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April 2018

News in brief CLS WITH

News in brief CLS WITH BUILT-IN TELESCOPE An international collaboration of scientists has created a contact lens (CL) which can shift between magnified and normal vision. The lens, which increases peripheral vision three-fold, is safer and cheaper than surgery and will allow people with sight loss to read text better and see faces, said Dr Eric Tremblay, a Swiss Federal Institute of Technology designer. The lenses have tiny telescopes built into the centre which work like binoculars and are activated by specially-adapted glasses that recognise winks, but ignore blinks. The new lens could be available for sale in two years. VITAMIN B3 FOR GLAUCOMA? Researchers from the Centre for Eye Research Australia (CERA) have started a six-month clinical trial to see if high-dose vitamin B3 (nicotinamide) can support existing therapies for glaucoma by protecting nerve cells from dying. The ability to recover from an eye injury diminishes with age, so CERA’s looking for treatments to boost recovery, said study lead Professor Jonathan Crowston. “If you can improve optic nerve recovery after an injury then we can reduce the risk of glaucoma progressing.” ARTIFICIAL PHOTORECEPTORS RESTORE SIGHT A Fudan University team in China has developed artificial photoreceptors to replace diseased and no longer functioning rod and cone cells within the retina. A study on laboratory mice, published in Nature Communications, showed the artificial photoreceptors, made from gold and titanium oxide nanowire arrays, could successfully convert light into electrical signals. COLLABORATION HELPS GLAUCOMA CARE A collaborative clinic at the University of New South Wales Centre for Eye Health, where optometrists and ophthalmologists work sideby-side, is providing beneficial for glaucoma patients. A study of the clinic’s first 18 months showed patients waited 43 days on average for an appointment; most (51%) were diagnosed with glaucoma; 41% had suspected glaucoma requiring monitoring; 2% had a different optical neuropathy; and 6% had no eye disease. The new model of care has great potential for helping to assess new, non-urgent outpatient referrals, said study co-author Dr Michael Hennessy. START-UP MAKES VISION CARE MORE ACCESSIBLE A Massachusetts Institute of Technology (MIT) spinout, PlenOptika has developed a highly accurate, portable autorefractor called QuickSee. Costing about a third of the price of traditional autorefractors, the device is ideal for developing countries and hard to reach areas, said the company. After six years in development, eight product iterations and clinical studies involving 1,500 patients across five countries, The QuickSee has just been released in India. ESSILOR-LUX MERGER GIVEN THE GO AHEAD The proposed merger of international eyecare heavyweights, Essilor and Luxottica, is all but a done deal after being unconditionally cleared by both the European and US Federal Trade Commissions. In other news, Essilor reported solid 2017 earnings with good overall performance in its lenses and optical instruments divisions, reflecting strong online sales and US growth, offsetting lower sales in other areas, notably Australia and Brazil. HAITI OPENS OPTOMETRY SCHOOL Supported by the Brien Holden Vision Institute (BHVI), the first School of Optometry has opened in Haiti, welcoming 17 new students, selected from 144 applicants, onto its Bachelor of Vision Sciences programme. Five years in the making, the new school, which is part of the Faculty of Medicine at l’Universite d’Etat d’Haiti in Port au Prince, will be of huge benefit to the 70% of Haitians who currently have little or no access to eye care, said Dr Luigi Bilotto, BHVI’s director of global human resource development. O-SHOW 2018 – FILLING UP FAST The take up of exhibitor space at this year’s boutique style O-Show in Melbourne, from 14-15 July, has been extraordinary, with just 10 booths left to fill, said Finola Carey, ODMA CEO, adding she’s delighted, but not surprised by the response. ‘’Certainly, the fact that the O-Show is owned and organised by ODMA for the benefit of the industry, has been warmly received.” RETINA SCANS AND AI TO DETECT HEART DISEASE The necrotic photoreceptor layer in the blind retina is replaced by an Au–TiO2 NW array Scientists from Google and its health-tech subsidiary Verily are assessing a person’s risk of heart disease using computer learning and retina scans. Using deep learning algorithms, trained on retina data from 284,335 patients, combined with knowledge about the patient’s age, blood pressure and smoking habits, Google’s software successfully