Multiple Sclerosis and the Eye (Part 1), p. 77 January 15, 2012 REVIEW OF OPTOMETRY Part 1 of 2 www.revoptom.com ■ VOL. 149 NO. 1 ■ JANUARY 15, 2012 ■ ANNUAL DRY EYE REPORT ■ CONTACT LENSES ALSO INSIDE: Seeing the Future with Contact Lenses, p. 26 Injections: The Third Method of Drug Administration, p. 32 The Increasing Value of OCT Imaging, p. 42 Choroidal Melanoma is a Life Sentence, p. 48 FC_RO1111.indd 1 1/5/12 2:20 PM © 2012 Marchon Eyewear, Inc. Eyewear, Marchon © 2012 eye maKe a differenceTM Marchon Eyewear is proud to honor and support ordinary people who’ve made extraordinary differences in the world. Dr. Gerard D’Aversa (in style M-162) and his daughter, Jaclyn (in M-213), believe giving back is a family effort. Together, the father and daughter duo worked closely with Unite For Sight to organize a mission to Ghana, aligned with the organization’s mission of providing sight restoring care to people in impoverished nations. They conducted eye health screenings, supplied equipment and modern day technology to the doctors there and, most rewardingly, performed surgery that restored the gift of sight. DO YOU KNOW SOMEONE WHO MAKES A DIFFERENCE? Tell us their story at Marchon.com Marchon has made a donation to UniTe fOr SiGHT MA.11.JR21023.EMAD.Dr.indd 1 12/22/11 3:35 PM EXTREME © 2011 Flexon is patented and distributed exclusively by Marchon Eyewear, Inc. Style: FL 480 Style: Inc. by Marchon Eyewear, © 2011 Flexon is patented and distributed exclusively Flexibility Fit Comfort Quality Style EXTREME FRAME REQUIRED. FL.11.JR21023.optical.indd 1 12/20/11 4:42 PM News Review VOL. 149 NO. 1 ■ JANUARY 15, 2012 IN THE NEWS Drug Slows Metastasis Nanoparticles called dendrimers offer a novel route into the retina for Of Uveal Melanoma age-related macular degeneration and retinitis pigmentosa treatments, A drug approved for epilepsy can also slow the spread of according to new research. Investiga- these deadly eye tumors. By Michael Hoster, Senior Editor tors at the Mayo Clinic, Wayne State University and Johns Hopkins Medicine type of drug that is com- ences and professor of biology and found that steroids attached to the monly used to treat molecular oncology at Washington dendrimers target the damage-causing Aepileptic seizures may slow University School of Medicine cells associated with neuroinfl am- or prevent uveal melanoma from in St. Louis. “When we look at mation, preserving vision and leaving metastasizing to other parts of aggressive melanoma cells under the rest of the eye unaffected. The the body, according to a study in the microscope after treatment results appear in the January issue of the October 28 online version of with HDAC inhibitors, they look Biomaterials. Clinical Cancer Research. more like normal cells and less like The researchers determined that tumor cells.” The FDA has launched a monitor- FDA-approved anti-epileptic drugs Treatment with HDAC inhibi- ing program to prevent outbreaks of known as histone deacetylase tors may allow patients with such toxic anterior segment syndrome (HDAC) inhibitors alter the way aggressive melanomas to live for (TASS)—a rare but potentially seri- that the aggressive form of uveal many years without any detectable ous complication of cataract surgery. Photo: Mark T. Dunbar, O.D. metastasis, Dr. Harbour predicted. Working with the Centers for Dis- “Melanoma in general, and ease Control and Prevention and the uveal melanoma in particular, is American Academy of Ophthalmology, notoriously diffi cult to treat once the FDA has established a registry for it has metastasized and grown in a devices used in cataract surgery and a distant organ,” he added. “I sus- program for identifying and evaluating pect that the best role for HDAC suspected device contaminants. inhibitors will be to slow or prevent the growth of tumor cells Elderly patients who took the carot- that have spread out of the eye, enoid zeaxanthin showed improve- but cannot yet be detected. This ments in vision, according to results might lengthen the time between from the Zeaxanthin and Visual melanoma expresses its key genes. the original eye treatment and the Function Study, reported in the No- According to the researchers, appearance of detectable cancer in vember 2011 issue of Optometry. The uveal melanoma is very aggressive the liver and elsewhere.” study included 60 predominantly male and typically spreads from the eye In addition, HDAC inhibitors veterans who had mild-to-moderate to other bodily organs, such as the cause only relatively mild side AMD. They were randomized to receive liver. effects such as drowsiness, Dr. 8mg zeaxanthin, 8mg zeaxanthin plus “HDAC inhibitors appear to Harbour explained. 