The Wall Street Journal "Health Blog" reported that the Centers for Medicare & Medicaid Services (CMS) appears late yesterday to have changed its mind about reimbursement for small amounts of Avastin [bevacizumab], which physicians use to treat patients with age-related macular degeneration (AMD).

Avastin, which is similar to Lucentis [ranibizumab], is used off-label to manage AMD, but unlike Lucentis, which costs approximately $2,000 per injection, Avastin costs only about $30 per injection, making it considerably cheaper. Late yesterday, however, CMS announced without explanation that as of Jan. 1, it will reverse its Oct. 1 decision to reimburse Avastin at approximately $7 per dose, and will return to its previous higher reimbursement for the drug.

MedPage Today explained that even after CMS lowered its reimbursement for Avastin on Oct. 1, "reimbursement for Lucentis...remained unchanged at a whopping $2,039," thereby creating "a disincentive for using a drug that has been estimated to save Medicare $1.5 billion each year in treating macular degeneration alone.

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MedPage Today reported that, according to a study presented at an ophthalmology meeting, "intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors can cause persistent hypertension in the eye after only one treatment," a complication affecting 3.45 percent of patients given bevacizumab (Avastin) or ranibizumab (Lucentis) for age-related macular degeneration (AMD).
After "retrospectively" looking at 116 wet AMD patients treated with either VEGF inhibitor at their tertiary referral center from 2006 through 2008, researchers found that four patients developed persistent ocular hypertension. However, the ocular hypertension usually responds to antiglaucoma medication, though it returns if the drops are discontinued, the investigators said.

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Field Defects early indication of Alzheimer's

Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. We know it
Is a progressive and fatal brain disease
Is the most common form of dementia
Has no current cure.
A standard eye exam technique can throw light on early detection of this condition. And that test is Visual Field.
One-sided defects, (also referred to as right or left partial homonymous hemianopsia) on visual field testing were a giveaway in 80% of cases with the visual variant of Alzheimer's disease, according to Pierre-Francois Kaeser, MD, and Francois-Xavier Borruat, MD, both of the Jules-Gonin Eye Hospital in Lausanne, Switzerland.

Although we know that there is no specific cure, the sooner patients are referred to a neurologist the better, since early diagnosis and treatment may result in a better end prognosis.

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Gene therapy may improve vision in Leber's congenital amaurosis

The CBS Evening News reported that there is good news for the more than 10 million Americans who suffer from some type of vision disorder. In an experimental gene therapy trial at the Children's Hospital of Philadelphia, researchers used DNA from a DNA bank to create a functioning gene that was missing in 12 patients who were legally blind. The gene was then injected into the eye with a thin needle, which created a missing protein inside the faulty retina, helping to restore vision.

The Los Angeles Times reported that the finding, published in the Lancet, suggests it may be possible to produce similar improvements in a much larger number of patients with retinitis pigmentosa and macular degeneration. The participants had Leber's congenital amaurosis, and were born with severely impaired vision, which typically deteriorates until patients "are totally blind."

The Wall Street Journal reports that although the treatment did not restore normal sight in any participants, there was some improvement in all of them. Six participants reported enough vision to no longer be considered legally blind, while four children achieved significant recovery of vision.

According to Katherine High, a gene therapy researcher at the University of Pennsylvania, all of the participants had mutations disabling a gene called RPE65 that produces a protein essential to vision, Bloomberg News reported. Study author Jean Bennett noted that patients improved on standard vision tests, such as reading eye charts, and their pupils had a much greater response when light was shined in their eyes after being treated.

The study showed that the youngest participant's treated eye became 10,000 times more sensitive to light, as measured by the pupil's ability to constrict, while the eyes of the adults became hundreds of times more sensitive, at best, thePhiladelphia Inquirer reported. And, although expectations for patients in their 20s were low, those patients "improved more than the researchers expected."

The authors noted that the visual recovery noted in the children confirms the hypothesis that efficacy will be improved if treatment is applied before retinal degeneration has progressed, HealthDay reported. While patients younger than 20 had larger visual field recoveries than older patients, the study also showed that pupillary response...improved in the injected eye of all 11 patients tested. BBC News, the UK's Telegraph, and AFP also covered the story.

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The New York Times that researchers from the Massachusetts Eye and Ear Infirmary, the VA Boston Healthcare System, and Cornell University have demonstrated retinal implants that they say will resist the jarring of daily use.

The implant contains a tiny array of electrodes whose tips slide into a snug berth just beneath the retina...and are held in place by natural suction. These electrodes prompt the remains of retinal circuits to transmit signals to the brain, allowing patients with retinitis pigmentosa, a disease that damages the rods and cones in the eye, and for macular degeneration, which also affects these photoreceptors, to detect light and dark and to find the edges of objects.