predicted 70% of future cardiovascular events, such as a heart attack or stroke, that would occur within five years of the retinal exam. Regarding the retina BY ELLA EWENS The first of the two-repeated autumn seminar evenings by Retina Specialists was held on 6 March in the leafy Auckland suburb of Parnell. Attending optometrists were greeted by the Retina Specialists team, wine and canapés. The all-female speaking line-up for the evening included Retina Specialists’ Dr Rachel Barnes, Associate Professor Andrea Vincent, Dr Dianne Sharp and Dr Narme Deva. A pictorial FAF journey A/Prof Vincent kicked off the evening with a pictorial journey through fundus autofluorescence (FAF) in clinical practice, showing us “pretty pictures” depicting the presentation of various retinal dystrophies and disorders. FAF is a non-invasive technique, which highlights lipofuscin (the main fluroflore in the retinal pigment epithelium). FAF may detect abnormalities beyond the clinical exam and is useful in classifying various retinal dystrophies and disorders, she said. In albinism, where the retina is not metabolically affected, the FAF appears normal. However, in choroideremia (an X-linked retinal condition affecting males) widefield Optos images show patchy changes with scalloped edges where the retina is ‘metabolically dead’. In X-linked retinitis pigmentosa there is a so-called water-shed zone seen between the good and bad metabolic areas of the retina. In PDE6B retinitis pigmentosa, FAF is very useful – visual results are closely correlated to FAF, so generally visual fields are not necessary and don’t give any extra information, A/Prof Vincent explained. Among other fascinating pearls, Vincent also revealed what she calls the ‘moustache sign’ of the adRP rhodopsin mutation – an inferior central rim of hyperfluorescence – and showed FAF images of eight siblings with different presentations of ABCA4 retinal dystrophies, where the whole retina may be affected. AMD new treatments? Dr Barnes spoke about the new treatment options for age-related macular degeneration (AMD). She begun her presentation by outlining the goals of the different treatments for both dry and wet AMD, and enthusiastically explained what else waits in the wings in the long journey to market. The first drug she discussed, Roche’s lampalizumab, an antigenbinding fragment of a humanised, monoclonal antibody directed against complement factor D (CFD), had showed promising initial results in early trials with a 20% reduction in geographic atrophy. The phase III results, however, showed no benefit at all. Nano-second laser may also have an application in early dry AMD, with pilot studies indicating a reduction in drusen. Phase III results are expected later this year. Looking at possible treatments for wet AMD, Barnes reminded us gravely that there is no permanent cure for this devastating disease and that real-world results often fall short of drug trials due to under treatment. A new pigment-derived growth factor, which it was hoped would work to reduce fibrosis and help mature vessels to regress, looked hopeful early on but was ineffective in phase III trials. Roche, however is still in the game, with its drug, also based on angiopoitein (a proangiogenic cytokine involved in neovascular AMD), and is persevering with the expensive trials required. A new formulation of ranibizumab (Lucentis: a recombinant humanized IgG1 monoclonal antibody fragment that binds to and inhibits vascular endothelial growth factor A) delivered by a port system is also an exciting possibility with more results planned soon, said Dr Barnes. Gene therapies using new viral vectors are also being trialled. While many trials seem to show early promise and then fall at the final hurdle, brolucizumab is in Phase III trials and results are looking very positive. With its small molecule size allowing higher potency in the eye, results are showing significant reduction in retinal thickness and better performance than aflibercept (Eylea), she said. Lastly Dr Barnes discussed the new imaging technique, OCT-A that offers a quick, non-invasive 3D method to image the retinal vasculature. It is particularly useful for showing the structure of choroidal neovascularisation and for visualising occult neovascularisation not visible by any other means, she said. MD and the ageing eye Dr Sharp presented a practical presentation on MD in the ageing eye. The high metabolic demand of the macular area of the retina makes it particularly susceptible to oxidative damage, she said. With more than 10% of babies born today destined to become centenarians, MD is more relevant today than ever. A recent