OCULAR INFLAMMATION
The role of immunosuppressives

According to a 12-doctor panel, the immunosuppressive drugs used in many cancer treatments can play a larger role in the treatment of severe cases of ocular inflammation.

The panel concluded that oral corticosteroids will remain the initial treatment for most cases of severe eye inflammation, but recommended consideration of immunosuppressive drugs in many cases, especially when long-term control of inflammation is required.

Immunosuppressive drugs may also be used in conjunction with corticosteroids. Besides improving results, this helps manage potential side effects of the corticosteroid therapy by reducing the required use of corticosteroids.

Visit www.ajo.com for the complete report. It's titled "Guidelines for the Use of Immunosuppressive Drugs in Patients with Ocular Inflammatory Disorders: Recommendations of an Expert Panel."

Am. J. Ophthalmol. 2000; 130: 492-513.

EMBRYONIC DEVELOPMENT OF THE EYE
Lens may play important role

�Scientists have made two discoveries involving the lens of the eye:

�         the lens may play an important role in the embryonic development of the eye

�         the lens appears to be necessary for the formation of other structures, such as the retina and the cornea.

Scientists drew these conclusions as a result of experiments involving the Mexican cavefish. The fish -- which spends its entire life in the dark -- begins to develop eyes as an embryo, but is blind and essentially eyeless by adulthood. Scientists gave the Mexican cavefish a lens from a different group of the same species that can see and that
doesn't live in a cave. The result? The Mexican cavefish grew a functioning eye.

Researchers hope to learn much more about how eyes form and grow. They hope this information will lead to a better understanding of what causes birth defects in children.

Science 2000; 289: 631-633.

ABBREVIATED HOSPITAL STAYS
Study questions savings

A recent study suggests that rushing patients home to avoid an extra day in the hospital produces little savings. According to the report, cutting the last day from a hospital stay reduces the total cost of care, on average, by 3% or less.

The researchers looked at actual costs incurred by 12,365 patients discharged from the University of Mich-igan Health System in Ann Arbor, Mich. The most expensive days occurred early on, when patients underwent expensive diagnostic tests and medical procedures. The last day in the hospital, in contrast, involved resource costs in the range of just $400 to $450.

J. Am. Coll. Surg. 2000; 191: 123-130, 192.

NAION
Trial examines neuroprotection

The Neuroprotection in Ischemic Optic Neuropathy (NPION) clinical trial, designed to determine the safety and effectiveness of a neuroprotective agent as treatment for nonarteritic ischemic optic neuropathy (NAION), began this October.

As you know, NAION is an infarction of the optic nerve head that kills retinal ganglion cells, resulting in the loss of visual function. Each year, doctors diagnose approximately 6,000 people in the United States with NAION.

Currently there is no effective treatment for NAION. The retinal ganglion cell death is irreversible. However, animal models have demonstrated that there is a short time after acute insult to the optic nerve during which it's possible to halt further cell death and prevent deterioration of visual function. Non-clinical studies suggest that a neuroprotective agent has potential for effective treatment when used during this brief time window.

Treatment of NAION must be initiated within 48 hours after the onset of symptoms. Therefore, clinical investigators recommend that you refer your patients to them immediately.

To enroll your patients in this ongoing trial, call (866) CARE 4 EYES.

AMD
TTT results discussed

Results from a study of transpupillary thermotherapy (TTT) were recently discussed at the Wills Eye Hospital Annual Retina Conference in Philadelphia.

The study showed that TTT photocoagulation can be effective in treating patients with subfoveal occult wet age-related macular degeneration (AMD). The TTT treatment improved or stabilized vision in 81% of eyes and decreased subretinal fluid in 83% of eyes.

Researchers used an 810-nm diode laser photocoagulator to treat 57 eyes of 52 patients with subfoveal occult wet AMD. Eighteen percent of the eyes showed an improvement in visual acuity (+2 or more lines); 63% of the eyes remained stable; and 19% lost two or more lines of visual acuity. Eighty-three percent of the eyes showed stabilization of their exudative process after one TTT treatment, as evidenced by resorption of subretinal and/or intraretinal exudate and hemorrhage.

Elias Reichel, M.D., who conducted the study, said, "These results demonstrate that eyes treated with TTT have minimal complications."

TEARS
Protein might indicate cancer

A team of Australian scientists has made a serendipitous discovery. While working on a permanent-wear contact lens, scientists in Sydney discovered that tears may indicate if people have, or are likely to develop, certain types of cancer.

The scientists found that tears of patients with certain forms of cancer, or a family history of cancer, contain a marker protein called Lg. This protein is found in breast and prostate cancer.

A spokesperson for the Australian scientists said, "One possibility is that people who have Lg in their tears are genetically disposed to breast and prostate cancers. Another possibility is that when people have or are developing the aforementioned cancers, the Lg protein increases in their tears."

CORNEA
Lab-grown cells transplanted

In Taipei, Taiwan, researchers have transplanted lab-grown cells to replenish damaged corneas. The transplants are working for about 60 out of more than 90 patients. The researchers don't know yet if the repair is permanent, but the patients' improved sight has lasted up to 15 months so far.

The experimental technique works by taking a slice eight-hundredths of an inch long from limbal epithelial cells and putting the slice in a lab dish on top of a piece of amniotic membrane. When the corneal cells grow to be about an inch across, researchers remove the patient's damaged eye tissue and replace it with the membrane and new eye cells.

Researchers caution that this procedure won't help people who are blind from birth or those who lost their sight because of damage to the nerves or to the retina. Nor is it for the totally blind. It's only intended for people who can still distinguish light from dark.

New Engl. J. of Med. 2000; 343: 86-93.

GLAUCOMA
Xalatan comparisons

At this year's American Academy of Ophthalmology meeting, three presentations suggested that Xalatan is cost-effective and that patient compliance is high compared with other medications.

The first study reviewed administrative claims of more than 3,000 glaucoma patients in national managed care plans. The study found that Xalatan and its generic equivalent, timolol, were the most prescribed glaucoma medications. Additionally, patients on Xalatan were more likely to be persistent with their therapy for 6 months than patients using other medications.

The second study examined 274 elderly Medicare managed care patients with glaucoma. The study found no difference in medical costs for patients starting on Xalatan compared with patients starting on brimonidine or beta-blockers -- even though many patients began using Xalatan in combination therapy.

The third study determined by meta-analysis that, compared with brimonidine, timolol and Xalatan were the more cost-effective glaucoma medications relative to their intraocular pressure (IOP)-lowering effect.