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Retinal changes may be associated with Alzheimer's

Neuroscientists at the University of California-Irvine have discovered that the retinas of laboratory mice, whose genes have been altered so they develop Alzheimer's disease, experience changes similar to those in the brains of humans who have the disease.
Alzheimer's, affects over 5 million people in the U.S. and is the leading cause of elderly dementia. Brain imaging techniques are useful, but retinal imaging could be less invasive, less expensive and easier to perform.
For a study appearing in the November issue of The American Journal of Pathology, UCI neuroscientist Zhiqun Tan and colleagues analyzed the retinas of Alzheimer's mice that had been treated with immunotherapy.
Specifically, in both the retinas and brains, there is an accumulation of amyloid plaque lesions, a hallmark of the disease in brain imaging tests. Researchers said that the findings will be crucial to developing retinal imaging technology that could help diagnose and treat people with Alzheimer's Disease.

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Michigan considering doctor's tax.

First the Auto Industry; now the medical profession.

Michigan has a great plan to move the rest of the population to the other 49 states!

The AP reports, "Debate continues over whether Michigan should put a three percent tax on doctors' gross receipts to raise more money for low-income healthcare programs" as the Republican-led state Senate held a hearing on the issue. Opponents say the tax would drive doctors out of the state and reduce access to healthcare, but supporters say the tax would give physicians who see Medicaid patients higher reimbursement rates instead of the 8 percent cut contained in Michigan's current budget plan.

Michigan doctors warn new tax may hurt their business. Michigan's Howell Daily Press & Argus reports some Michigan physicians in private practice are warning a three percent tax proposed under MI House Bill 5386 may force them out of business. While proponents assure the additional federal reimbursements that will be afforded by the tax revenue will offset at least some of the cost of the new tax, some doctors say they have stopped accepting Medicaid altogether. Dr. John Vassallo, a physician in Genoa Township, said there's no guarantee the state will come through on promised reimbursements, which he said are frequently denied.

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The San Francisco Chronicle "City Brights" blog reported that anyone who spends two or more uninterrupted hours per day in front of a computer screen -- regardless of size -- is prone to Computer Vision Syndrome.
The condition is defined by the American Optometric Association as the complex of eye and vision problems related to near work, which are experienced during or related to computer use.

The most common symptoms associated with Computer Vision Syndrome (CVS) are

• eyestrain
• headaches
• blurred vision
• dry eyes
• neck and shoulder pain

These symptoms may be caused by:

• poor lighting
• glare on the computer screen
• improper viewing distances
• poor seating posture
• uncorrected vision problems
• a combination of these factors

Currently, Dr. Harvey Moscot, a renowned Optometrist in New York City and a CVS specialist, is conducting a study to evaluate the effectiveness of specialized lenses for the reduction of CVS symptoms.

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Bedside Eye Exam Outperforms MRI in Identifying Stroke

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Medscape reported that, at a meeting of the American Neurological Association, researchers using a bedside eye exam showed how they were able to outperform magnetic resonance imaging (MRI) and flag 100% of strokes.
In their prospective cross-sectional study, investigators examined 101 patients at high risk for acute vesticular syndrome. The researchers administered 3 tests checking vestibule-ocular-reflex on horizontal head impulse, nystagmus, and ocular alignment during prism cross-cover. All patients underwent neuroimaging. The researchers only misclassified 1 out of 25 patients who had a vestibular disease that was a benign condition of the inner ear, while 12% of patients who had a stroke identified on a later MRI had an initially false-negative result.

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Image by pmorgan via Flickr

Following a MedPage Today story, HealthDay reported that increased survival of extremely pre-term infants has led to a greater number of babies with vision problems caused by abnormal development of blood vessels in the retina, according to a study published in the Oct. issue of the Archives of Ophthalmology.

Swedish researchers examined data on 506 extremely pre-term infants (born before 27 weeks of gestation) who survived until their first eye examination and found that 368 (72.7 percent) had retinopathy of prematurity -- 37.9 percent with mild cases and 34.8 percent with severe cases. Notably, gestational age was a more significant risk factor for retinopathy of prematurity than birth weight.

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PHASE Ib CLINICAL TRIAL FOR AMD YIELDS PROMISING RESULTS.

