Atropine: Reducing Nearsightedness in Children

Nearsightedness is becoming more common in children all around the world. In China as many as 80 percent of the children are nearsighted, according to a National Public Radio article. A report presented at the American Academy of Ophthalmology annual meeting in Las Vegas last month reported drops of atropine helped reduce nearsightedness in children.

Atropine, a toxin found in deadly nightshade and jimsonweed, was used as far back as the 19th and early 20th centuries. Because larger pupils were considered attractive, French women would add atropine to their eyes to dilate their pupils. Later it was used to treat amblyopia, or lazy eye, because it blurs vision therefore forcing a weaker eye to work harder, according to NPR.

Doctors began to research the effects of atropine on nearsightedness in the 1990s. Although it is not entirely clear how atropine works, a hypothesis suggests atropine helps hinder the growth of elongated eyeballs that cause nearsightedness. In Asian countries, myopic children are prescribed a one-percent solution of atropine eyedrops, according to NPR.

eyedropsBecause atropine dilates the pupils and blurs vision, it comes with its own set of side effects. People who use atropine drops might have a hard time seeing up close or being able to look at bright lights.

Dr. Donald Tan, a senior adviser at the Singapore National Eye Center, and his colleagues have researched atropine to better treat eye problems for more than three decades. “We realized, yeah, atropine does work, but we’ve got to reduce the dose so we can reduce some of these side effects,” he said. “Otherwise it will never be practical.”

Tan and a group of researchers gathered 400 nearsighted children in Singapore to test different doses of atropine in a five-year period. The atropine eyedrops were administered once a day for two years. Some people could experience a growth spurt in their eyes after using atropine. To account for this, Tan and the researchers monitored the patients for a year without the eyedrops. If a patient’s nearsightedness returned, he or she would have to use the low-dose atropine eyedrops for another year or two, according to NPR.

The patients who received the lowest dosage, 0.01 percent atropine eyedrops, showed the least worsening of nearsightedness. “We slowed the progression of myopia by 50 percent,” Tan said. Those patients also reported almost no uncomfortable side effects, according to NPR.

Approximately 40 percent of Americans are nearsighted, a low dose of atropine could reduce extreme nearsightedness that ultimately leads to retinal detachment of retinal degeneration. The Food and Drug Administration has only approved a one-percent solution of atropine.


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Smartphone Users Have At Least One Health App

A study published in the Journal of Medical Internet Research found a majority of smartphone users have at least one health app. However, more than half of the people surveyed no longer used their health apps, according to a DOTmed article. Privacy concerns, app costs or burdensome data were among the reasons why most people did not use the health apps.

Dustin Duncan, epidemiologist and the study’s senior investigator, and his colleagues conducted the study to understand health app usage and patterns in the United States to better improve population health. The study surveyed 1,604 adult smartphone users evenly split between male and female participants, according to DOTmed.

Of those surveyed, “42 percent had downloaded five or more health apps that were mostly related to fitness and nutrition,” according to DOTmed. The study also found the demographics that are more likely to use health apps on smartphones. healthapps

These demographics include people who are younger, have higher education, are wealthier, are Hispanic or are obese are more likely to use health apps. Of the people surveyed, 65 percent said they used health apps daily. Most participants believed the apps improved their health, and the majority of people believed in the accuracy of the health apps with high confidence, according to DOTmed.

As for reasons why most smartphone owners stop using health apps, cost is the top contributor. “For me the most surprising finding was the high percentage – 41 percent – that wouldn’t pay for a health app or stopped using them because of hidden costs,” said Dr. Duncan, who is also an assistant professor at New York University Langone Medical Center.

While Paul Krebs, co-author of the study and clinical psychologist, stated people might not use health apps because of the lack of physician recommendation. “Only 20 percent of respondents reported that a doctor ever recommended a health app to them,” he said. “This isn’t surprising since evidence for their effectiveness is still very poor. We need more good clinical trials of these apps.”

The researchers used the survey results to recommend suggestions to app developers that included more apps that are user-friendly and evidence-based, privacy features, availability and content people are willing to pay for. “We hope the results of the study will help developers to ultimately improve people’s health and increase customer satisfaction,” Dr. Krebs said.