model-of-care, commissioned by the government, highlighted the national low understanding of the disease and areas requiring improvement, such as speed to treatment. This model set out the importance of prompt care and said the time from first diagnosis to first treatment should be no more than one week. The Beckman classification can be used to identify different stages of AMD and help to predict the risk of progression at each stage, she said. “Small fine drusen (or druplets as they are sometimes called) are not MD and it is wrong to call them this. Soft drusen combined with pigment changes are high risk. Give the patient an Amsler Grid test www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand Drs Narme Deva, Dianne Sharp and Rachel Barnes Stuart Campbell and Richard Chinn and monitor them closely.” Those with choroidal neovascularisation can particularly be helped by getting them treatment fast, she added. Dr Sharp also shared some data from UK records over a 12-month period, showing that the starting vision level is of great importance. Optometrists present were also interested in discussing RANZCO’s revised referral pathway for MD. “Too often a patient stops attending appointments after anti-VEGF treatments because their vision is good, only to have problems reoccur,” said Dr Sharp, providing examples of the sequelae of neovascular MD. Patients must be educated that this is a chronic disease that requires long-term management, she stressed. DR, risks and treatment Dr Deva tackled diabetic retinopathy, a main cause of the blindness in working-age people. One third of diabetics will have retinopathy and for a third of those it will threaten their vision. To reduce risk during the early stages, optometrists must ask about how well patients are controlling their blood sugar levels, she said, citing data that intensive therapy, reduced the risk of developing retinopathy by 76%. A good understanding of the disease and encouraging patients to form good, healthy-eating and monitoring habits is key in these early stages. The second question that optometrists should ask is, “how is your blood pressure?” said Dr Deva. The Wisconsin epidemiologic study of diabetic retinopathy showed that lowering blood pressure can half the risk of retinopathy. The third question centres around cholesterol levels, and while this is not as well-supported by clinical data as blood sugar levels, good cholesterol control can reduce the progression of retinopathy, she said. Dr Deva then summarised the treatments for diabetic retinopathy and associated macular oedema focusing on lasers and anti-VEGF injections. Widefield imaging is helping us monitor treatments over time, she said. Keeping to the technological theme, Dr Deva also discussed the growing interest in artificial intelligence and the rise of studies using machines that can perform deep learning (see NZ Optics March 2018 issue, p14), “that is, showing a machine data and have it teach itself how to analyse it,” may well at some point in the future replace optometrists and ophthalmologists, analysing many data points, from diagnosis and classification to risk assessment, in mere minutes, and suggesting appropriate treatment plans. Concluding remarks Sandhya Mathew and Surekha Parag Hilary Rayner, Retina Specialists practice manager, said the evening was a great success. “It was wonderful to see so many people at our event and we are looking forward to meeting our next group in a couple of weeks. Everyone is busy these days so we really try to make the education meetings we hold interesting and useful and we really appreciate the effort that people make to come along.” ▀ Retina Specialists’ Spring seminar evenings will be held on the 4 and 18 September. For general enquiries or classifieds please email info@nzoptics.co.nz For editorial, please contact Lesley Springall at lesley@nzoptics.co.nz or +64 27 445 3543 For all advertising/marketing enquiries, please contact Susanne Bradley at susanne@nzoptics.co.nz or +64 27 545 4357 in the first instance, or Lesley Springall at lesley@nzoptics.co.nz To submit artwork, or to query a graphic, please email susanne@nzoptics.co.nz NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd. Copyright is held by NZ Optics 2015 Ltd. As well as the magazine and the website, NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the products and services of the industry. NZ Optics is an independent publication and has no affiliation with any organisations. The views expressed in this publication are not necessarily those of NZ Optics 2015 Ltd or the editorial team. 4 NEW ZEALAND OPTICS April 2018

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