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MacuCLEAR, Inc. and Mystic Pharmaceuticals, Inc. have announced preliminary successful results of a Phase Ib Clinical Trial for the treatment and prevention of the progression of age-related macular degeneration (AMD). According to a press release from Mystic, the preliminary results indicated that MacuCLEAR's MC-1101 drug is safe and well tolerated by study participants, and has a biological effect on blood flow in the back of the retina. Trial participants used Mystic's VersiDoser ophthalmic delivery system to self-administer MC-1101 to the front of the eye during the trial. A key finding of the study was the successful migration of the drug to the back of the eye and the study included Proof of Concept (“POC”) indicators.

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Latisse sales through the roof!

The Los Angeles Times reports, In an otherwise lackluster beauty industry lash enhancers are all the rage.


Allergan's lash enhancer, Latisse, is the first FDA-approved lash-growing product, which is available by prescription only. Latisse grossed $25.4 million in sales in the first half of this year, and the company says it anticipates doing $60 million in total by year's end.

Meanwhile, competitors, including Dr. Simon Ourian's Epione Lash RX...came out at the end of August and sold 1,000 units in its first couple of weeks. The products are designed to be brushed close to the upper and lower lashes before bedtime, and within a few weeks lashes appear thicker and longer. But, dermatologists warn about potential sensitivity. Jessica Wu, assistant clinical professor of dermatology at USC, cautioned that people have underlying conditions, so you need to talk to your eyecare provider before starting treatment.

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FDA to study quality of life problems associated with Lasik surgery

The AP that "the Food and Drug Administration announced plans Thursday to study the scope of problems connected with laser eye-correcting surgery, which include blurred vision and dry eyes." The agency "says it will work with the National Eye Institute and the Department of Defense to determine the percentage of patients who experience negative side effects following" Lasik (laser-assisted in situ keratomileusis) surgery. Dr. Jeffrey Shuren, the acting head of FDA's medical device division, said, "This study will enhance our understanding of the risks of Lasik and could lead to a reduction in patients who experience adverse effects."

Bloomberg News that "the first phase of the study began in July and involves online questionnaires." According to Bloomberg, "pressure from patients dissatisfied with laser eye surgery prodded US regulators to begin a study of the procedure's effects and warn Lasik centers to better track complications, an advocate said." The agency said Thursday "that recent inspections showed 17 undisclosed Lasik centers had inadequate systems for reporting adverse effects of the surgery."

Although "Lasik has many ardent admirers among the more than 12 million in the US who have had it, between 2% and 5% of patients getting the surgery -- as many as 75,000 per year -- are thought to have lasting post-operative problems that range from painful dry-eye to poorer vision, halos, glare and even blindness," the Los Angeles Times "Booster Shots" blog reports. "The FDA calls these 'quality of life' problems following the laser surgery, and has acknowledged that it has recorded no more than a small fraction of such problems during the Lasik industry's period of explosive growth." CQ Today and the UK's Press Association also cover the story. Reuters, meanwhile, reports on the FDA's warning to Lasik centers.

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visuospatial skills decline three years before Alzheimer's

HealthDay reported that, according to a study published in the Oct. issue of the Archives of Neurology, the ability to perceive relationships between objects (visuospatial skills) may decline years before a person is diagnosed with Alzheimer's disease. In a study population of 444 people, researchers from the University of Kansas used data from "cognitive assessments" to chart declines in various areas before participants were diagnosed with dementia. They found an inflection point (sudden change to a steeper slope of decline) in visuospatial abilities three years before clinical diagnosis of dementia. After that, "declines in overall cognition occurred the next year, while inflection points for verbal and working memory weren't seen until one year before diagnosis."

The UK's Telegraph quotes the authors as saying that "research into early detection of cognitive disorders using only episodic memory tasks, such as word lists or paragraph recall, may not be sensitive to either all of the earliest manifestations of disease or the most rapidly changing domain.

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Medscape reported that, according to a paper appearing online in Stroke, the risk for stroke, both ischemic and hemorrhagic, is increased by 30 percent within a year of "a herpes zoster attack," a figure that soars about four-fold should the attack involve the eye (herpes zoster ophthalmicus).

Researchers in Taipei reached those conclusions after scouring the Taiwan National Health Research Institute database to estimate the incidence of stroke among 7,760 adult patients treated for herpes zoster between 1997 and 2001, according to MedPage Today . Those patients were compared with 23,280 who had not been diagnosed with shingles.

The authors explained that the major mechanism of [their] findings is that stroke results from herpes zoster virus-induced vasculopathy [blood vessel damage].

The vessel to the brain damaged by the virus could be occluded [blocked] or ruptured lead investigator Dr. Jiunn-Horng Kang said.