Database Could Link Social Media to Medical Records

More than half of 5,000 patients in a new study were on Facebook or Twitter, and of those patients 71 percent were comfortable with doctors using their social media accounts as comparison to their health records, according to DOTmed HCB News.

The data compiled from researchers from the Perelman School of Medicine at the University of Pennsylvania was published in the journal BMJ Quality & Safety. The researchers used the data collected to build a language databank that could link social media content to health effects, according to DOTmed.

foodpost“We don’t often think of our social media content as data, but the language we use and the information we post may offer valuable insights into the relationship between our everyday lives and our health,” noted Dr. Raina M. Merchant, senior author of the study, director of the Social Media and Health Innovation Lab and assistant professor of Emergency Medicine at Penn Medicine.

The study involved volunteer emergency room patients and a language database comprised of more than 1.4 million Facebook posts and tweets as far back as 2009. The data, which contained more than 12 million words, helped researchers find correlations between online content and health, according to DOTmed.

The information gathered from the post varied with some posts specifically related to medical habits, such as “I forgot to take my water pill for my heart failure today.” Other posts just included photos of salty foods. The study also showed people who had a diagnosis recorded in their electronic medical record were more likely to use medical terms about their diagnosis on those posts.


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EyeCare America – No Out-of-Pocket Cost to Those Who Qualify

The Foundation of the American Academy of Ophthalmology can provide eye care at no out-of-pocket cost to people who qualify through its public service program EyeCare America. The program provides two main services through an online referral center. Referrals are given to United States citizens and legal residents who do not have an ophthalmologist. To receive a referral, you can not belong to an HMO or have eye care coverage through Veterans Administration, according to the AAO website.

examdoctorThe following two services are provided:

  • If you are 65 or older and have not seen an EyeMD in three or more years, you could receive a medical eye exam and up to one year of care for any disease condition during the initial exam at no out-of-pocket cost
    • Volunteer ophthalmologists waive co-payments, accepting Medicare and/or other insurance reimbursement as payment in full and patients without insurance receive this at no cost
  • If you are not eligible for the above option but are determined to have an increased risk for glaucoma (can be assessed through age, race and family history) and have not had an eye exam in more than a year, you could receive a free glaucoma eye exam if uninsured

EyeCare America only provides medical eye care. The programs does not cover hospital and surgical facility costs, anesthesiologists, medications and eye prescriptions or cost of glasses.

To see if you qualify for EyeCare America, visit the Online Referral Center.

To become a volunteer ophthalmologist or partner with the program, visit the AAO website.


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Ophthalmologists Say Vision Should Be Priority for Diabetics

Lose of sight is a common concern for people as they age, however ophthalmologists remind people that aging should not be the only concern. Having diabetes is a significant risk factor for developing eye diseases, and ophthalmologists say vision should be priority for diabetics, according to the American Academy of Ophthalmology.

To raise awareness about these risks during National Diabetes Month, the AAO is asking the 29 million American with diabetes to recognize their greater chances of having eye problems, like diabetic retinopathy, glaucoma and cataracts. Diabetic retinopathy is the No. 1 cause of vision loss for working age Americans, according to the National Eye Institute. More than 15 million Americans will be affected by 2050.

Ophthalmologists suggest a dilated eye exam can be the best first-line defense against loss of vision because of diabetic eye disease, according to AAO. Read the following tips about preventing and detecting diabetic eye disease.diabeticretinopathy

  • Early detection is key

“It’s very important for all people with diabetes to know that diabetes can affect their eyes,” said ophthalmologist Purnima S. Patel M.D. Diabetes affects the body by causing damage to small blood vessels. The back of the eye contains some of the smallest blood vessels that can bleed or leak fluid causing a decrease in vision or even blindness. Dr. Patel explains this is diabetic retinopathy. If this is detected early, there are ways to control it and prevent vision loss.

