EW Weekly, March 25, 2016

March 25, 2016
Volume 21 , Number 12

Eye-tracking device for concussiondetection granted U.S. approval

The U.S. Food and Drug Administration granted regulatory approval for the Eye-Sync, an integrated head-mounted eye-tracking device that analyzes eye movement impairment through the use of virtual reality and may be able to determine if a player has suffered a concussion in less than 60 seconds, said developer SyncThink (Boston). 
Rather than diagnose a concussion on the playing field, this device "detects disruption in visual information," the company noted in a press release. In January, the National Football League noted the rate of concussions in the 2015 season was up nearly 32% compared with data from 2014, while the Centers for Disease Control and Prevention reports that each year nearly 500,000 children are treated for a traumatic brain injury, including concussion.

First patients dosed in phase 1/2 RP study

A phase 1/2 study evaluating RST-001, a first-in-class gene therapy application of optogenetics for the treatment of retinitis pigmentosa (RP), has dosed its first patient, developer RetroSense Therapeutics (Ann Arbor, Michigan) said in a news release. 
An initial dose-ranging study is proposed whereby 3 dose levels of RST-001 will be studied in 3 separate groups of adult patients with advanced disease. This first part of the study is aimed at determining a single dose of the experimental agent that is safe and well tolerated, to further evaluate in a fourth group of patients. The second part of the study is aimed at obtaining additional safety data at the highest tolerated dose and providing important additional clinical data to guide the design of future efficacy studies. 
In 2014, the Food and Drug Administration granted orphan drug designation for RST-001 based on its development as a treatment of RP.

Foods high in vitamin C may cut cataract progression

A diet rich in vitamin C could cut risk of cataract progression by a third, according to the American Academy of Ophthalmology (San Francisco), which published the study. The research is the first to show that diet and lifestyle may play a greater role than genetics in cataract development and severity. 
Researchers at King's College London looked at whether certain nutrients from food or supplements could help prevent cataract progression, and examined more than 1,000 pairs of female twins from the U.K. Participants answered a food questionnaire to track the intake of vitamin C and other nutrients, including vitamins A, B, D, E, copper, manganese, and zinc. To measure the progression of cataracts, digital imaging was used to check the opacity of their lenses at around age 60. The researchers performed a follow-up measurement on 324 pairs of the twins about 10 years later. 
During the baseline measurement, diets rich in vitamin C were associated with a 20% risk reduction for cataract. After 10 years, researchers found that women who reported consuming more vitamin C-rich foods had a 33% risk reduction of cataract progression. These results make the study the first to suggest that genetic factors may be less important in progression of cataract than previously thought.

Mitochondrial dysfunction linked to Fuchs'

Researchers at Schepens Eye Research Institute of Massachusetts Eye and Ear (Boston) have shown a link between mitochondrial dysfunction in corneal endothelial cells and the development of Fuchs' endothelial corneal dystrophy (FECD). This study is the first to demonstrate that lifelong accumulation of oxidative DNA damage leads to mitochondrial dysfunction and subsequent cell death in the tissue of the corneal endothelium. These changes are the result of free radical-induced molecular changes that are characteristic of FECD, the authors said. 
In their study, the researchers detected an increase in mitochondrial and nuclear DNA damage in FECD and correlated the damage with loss of mitochondrial energy production. The result was mitochondrial fragmentation followed by release of cytochrome c, a small protein associated with the inner membrane of the mitochondrion. These age-induced molecular changes underscore the degenerative aspects of FECD pathogenesis. Although surgical therapies are effective in treating FECD, they all involve tissue transplantation. The research team plans to develop novel cytoprotective and anti-aging therapies that could provide alternative and safer treatment options for FECD patients, the university said. 
This work was supported by an NEI/NIH RO1 Ey020581, and an Alcon Research Institute Young Investigator Grant.


  • The presence of eyelid laxity associates with abnormal tear parameters compared with the absence of eyelid laxity, and this may play a role in dry eye, according to P. Chhadva and colleagues. They prospectively recruited 138 patients with normal external anatomy from a Veterans Administration hospital. Symptoms (via the Dry Eye Questionnaire 5 and Ocular Surface Disease Index) and signs of DE were assessed. It was observed that 71% of participants (n=98) had clinical evidence of eyelid laxity (upper and/or lower) compared with 29% (n=40) with no eyelid laxity. Individuals with eyelid laxity were older (67±10 vs. 55±8 years without laxity, P<0.005) and more frequently male (76% of males had laxity vs. 18% females, P<0.005). Patients with eyelid laxity had increased symptoms and signs of DE compared with their counterparts without laxity including ocular pain described as grittiness (63% vs. 45%, P=0.049), decreased tear break-up time (8.6±3 vs. 10.3±4 seconds, P=0.02), increased corneal staining (2.5±3 vs. 1±2, P=0.002), decreased Schirmer's score (14±6 vs. 17±7 mm, P=0.01), increased meibomian gland dropout (2±1 vs. 0.8±0.8, P<0.005), increased eyelid vascularity (0.8±0.8 vs. 0.2±0.5, P<0.005), and more abnormal meibum quality (2±1.3 vs. 1.4±1.2, P=0.02). The study is published in Cornea.
  • Cataract extraction offers good long-term visual rehabilitation for the majority of patients. The most common comorbidity causing large functional loss 15 years after surgery was age-related macular degeneration, according to a study. E. Mönestam conducted a prospective, longitudinal population-based cohort study on patients in Sweden who had undergone cataract surgery from 1997 to 1998. The study included 190 patients (83% of survivors). Fifteen years after surgery, the median CDVA in the operated eye had deteriorated from 20/20 postoperatively to 20/25 (P=.0001). Sixty percent of the patients had worsening of CDVA of less than 0.1 logMAR units compared with postoperatively. Fifty-four percent (103/190) had no deterioration in subjective visual function (VF-14), and 79% (150/190) had 10 points of decline or less. Previous Nd:YAG laser capsulotomy was more common in those younger than 65 years at surgery (49% versus 25%) (P=.002). The study is published in the Journal of Cataract & Refractive Surgery.
  • The rate of endothelial cell loss at 2 years after Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery was similar regardless of donor age (≥80 years vs. ≤79 years), suggesting age should not be a factor when using donor tissue, according to S. Nakatani and A. Murakami. They divided 90 eyes that underwent DSAEK at Juntendo University Hospital between January 2008 and December 2012 into two groups. Group 1 received corneas from elderly donors aged 80 years or older (29 eyes), and group 2 received corneas from donors aged 79 years or younger (61 eyes). The mean age of the donors was 86.3±28.9 years (range, 80-98 years) in group 1 and 62.1±23.2 years (range, 26-79 years) in group 2. At 2 years after surgery, median logMAR visual acuity was 0.48±0.38 in group 1 and 0.42±0.47 in group 2, while the median loss of endothelial cell density was 38.9±22.5% and 39.7±23.8%, respectively. There was no significant difference between the 2 groups for all the parameters. The study is published in Graefe's Archives for Clinical and Experimental Ophthalmology.

EYEWORLD WEEK Online is edited by Stacy Majewicz and Michelle Dalton.

EyeWorld Week Online (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators, is published every Friday, distributed by email, and posted live on Friday.

Medical Editors: Eric Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara Chan, MD, cornea editor; Nathan Radcliffe, MD, glaucoma editor; and Vance Thompson, MD, refractive editor.

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