Runs to Help Cancer Patients


Posted: 9:57 AM Nov 6, 2007
Last Updated: 10:03 AM Nov 6, 2007
Reporter: John Johnson
Email Address: [e-mail]
Source Link: WTOK News Meridian, Miss. www.wtok.com/news/headlines/11049211.html#


Three years ago, I received some distressing news from my doctor. I was told by my ophthalmologist at University Medical Center that I have glaucoma.
It can cause blindness, but can be treated.

Glaucoma runs in my family. My father had it. Although I have been healthy for most of my life, I decided to do more to maintain it and took up running.

I went to three people I know for help. They know about running. They know the health benefits and run with a purpose nearly every day.

Meridian physician, Dr. Ronnye Purvis, was willing to give me advice and training tips.

Since January, I have been training every day for a 26.2 mile marathon in Huntsville on Dec. 8. Mind you, I have never run more than the point 2 miles at best. But this effort is to raise money to raise funds to help families who are facing cancer.

Ironically, I didn't even like running. But making our area healthy for future generations is what I have been learning about.

Through a partnership between WTOK-TV, Jeff Anderson Regional Cancer Center and the Community Foundation of East Mississippi, you may support this effort by contributing to the Cancer Patient Benevolence Fund.

The Community Foundation notes that cancer patients face many challenges while undergoing treatment. Consider these expenses:

One hundred percent of your gift is tax deductible and will stay in our community to help cancer patients with special needs during their course of treatment. All patients are screened by a licensed social worker from Jeff Anderson Regional Cancer Center.

Picture link: media.graytvinc.com/images/john+running.JPG

[Ms. Kathy]

Glaucoma creeps up on more Americans
Source Link: USA Today rss.usatoday.mlogic3g.com/detail.jsp?key=783311&rc=ne

11/5/2007 2:20 AM
By Erin Evans, USA TODAY

(USA TODAY) -- It is called the "sneak thief of sight" for a reason: Years pass before patients notice vision loss an absence of symptoms while damage is done and sight is stolen with no way to get it back.

Glaucoma, the leading cause of preventable blindness, is an eye disease that silently causes vision loss by damaging the optic nerve, the main cable from the eye to the brain that gives people sight.

And if the forecasters are right, the level of vision lost to glaucoma among Americans is about to get much worse.

Glaucoma already affects 67 million people worldwide, but that number is projected to hit 80 million by 2020, says Harry Quigley, professor of ophthalmology at the Johns Hopkins University Wilmer Eye Institute in Baltimore.

"The disease increases exponentially with age," Quigley says. "It's not that the disease is getting worse, it's that people are living longer and are more likely to develop the disease."

Baby boomers, he says, will help drive the increase.

Several studies also have linked glaucoma to diabetes. However, Quigley says the association is often very weak, and although some diabetics have glaucoma, the risk factor is often secondary to age, family history and racial background.

Eye disease is a common complication for diabetics, but most often, they suffer from diabetic retinopathy, which involves progressive damage to the retina, the light-sensitive tissue at the back of the eye.

[Ms. Kathy]

Prostaglandins Generally Safe for Patients With Ocular Inflammation but Caution Should Be Used: Presented at AAO


"Prostaglandins Generally Safe for Patients With Ocular Inflammation but Caution Should Be Used: Presented at AAO"


By Earl R. Nichols NEW ORLEANS, LA -- November 13, 2007 -- Using prostaglandins to control glaucoma in patients with either uveitis or inflamed eyes appears to be safe with no increase in the number of new cases or recurrences of uveitis and apparently no reduction in the efficacy of the drug. These conclusions were presented here November 10 in a Glaucoma Subspecialty Day presentation at the annual meeting of the American Academy of Ophthalmology (AAO). However, caution should still be exercised in prescribing these drugs and perhaps they should be reserved for patients who do not respond to other antiglaucoma medications, attendees were told. According to presenter Simon Law, MD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, United States, prostaglandins are now the most widely used medications for treating glaucoma. However, there have been some questions as to whether they should be used in patients with various eye conditions that would affect the blood-aqueous barrier or the corneal surface. Some small case studies and retrospective studies have reported that prostaglandins could actually cause uveitis [de novo. It's thought that prostaglandins could also cause a recurrence in uveitis or even lose their efficacy in patients who have ocular inflammation.
However, Dr. Law said larger studies now appear to show minimal negative reactions when prostaglandins are used in most patients. For example, a study of 527 patients using latanoprost reported that among 13 patients who had inactive uveitis, there were 3 recurrences over a 10-month period. These inflammations were described as "trace amounts" and were treated with topical steroids. The patients even able to keep using latanoprost.

A smaller case study reported that 4 out of 5 eyes among patients using latanoprost had uveitic flares but that all of these patients had multiple risk factors.

"The association between the use of prostaglandins and either a disruption of the blood-aqueous barrier or the onset of uveitis is weak," said Dr. Law. "However, these drugs should still be used cautiously in patients with active uveitis."

At the same time, he said, there are conflicting reports as to whether the use of prostaglandins will influence postoperative inflammation. Some studies have suggested that there is a disruption of the blood-aqueous barrier while other studies have been less clear. Nonetheless, he advised caution when treating such patients.