  • Comprehensive eye exam can detect diabetic eye disease

A comprehensive eye exam includes a dilated retinal exam with special microscopes and lenses is a diabetic retinopathy exam, according to retinal specialist Abdhish R. Bhavsar, M.D. An ophthalmologist would only need specialized instruments to see the retina in great detail. “The retina at the back of the eye is like the film in a camera, and it makes the picture and sends the signal to the brain,” he said.

  • The kind of diabetes you have determines what kind of diabetic eye exam you need

Adults with type 2 diabetes should have a comprehensive eye exam with dilation as soon as they are diagnosed and then at yearly intervals. Anyone with type 1 diabetes should have a dilated eye exam five years after being diagnosed and then at yearly intervals, according to ophthalmologist Gary Hirshfield, M.D.


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Good Diet in Early Adulthood Means Healthier Aging

A new study published in the journal Circulation found a good diet in early adulthood could mean healthier aging. The study published Oct. 26 found that young adults who ate more than five servings of fruits and vegetables a day had healthier hearts as they aged, according to the Orlando Sentinel.

healthy-fruits-and-vegetablesThe study included more than 2,500 adults divided into groups based on how many fruits and vegetables they ate. Researchers used CT scan 20 years later to examine heart health. Those young adults who ate the most fruit and vegetables were 26 percent less likely to have calcified plaque in their arteries. Calcified plaque is associated with the arteries hardening and increasing the chances of heart disease, according to the Orlando Sentinel.

Dr. Michael Miedema, the study’s author and senior consulting cardiologist and clinical investigator at the Minneapolis Heart Institute, said people should not wait until they are older to choose to eat healthier. “Our study suggests that what you eat as a young adult may be as important as what you eat as an older adult,” he said.

But, how is this different from anything you have read or heard before? This is the first study to demonstrate the benefits of eating more fruit and vegetables as a young adult by protecting the heart in later years. Previous research only found strong links between a good diet of fruits and vegetables and lower heart disease risk in middle-aged adults.

While the study may not prove directly how much fruits and vegetables you need for a ‘good diet,’ the results are a step forward. “Further research is needed to determine what other foods impact cardiovascular health in young adults,” Dr. Miedema said.


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Dry Eye Pharma Sales Growing to $1.6 Billion

More than 50 million people in the United States suffer from dry eye disease, and the occurrence is not ceasing, according to Ophthalmology Management. The pharmaceutical market for dry eye has seen year-over-year growth of more than six percent with estimated dry eye pharma sales growing to $1.6 billion based on global estimates. Ophthalmology practices considering adding more value to the practice should look to selling dry eye products, according to OM.dryeyeproducts

For almost 25 years, an assistant professor of clinical ophthalmology in the Department of Ophthalmology at Washington University School of Medicine in St. Louis has sold different products and medications to his patients at his practice. Gregg J. Berdy, MD, FACS, of Ophthalmology Associates currently sells dry eye products, such as supplements, eye masks and tears. Berdy said he increase the convenience for patients to buy products while also receiving a financial boost in the extra sales, according to OM.

Another doctor in Minnesota also stated the convenience patients have when they have everything available in one place. “The major reason we sell these was the overall confusion that our patients encountered in the marketplace trying to find products that met their needs,” said David R. Hardten, MD, of Minnesota Eye Consultants. His practice sells vitamins and hydrating and warming masks through its website.

However, there are challenges that arise from selling products in any practice. Knowledgeable staff and inventory management are examples of the challenges practices can face. These challenges can be resolved if the ophthalmologist is dedicated to her or his patients and fixing their dry eye problems. Rebecca Petris, owner of The Dry Eye Company, said, “Dry eye is a symptom disease, and managing day-to-day symptoms in moderate to severe cases is often extremely challenging for patients. Doctors who get this are more likely to understand the role of consumer devices.”


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Gene Therapy Shows Promise for Visually Impaired

Spark Therapeutics’ experimental gene therapy showed improved vision in patients with hereditary vision impairment. The company hopes to gain U.S. Food and Drug Administration approval to become first gene therapy to reach the United States market, according to the Wall Street Journal.

