EyeWorld Weekly Update, April 14, 2017

April 14, 2017
Volume 22 , Number 15

New potential therapeutictarget identified for PDR

Runt-related transcription factor 1 (RUNX1) is a new potential therapeutic target for retina neovascularization, according to researchers at Massachusetts Eye and Ear, Boston. RUNX1 was found in abnormal retinal blood vessels; when researchers inhibited RUNX1 with the small molecule drug Ro5-3335, a 50% reduction of retinopathy occurred. Investigators studied tissue from patients who had proliferative diabetic retinopathy (PDR) and found the presence of RUNX1 in diseased blood vessels but not normal blood vessels, according to a Massachusetts Eye and Ear press release. They used Ro5-3335-developed originally as a cancer treatment-to inhibit the activity of RUNX1. The use of RUNX1 led to a significant reduction in tufts in oxygen-reduced retinopathy. The findings could provide another mode of treatment for PDR, the investigators concluded. The research is published in Diabetes.

Novartis to in-license dry eye treatment

Novartis (Basel, Switzerland) will in-license ECF843, a treatment for dry eye from Lubris LLC (Boston) for use outside of Europe. ECF843 is a recombinant form of human lubricin (rh-Lubricin). A small Phase 2 clinical study found that ECF843 provided immediate improvement in dry eye symptoms, most likely by increasing lubrication across eye and tear surfaces and by improving dry eye signs within 28 days, according to a Novartis press release. Lubricin is an endogenous glycoprotein that is expressed in areas of high shear stress and friction, the press release explained. It then binds to and protects tissues of the ocular surface.

Imprimis enters agreement for worldwide rights to Klarity

Imprimis (San Diego) has entered a licensing agreement for the worldwide rights for Klarity, a dry eye treatment. Klarity is a preservative-free formulation and can be adapted for a range of viscosities, from a topical drop or gel to a dispersive viscosurgical device. Klarity was developed by Richard L. Lindstrom, MD. Klarity is designed to treat ocular surface pathology associated with ophthalmic surgery, contact lens wear, and for moderate to severe dry eye. Active ingredients include chondroitin sulfate as well as dextran and glycerol.

Dry eye an overwhelmingly common symptom in those with Sjögren's syndrome

According to a Harris Poll of 2,900 patients with Sjögren's syndrome, dry eye and dry mouth are overwhelmingly the most common symptoms experienced. The poll, conducted for the Sjögren's Syndrome Foundation, found both symptoms occurred in 97% of respondents. Other common symptoms included fatigue (94%), dry or itchy skin (93%), trouble sleeping (91%), and forgetfulness (90%). In most patients, dry eye symptoms occurred every week or multiple times within a week. Almost all patients used eye drops, artificial tears, or over-the-counter ointments. Seven in 10 respondents said that Sjögren's got in the way of their daily activities. Ninety-six percent of the respondents were female, and about one-third were under the age of 60. April is Sjögren's awareness month.

NEI grant awarded to identify targets for AMD and other heritable retinal diseases

The National Eye Institute has awarded two professors at the Jackson Laboratory (Bar Harbor, Maine) a $2.4 million grant to study diseases of the retinal pigment epithelium (RPE), with the plan to find therapeutic targets for age-related macular degeneration and other heritable retinal diseases. Patsy Nishina, PhD, and Gregory Carter, PhD, will study mouse models of inherited RPE-driven disease, according to a Jackson press release. They will analyze other mouse models with mutations involved in cell adhesion and extracellular matrix molecules for signs of RPE diseases.


  • Factors that increase the risk for pseudophakic cystoid macular edema (CME) after cataract surgery in patients with diabetes include duration, severity, diabetes type, lens hardness, and hemoglobin A1C level, reported Jin Yang, MD, PhD, and coinvestigators. Their prospective nonrandomized study followed patients with diabetes for up to 6 months after phacoemulsification to evaluate their foveal thickness, macular sensitivity, and corrected distance visual acuity. Three groups of patients were identified: nonpseudophakic CME, level 1 pseudophakic CME, and level 2 pseudophakic CME. Patients with subclinical level 1 CME had a 30% to 40% increase in foveal thickness and a 20% drop in macular sensitivity. Level 2 patients had a 40% or more increase in foveal thickness and a 20% decrease in macular sensitivity. Clinical pseudophakic CME occurred in 3.2% of patients. "A 40% or more increase in foveal thickness and 20% or more decrease in macular sensitivity offer an objective and reliable diagnostic standard to report pseudophakic CME in diabetics," the investigators concluded. The research is published in the Journal of Cataract & Refractive Surgery.
  • A Failure Modes and Effects Analysis applied to bilateral same-day cataract surgery identified 15 significant potential failure modes. Led by Neal H. Shorstein, MD, investigators identified lapses in instrument processing and compounding errors with intracameral antibiotics that could lead to endophthalmitis or toxic anterior segment syndrome (TASS). They also found ambiguous documentation of IOL selection by surgeons, leading possibly to unintended IOL implantation. Among the 4,754 eyes in the study, one eye developed endophthalmitis, one had an unintended IOL implantation, and no eyes developed TASS. Recommendations from the investigators include improving oversight of cleaning and sterilization practices, separating lots of compounding drugs for each eye, and enhancing IOL verification procedures. The study is published in the Journal of Cataract & Refractive Surgery.
  • Children with glaucoma have a health-related quality of life score similar to those described by children with severe congenital cardiac effects, those who have undergone liver transplants, and those who have acute lymphoblastic leukemia, according to Annegret Dahlmann-Noor, MD, PhD, and coinvestigators. They focused on functional vision and vision-related and health-related quality of life in children up to age 16 in their cross-sectional observational study. Investigators used three validated instruments to assess these areas: the Cardiff Visual Ability Questionnaire for Children, the Vision Impairment for Children, and the Pediatric Quality of Life Inventory version 4.0. Scores for functional visual acuity, vision-related quality of life, and health-related quality life were reduced in children with glaucoma. Parents reported a greater impact of glaucoma on their child's health-related quality of life than the children reported. The research is published in Ophthalmology.
  • Corneal crosslinking (CXL) in children with keratoconus appears to be effective, according to a study led by Lisa McAnena, MB, BCh. Investigators reviewed various databases for all studies focused on standard, transepithelial, or accelerated protocols for CXL in patients age 18 or younger. They identified a total of 13 papers published between May 2011 and December 2014. There were 490 eyes examined (401 patients) with a mean age of 15.25 years. Nine papers were included in the meta-analysis; these papers showed a significant improvement in uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and stable Kmax at 12 months as well as stable UCVA, improved BCVA, and improved Kmax at 24 months in a standard protocol group. In the transepithelial group, UCVA, BCVA, and Kmax were stable at 12 months. Standard CXL appeared effective in stopping the progression of keratoconus in pediatric patients at 12 months, but the investigators recommend more long-term studies. The research is published in Acta Ophthalmologica.

This issue of EyeWorld Weekly Update was edited by Amy Goldenberg and Vanessa Caceres.

EyeWorld Weekly Update (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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