Glasses that adjust focus.

The New York Times (8/5, D3, Markoff) reports that applied physicist Stephen Kurtin, PhD, has invented eyeglasses that "he believes can free nearly two billion people around the world from bifocals, trifocals, and progressive lenses." The eyeglasses "have a tiny adjustable slider on the bridge of the frame that makes it possible to focus alternately on the page of a book, a computer screen, or a mountain range in the distance." Kurtin "has succeeded in creating glasses with a mechanically adjustable focus," which "he says...are better than other glasses and some forms of LASIK surgery." Just "this month, TruFocals, the company he founded three years ago, has begun selling its first adjustable focusing eyeglasses through a small group of optometrists and will soon sell directly online." The "first to become commercially available" in the US, the TruFocal eyeglasses will "sell for $895." They "consist of a lens that is comparable in thickness to that of commercial eyeglasses."

Eye drops with nerve growth factor may help glaucoma

Following a Canadian Press story, HealthDay (8/4, Mozes) reported that, according to a study published online Aug. 3 in the Proceedings of the National Academy of Science, researchers from Italy's University of Rome "found that the topical use of nerve growth factor" in eye drops "spares retinal ganglion cells from nerve damage caused by the build-up of eye pressure associated with glaucoma." Focusing "on using nerve growth factor in eye drops to treat dozens of rats in whom glaucoma was induced," the team "documented a significant drop in the rate of retinal cell death." Next, the investigators "tested the nerve growth factor eye drops on three patients with advanced glaucoma." Not only did "the vision of two of the patients actually" improve "and the vision of the third patient" stabilize, but "the observed improvements in visual field, optic nerve function, contrast sensitivity and visual acuity remained in place 18 months after the first eye drops were administered," the authors said. (courtesy AOA)

Eye exams can detect disease in other parts of the body.

We are not talking about iridology. The condition of the eyes can be a great indicator of overall health.

The UK's Daily Mail (8/4, Lambert) reports that "research from the" UK's "College of Optometrists suggests that a quarter of adults have gone for more than two years without having their eyes examined, while 18 percent have left it more than three years." Putting off an eye examination may be risky, since "optometrists are trained not just to pick up vision defects, but also to spot symptoms in the eye that are a sign of a dozen serious diseases elsewhere" in the body. The article goes on to detail the experience of five patients ranging in age from 23 to 72 whose optometrists discovered ulcerative colitis, pilocytic astrocytoma, myasthenia gravis, type 1 diabetes, and dangerously high blood pressure during routine eye examinations.
Survey suggests nearly two-thirds of children under six have never had an eye examination. HealthDay (8/3, Preidt) reported that, according to a survey conducted by Prevent Blindness America and VSP Vision Care, "more than 20 percent of kids aged 12 to 17 have trouble seeing the classroom chalkboard." Specifically, "of the nearly 1,500 children in the survey, more than 25 percent of the teen age group complained of headaches, even though 45 percent of them wore some type of prescription eyewear." Approximately "25 percent of children aged six to 11 wear prescription glasses." Children's eye problems also increased with age, with myopia being "the most common vision problem in older children." Notably, the survey indicated that "more than 66 percent of those under the age of six have never had their eyes examined by an eye doctor." Prevent Blindness America urged parents to have their children's "vision checked regularly." (courtesy AOA)

Repurposing a Glaucoma Medication

In the New York Times (8/2, MM15) Consumed column, Rob Walker discussed advertising claims made by the eyelash-enhancing drug Latisse [bimatoprost], "a recent offering from Allergan, the company best known for Botox [botulinum toxin type A], its physician-administered cosmetic-injection product." The Times noted that "during clinical testing of a glaucoma medication called Lumigan [bimatoprost ophthalmic], Allergan's researchers noted a side effect: eyelash growth." So, "recognizing the market potential for such a thing, the company conducted a new safety-and-efficacy study, this time making the former side effect the main focus, explained Robert Grant, the president of Allergan Medical, the company's aesthetic-products division." In December, 2008, "the Food and Drug Administration gave Allergan clearance for this new use." In advertisements, "Allergan isn't making a disease-related claim about Latisse, but rather positioning it, like Botox, as part of what the company calls a 'science of rejuvenation.'"

FDA discussed no-rub contact lens solutions

From "Off-the-cuff" by Art Epstein OD: In mid-May, the FDA sent a letter to manufacturers who have marketing clearance for no-rub multipurpose contact lens solutions. The letter expressed apparent FDA concerns with “no-rub” solutions, and was ostensibly based on “the discussion and recommendation of the Ophthalmic Devices Panel Advisory Committee”. I attended that advisory panel meeting and what the FDA reports and what I observed were considerably different.

The letter explains that the FDA Center for Devices and Radiological Health (CDRH) worked with “the Centers for Disease Control and Prevention (CDC) twice in the past two years concerning outbreaks of rare corneal pathogens associated with use of specific “no-rub” contact lens multipurpose solutions”. However, as you will read in the next paragraph, despite the apparently intentional emphasis, the products' “no-rub” approval had nothing to do with the outbreaks—at least not according to the US CDC.

As a clinician, I found the presentation by Jennifer Rabke Verani, MD, MPH, who represented the CDC, the most intriguing part of the panel meeting. Dr. Verani reported that patient hygiene, including rubbing and rinsing or even hand washing, played no role in either the Fusarium or Acanthamoeba outbreaks. The CDC concluded that both outbreaks were due to insufficient anti-microbial efficacy and were not associated with the lack of rubbing and rinsing by patients. These important conclusions appear to have been ignored by the FDA.

According to the FDA, the Advisory Committee concluded “that there is improvement in lens care when using a “rub-and-rinse” regimen as compared to a “rinse alone” regimen”. This is because “rub-and-rinse” regimens help prevent microbial adhesion to the contact lens, help prevent formation of biofilms, and generally reduce the microbial load on the lens and the lens case”. I would agree that rubbing likely results in cleaner lenses, but the FDA's broad generalizations are neither totally accurate nor scientifically sound. Despite the long held belief that rubbing reduces infection risk, we still lack the clinical or scientific evidence to prove it.

Panel member Dr. Tim McMahon, perhaps recognizing the potential safety net provided by an advanced no-rub formulation, recommended supporting no-rub labeling, provided products could meet the same stringent antimicrobial requirements necessary for rub products. To my recollection, the panel agreed with Tim.

The direction the FDA appears too be taking is worrisome. We don't fully know what constitutes an infectious load on a contact lens or what co-factors predispose a cornea to infection. Likewise, disregarding statistically valid conclusions from two in-depth epidemiological investigations is inexplicable. If the FDA intends to promulgate new rules to help safeguard contact lens wearers, at the very least, new regulations should be based on science rather than on dogma or regulatory agenda.