The Philadelphia-based biotechnology startup released the results of its clinical trial in a news release, however only included few details. These results seem to show promise from the safety concerns the gene therapy field has faced in previous years. In the late 1990s and early 2000s, gene therapy research came to halt because study participants developed cancer or died after receiving that kind of therapy.

Gene therapy includes injecting genetic material into a person’s cells to treat or prevent certain diseases, according to WSJ. Around the world, gene therapy is picking up. The European Commission approved the Uniqure NV’s Glybera, the western world’s first gene therapy. Glybera is used for the treatment of people with a rare enzyme deficiency.

peripheralvisionMutations in a gene known as RPE65 that cause visual impairments such as loss of night- and peripheral-vision to complete blindness are targeted through Spark’s gene therapy. SPK-RPE65, the name for Spark’s therapy, includes a copy of a functional RPE65 gene inside of a type of virus that is stripped of its viral DNA, according to the WSJ. The virus is only the delivery system for the gene when it is injected in the eyes.

The study contained 19 participants with confirmed RPE65 mutations and nine people who did not receive the gene therapy. Participants had to navigate through indoor obstacle courses with various levels of lighting. Researchers videotaped the participants through the course to track their outcomes, according to Spark Chief Executive Jeffrey D. Marrazzo. The functional vision in patients who received the therapy improved after a year of treatment in comparison to the control group. The patients who received the therapy also improved their sensitivity to light in comparison with the control group.

Although there were no serious side effects to the therapy, Spark noted side effects related to the injection of the therapy. Some participants experienced eye inflammation or elevated intraocular pressure, according to the WSJ.

Although the Spark results do not quantify measurable visual improvements in the participants, Debra Thompson, professor of ophthalmology and visual sciences at the University of Michigan’s Kellogg Eye Center, said the study appears to be significant. “Even small gains in visual function can make a huge difference in quality of life,” she said.


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Allergan, Pfizer and Merger Talks

It has been a busy month for Allergan, the global pharmaceutical company focused on eye care among other things. The company acquired AqueSys in an all-cash transaction earlier this month, according to a press release.

AqueSys, a glaucoma treatment company, specialized in developing surgical products to preserve vision for glaucoma patients. The acquisition included a $300 million up-front payment and potential regulatory approval and commercialization milestone payments for AqueSys’ Xen45, according to Ocular Surgery News. Xen45 is a minimally invasive implantable shunt that reduces intraocular pressure for glaucoma patients.allergan

“The acquisition of AqueSys and Xen45 is highly complementary to our leadership position in eye care and underscores our commitment to develop and commercialize treatments that advance care and add value for ophthalmologists and their patients,” said Brent Saunders, CEO and president of Allergan.

As for merger talks, Allergan confirmed it is in early talks with the American pharmaceutical company. If the deal is made, Pfizer could add dry eye treatment Restasis and AqueSys to its arsenal of products, according to the Wall Street Journal.


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Spanish University Launches Online Course in Refractive Surgery

A Spanish university launched the first worldwide online university course in refractive surgery this month. Miguel Hernández University, which is located in Alicante, Spain offers a comprehensive, 250-hour, one-year distance learning program that can lead to a university certificate, according to Ocular Surgery News.

“A very innovative approach to subspecialty area that is neglected by traditional residency curricula. An opportunity for young and less young ophthalmologists around the world to have access to a course of the highest academic standard without having to move or commute,” said Jorge L. Alió, MD, PhD, course director.

surgery2The course’s focus is refractive surgery. The course includes lessons on lens surgery, corneal surgery and cross-linking. It includes six modules instructed through videos for four hours a week in six months. The program is flexible, letting students enter, exit and re-enter the modules according to their own personal time and schedules. An assessment is required at the end of each module.

“The video tutorials are given by me personally, as they reflect our approach to refractive surgery, based on the hundreds of papers and books we have published and on our long and wide experience in the field,” Alió said.

The following six months students work under the supervision of a tutor on producing a paper on a topic relevant to the course that can be published. The tutor is someone with international reputation in the field. The faculty includes 34 tutors and two scientific advisors who consist of internationally recognized key opinion leaders in their respective subspecialties, Alió said.


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