EyeWorld Weekly Update, July 7, 2017

July 7, 2017
Volume 23 , Number 23

Generic Vigamox launched in U.S.

Lupin Limited (Mumbai, India) announced the U.S. launch of its moxifloxacin hydrochloride ophthalmic solution USP, 0.5% (base) as an AT1 generic equivalent to Vigamox (Novartis, Basel, Switzerland), indicated for bacterial conjunctivitis. This generic solution received FDA approval a few years ago. This news comes several weeks after a new study published in Ophthalmology suggested 60% of conjunctivitis patients are prescribed antibiotic drops when, in most cases, they are rarely needed. Twenty percent receive an antibiotic-steroid combination, which could actually prolong or worsen the condition. "This study opens the lid on overprescribing of antibiotics for a common eye infection," said lead author Nakul Shekhawat, MD. "It shows that current treatment decisions for pink eye are not based on evidence, but are often driven more by the type of healthcare practitioner making the diagnosis and the patient's socioeconomic status than by medical reasons. The potential negative consequences are difficult to justify as we move toward focusing on value in healthcare."

Dry Eye Awareness Month

July is Dry Eye Awareness Month. According to a news release from the Alliance for Eye and Vision Research (AEVR) and the Tear Film & Ocular Surface Society (TFOS), there are 30 million people in the U.S. alone suffering from dry eye, caused by a variety of conditions or factors. On July 12, AEVR and the TFOS will host a congressional briefing with experts who will discuss the latest TFOS Dry Eye Workshop Report, in addition to advances in dry eye screening and other aspects of the disease. The report updates the definition, classification, and diagnosis of dry eye from the previous 2007 report and includes epidemiology, pathophysiology, management, therapy, and more about the disease. The National Eye Institute (NEI), in recognition of Dry Eye Awareness Month, highlighted some of its related research, including studies that led to the discovery and testing of lacritin, a protein that stimulates basal tear production. Currently, according to NEI, a 27-site clinical trial, sponsored by industry, is underway using synthetic lacritin in patients with Sjögren's syndrome, and separately, an NEI-funded researcher is developing a test for lacritin deficiency. Other NEI-funded research includes analysis of lipid-binding proteins for tear lipid layer stability, stem cell therapy to rebuild lacrimal glands, and the Dry Eye Assessment and Management Study (DREAM), the first large, independent, multisite clinical trial looking at oral omega-3 fatty acids for dry eye.

Katena acquires NuPak Medica

Katena products (Denville, New Jersey) announced its purchase of NuPak Medical (San Antonio), an ISO 13485-certified and FDA-registered contract manufacturing service for the medical device industry, for an undisclosed amount. According to a Katena press release, NuPak services include product assembly and packaging and injection molding for several specialties, including ophthalmology.


  • A report by the American Academy of Ophthalmology's Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel describes a literature search conducted to assess the efficacy of topical atropine for prevention of myopic progression in children. The literature search, which took place in December 2016 with no date restrictions, yielded 17 relevant studies with level I, II, or III evidence. Eight studies were identified with level I and II evidence and each showed less myopic progression with atropine compared to controls. A rebound effect was, however, noted in studies that looked at myopic progression after stopping atropine. "This review of the level I and II and select level III evidence demonstrated a reduction in myopic progression in children treated with atropine by as much as 1 D/year during treatment," the members of the panel wrote, noting, however, that much of the evidence is from Asian countries and thus may "not be generalizable to other populations." This research was published in Ophthalmology.
  • Patients with congenital Zika virus syndrome, those exposed to the virus during gestation, exhibit a variety of anterior and posterior segment malformations, according to a case series described by Bruno de Paula Freitas, MD, and co-researchers. The case series included six infants with confirmed congenital Zika syndrome (CZS) who exhibited conditions such as microphthalmia, iris coloboma, cataract, and fundus abnormalities. "The current study alerts clinicians to the fact that besides ocular posterior lesions and glaucoma, microphthalmia and anterior segment findings might be present in babies with CZS. Thus, infants with a suspected congenital ZIKV infection should undergo a complete ophthalmologic evaluation that includes assessment of the anterior and posterior segments," Freitas et al. concluded in the article published in Ophthalmology.
  • While previous studies on the ocular effects of space travel have suggested that increases in intracranial pressure due to cephalad fluid shifts in a weightless environment are resulting in everything from choroidal folds to retinal nerve fiber layer thickening to decreased visual acuity, new research published in Physiological Reports posits that elevated carbon dioxide could be a factor as well. Steven Laurie, PhD, and co-investigators tested various positions-seated, head down tilt, and head down tilt with increased carbon dioxide exposure-on eight male subjects for 1 hour in each condition, finding that both tilted positions resulted in elevated IOP but even more so in higher CO2 conditions, although no ocular changes were seen in any of the groups. According to a press release, genetic variations between the study participants and NASA astronauts who experienced ocular changes after space travel were analyzed and "may provide promising insight into understanding the individual variability in many physiological outcomes that develop during spaceflight, including greater susceptibility to increased arterial [partial pressure of carbon dioxide] levels, potentially increasing the risk for symptoms related to CO2 exposure," the researchers wrote.
  • Research suggests patients with type 2 diabetes and obstructive sleep apnea (OSA) are at greater risk of progressing to blindness from diabetic retinopathy during a shorter timeframe. The study published in the American Journal of Respiratory and Critical Care Medicine showed that sight-threatening diabetic retinopathy was more common in type 2 diabetes patients who had OSA compared to those without OSA, corresponding author Abd Tahrani, MD, said. Also, type 2 diabetes patients with OSA were more likely to develop advanced diabetic retinopathy in less than 4 years. Prior to this study, there had been no published research on the impact of obstructive sleep apnea and diabetic retinopathy progression.
  • Scientists have created a non-cytotoxic, non-steroidal treatment for bacterial keratitis infection using carbon quantum dots coated in spermidine. Carbon quantum dots are nano-sized semiconductor particles. According to the article published in ACS Nano with lead author Hong-Jyuan Jian, the carbon quantum dots were created "by direct pyrolysis of spermidine (Spd) powder through a simple dry heating treatment." These quantum dots were then found to have antibacterial properties against bacteria, including some drug resistant strains. The study authors speculate that the "super-cationic" state of the 6 nanometers in diameter dots disrupts the bacterial membrane, while leaving animal cells intact.

  • 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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