9mg lutein, or 9mg lutein for one year. reverse the aggressive molecular Clinical trials on patients with Researchers concluded that, indepen- signature that we had identifi ed metastatic uveal melanoma could dent of lutein, zeaxanthin contributed several years ago as a marker begin within the next six to 12 to improved vision in night driving, fi ne for metastatic death,” said lead months, he noted. detail and the disappearance of blind researcher J. William Harbour, Landreville S, Agapova OA, Matatall KA, et al. Histone spots. deacetylase inhibitors induce growth arrest and differentia- M.D., distinguished professor of tion in uveal melanoma. Clin Cancer Res. 2011 Oct 28. ophthalmology and visual sci- [Epub ahead of print] 4 REVIEW OF OPTOMETRY JANUARY 15, 2012 004_RO0112_News.indd 4 1/5/12 2:11 PM MFTTIBTOFWFSNFBOUNPSF $1,000 Trade-In Easiest To Use POBOZUPOPNFUFS USBEFEJO"VHVTUUP Smallest Footprint +BOVBSZ Lowest Price Less isNPSF 1VMTBJS%FTLUPQJTVODPNQMJDBUFEBOE UIFSFGPSFRVJDLUPVTFGPSUIFOPWJDF BOEQSPGFTTJPOBMBMJLF5BLJOHDPOUSPMPG UPOPNFUSZIBTOFWFSCFFOFBTJFSPSGBTUFS $MFBSVTFSDPOUSPMTBOEBDPMPSWJEFP BMJHONFOUTDSFFODPNCJOFUPTFUBOFX TUBOEBSEJOVTBCJMJUZ 5IF1VMTBJS%FTLUPQIBTBTNBMMBOETQBDF TBWJOHGPPUQSJOUUIBUDPNCJOFEXJUIUIF FMFHBOU TMJNPQUJDBMNBJOGSBNFBMMPXT JUUPCMFOETFBNMFTTMZJOUPUIFDMJOJDBM FOWJSPONFOU5IFPQFOOFTTPGUIFEFTJHO JODSFBTFTUIFDPOöEFODFPGCPUIQBUJFOU BOEDMJOJDJBO $POUBDU,FFMFSPSZPVSQSFGFSSFE,FFMFS The Keeler Family of Tonometers offers your practice EJTUSJCVUPSUPEBZUPMFBSONPSFBCPVUUIF 1VMTBJS%FTLUPQBOEUIFSFTUPGUIF,FFMFS the choice of technology that’s right for you! GBNJMZPGUPOPNFUFST (SFBU-PX1SJDF $6,250.00 Keeler K.A.TK AT. IntellelliPiPuPuff XXXLFFMFSVTBDPN] A HALMA COMPANY ,FFMFS*OTUSVNFOUT *ODt1BSLXBZt#SPPNBMM 1"t5FM t'BY tFNBJMLFFMFS!LFFMFSVTBDPN RO1111_Keeler.indd 1 10/31/11 2:16 PM News Review Myopia Treatments for Kids Come Up Short or Cause Side Effects urrent treatments to slow Photo: National Eye Institute–National Institutes of Health maceutical eye drops (fi ve of these the progression of myopia were of anti-muscarinic medica- Cin children either don’t tions). work or cause problematic side ef- • One study investigated new fects, according to a recent review lenses designed to reduce periph- published by pediatric eye doctors eral hyperopic defocus (i.e., lenses and study methodologists. that help to focus peripheral vision The reviewers analyzed data as well as central vision). from 23 randomized controlled • One study evaluated both trials, which included a total of multifocal lenses and pharmaceuti- 4,696 participants. They consid- cal eye drops. ered a number of potential myopia The follow-up period was at treatments including bifocal glass- least one year for all studies. es, eye drops, intraocular pressure- Of all methods of myopia inhibition, anti- Of all the treatments, anti- lowering drugs and contact lenses: muscarinic drops work the best, but their muscarinic eye drops offered the • Two studies investigated un- use is limited and causes side effects. largest positive effects for slowing dercorrection of myopia. myopia progression, the authors • 12 studies investigated mul- soft contact lenses (BSCLs). found, but they caused either light tifocal spectacles (progressive • Two studies investigated sensitivity or blurred near vision. addition lenses [PALs] or bifocal rigid gas permeable contact lenses Also, these drops are not yet com- spectacles). (RGPCLs). mercially available, so their use is • One study investigated bifocal • Six studies investigated phar- limited and impractical. PALs and bifocal spectacles were found to yield a small Eyes in the Back of Its Head slowing of myopia progression. Biologists at Tufts University were able to make tadpoles grow eyes on their backs and RGPCLs were found to have no tails by genetically manipulating the membrane voltage of cells in frog embryos. evidence of effect on myopic eye This new mechanism could have great potential in the formation of complex organs for growth, while undercorrection transplantation and regenerative medicine applications. of myopia was found to increase Photo: Sherry Aw, Ph.D. and Michael Levin, myopia progression slightly. Lastly, “other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses (BSCLs) with a distance center, are prom- ising but currently no published randomized clinical trials exist,” the authors concluded. An overview of the report is available at: http://onlinelibrary. wiley.com/doi/10.1002/14651858. CD004916.pub3/pdf/abstract. Walline JJ, Lindsley K, Vedula SS, et al. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2011 Dec 7;12:CD004916. 6 REVIEW OF OPTOMETRY JANUARY 15, 2012 004_RO0112_News.indd 6 1/5/12 2:14 PM RO0112_House Vision Source.indd 1 12/27/11 3:41 PM News Review New Online Tool Calculates