"It has been suggested that the disruption of the blood-aqueous barrier is not directly mediated by the prostaglandin use, but by the synthesis of endogenous prostaglandins and other substances triggered by the exogenous prostaglandins." The inflammation and flares could also be caused by the preservatives in the eye drops, he added, noting that benzalkonium chloride is well known to cause hyperaemia, itching, and irritation in the eyes of glaucoma patients.

There are two caveats to using prostaglandins in the eyes of glaucoma patients with any kind of inflammation. These drugs should not be used in patients who have herpetic simplex keratitis, multiple risk factors for uveitis, or who have had recent eye surgery. In the latter case, studies have suggested that the risk of complications can be fairly high.

Dr. Law added that physicians should be aware that prostaglandin use in patients with existing uveitis could have a deleterious impact on the drug's intraocular pressure (IOP)-lowering capabilities. In some cases, the drugs may become totally ineffective.

"The IOP dynamic in an inflamed eye may involve the interaction of a number of altered pressure regulatory mechanisms. Although prostaglandins are effective in controlling IOP in general, their efficacy in eyes with active uveitis may be unpredictable," he said.

Physicians may want to exercise caution in prescribing prostaglandins for most patients with inflamed eyes and perhaps prostaglandin use should be reserved for patients who do not respond to other topical ocular hypotensive drugs or those who are not good candidates for IOP-lowering surgery.

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Source Link: www.docguide.com/news/content.nsf/news/852571020057CCF6852573920065D45A

[Ms. Kathy]

Glaucoma
Early phaco lowers IOP more than iridotomy in some glaucoma patients

Breaking News 11/12/2007


NEW ORLEANS — Performing early phaco on patients with acute primary angle-closure glaucoma unresponsive to medication resulted in lower IOP than with laser peripheral iridotomy, a study found.

The results, from a randomized trial of the two techniques, could be due to a lower response threshold for phaco in post-acute primary angle-closure glaucoma patients with cataract, Dexter Yu-lung Leung, MBChB, said at a free paper session at the annual American Academy of Ophthalmology meeting here.

"Further studies will be required to determine the optimal timing of phaco, which would be to reduce complications," Dr. Leung said.

Dr. Leung and colleagues found that at 18 months, the 3% rate of IOP rise for the phaco group was significantly lower than the laser peripheral iridotomy group, at 46.7% (P < .0001). An IOP of more than 55 mm Hg is also an added risk factor for further IOP rise, Dr. Leung said.

The study looked at 62 eyes of 62 subjects who had acute primary open angle-closure glaucoma. Glaucoma was aborted by topical and or systemic anti-glaucoma treatment, Dr. Leung said. Phaco, with IOL implantation of AcrySof (Alcon), was performed by a single surgeon under topical or peribulbar anesthesia, with a temporal 3.5 mm clear corneal incision, he said. Laser peripheral iridotomy was performed under topical anesthesia with a sequential Argon YAG technique.

---

Source Link: OSN Supersite www.osnsupersite.com/view.asp?rID=24742

[Ms. Kathy]

New Class of Drugs Might Treat Many Conditions
05.08.08, 8:00 PM ET
Source Link: www.forbes.com/forbeslife/health/feeds/hscout/2008/05/09/hscout615397.html

FRIDAY, May 9 (HealthDay News) -- A new class of drugs called vaptans may be able to treat a wide variety of conditions including painful periods, brain hemorrhage, psychotic disorders and glaucoma, Belgian researchers report.
Vaptans, short for vasopressin-receptor antagonists, work by targeting the vasopressin hormone system, which plays an important role in controlling blood and water volume in the body. These drugs, which can be taken orally or intravenously, block the action of vasopressin, according to the report in the May 10 issue of The Lancet.

In the report, Dr. Guy Decaux, from Erasmus University Hospital in Brussels, and his colleagues reviewed the current state of vaptans, of which there are several subclasses, that have been development or are under development.

Among these new drugs are relcovaptan, which has shown initial positive results in treating painful periods, as well as Raynaud's disease, which affects blood flow to the arms and legs, and tocolysis, (premature labor, leading to premature birth).

Another subclass of vaptans that include mozavaptan, lixivaptan, satavaptan and tolvaptan are diuretics, which remove water from the body, while maintaining the body's electrolyte, or salt mineral, balance. Other diuretics don't maintain the body's electrolyte balance, the researchers noted.

Some vaptans can be used to treat hyponatremia, which is a life-threatening loss of salt. Currently, conivaptan is the only vaptan approved by the U.S. Food and Drug Administration for treating hyponatremia.

Other vaptans in development might be used to treat kidney failure, diabetic nephropathy, a progressive kidney disease associated with diabetes, cirrhosis and depression, the researchers wrote.

In addition, early studies of vaptans for treating glaucoma, Menire's disease-- an inner ear condition affecting hearing and balance -- brain hemorrhage, and small-cell lung cancer, have had promising results, Decaux's team noted.

Despite these promising results, one expert isn't ready to called vaptans a miracle cure yet.

"This is nice review of an emerging class of drugs," said Dr. Gary S. Francis, director of the coronary intensive care unit at the Cleveland Clinic. "But it is a little early to know if they will prove to be highly useful."

More information

For more on conivaptan, visit the U.S. Food and Drug Administration