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AMD associated with lipoprotein build-up at back of retina

Age-related macular degeneration (ARMD) is a major cause of vision loss in the elderly and exists in two forms “wet” and “dry.”

In the “wet” form, abnormal blood vessels behind the retina grow into the macula, and can separate it from the rest of the retina leading to sight-threatening complications.

The “dry” form of the disease is much more common, but until recently was poorly understood. A leading research team in this area, led by Christine Curcio (University of Alabama School of Medicine, Birmingham, USA) summarizes current knowledge in a review published in the Journal of Lipid Research.

A build-up of lipoprotein particles at the back of the retina, similar to the build-up of cholesterol in coronary arteries, may play a key role in the development and progression of the “dry” form of age-related macular degeneration, show results from a review of recent research.

The current focus of Curcio and colleagues is Bruch’s membrane (the innermost layer of the choroid) and the retinal pigment epithelium, in particular the boundary between the retinal pigment epithelium and Bruch’s membrane.

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Angiogenesis Inhibitor Works in Macular Edema

According to two studies presented at a retina meeting, patients with macular edema related to retinal vein occlusion had significant improvement in vision when treated with ranibizumab (Lucentis) in each of two dosages. In trials including approximately 400 patients apiece, researchers from Johns Hopkins University and Houston's Methodist Hospital randomized patients to monthly 0.5 mg or 0.3 mg intravitreal injections of ranibizumab, or to sham injections, for six months. Notably, 46 to 47 percent of patients in both ranibizumab groups improved by at least 15 letters, compared with 16.9 percent of the control group.

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Save your Vision Tips!

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Eat Dark, Leafy Greens

Spinach, kale, collard greens, and other deep-colored vegetables contain lutein and zeaxanthin, two carotenoids that “have been associated with reducing the risk of developing cataracts and macular degeneration”. Try to eat two servings a day―for example, a handful of spinach in your salad at lunch and a side of broccoli at dinner.

Antioxidants

Foods such as berries, oranges, plums, and cherries help minimize free-radical damage, which is caused by environmental factors (like sunlight and pollution) and can quicken the hardening of lenses and contribute to cataracts and macular degeneration. Eat at least two servings a day―a cup of blueberries with your breakfast, say, and an orange as an afternoon snack.

Take a Multivitamin

A National Eye Institute study showed that supplements with antioxidant vitamins C and E, beta-carotene, and the minerals copper and zinc slowed the progression of advanced macular degeneration in high-risk patients. And a recent article in the Archives of Internal Medicine concluded that vitamins B6 and B12 and folic acid may also help. Still other studies suggest that vitamins may delay the onset of cataracts.

Get Your Omega-3s

You’ve heard that they’re good for your heart, but “evidence suggests omega-3 fatty acids found in certain fish, such as salmon, halibut, and tuna, can help maintain the eyes’ protective tear film, minimize dry eyes, and even prevent cataracts. Eat two to three servings a week, or consider taking a fish-oil supplement every day. Also cut down on red meat: A recent study showed that high consumption levels may increase the risk of macular degeneration.

Get some Veggie

These crisp vegetables, as well as other orange offerings, like pumpkin and butternut squash, contain beta-carotene, a carotenoid that may help keep eyes healthy.

Swear by Sunglasses

UV light is a major player in the hardening of the lenses and the development of cataracts and macular degeneration. That means it’s important to wear sunglasses with dark lenses that filter out 100 percent of UV rays (the label should indicate this) whenever you’re outside. we also recommend patients to put on a hat. “All glasses allow some light in through the tops and the sides” . “It bounces off your cheeks and right into your eyes.” Choose one that has a brim of at least four inches.

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Vision impacts life success

MedPage Today reported that, according to a study published online in Ophthalmology, patients with age-related macular degeneration (AMD) have a 50 percent increased risk of coronary heart disease.



Researchers from the Singapore National Eye Center conducted a population-based cohort study of 1,786 patients who didn't have heart disease and 2,228 patients without stroke at baseline. Patients were between the ages of 69 and 97. The investigators found that those with early macular degeneration had a higher cumulative incidence of heart disease than those without (25.8 percent versus 18.9 percent).

Notably, there was a significantly higher cumulative incidence of heart disease for those with specific signs of early macular degeneration -- soft drusen, hyperpigmentation, and RPE depigmentation

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Handheld device detects blindness in infants

A new handheld device, developed in part by biomedical engineers at Duke University Medical Center, uses spectral domain optical coherence tomography to allow doctors to look for retinopathy of prematurity in infants, a condition that could lead to blindness.

The new device developed by Bioptigen, which creates a 3D image of the back of the eye, can even be taken to infants in the neonatal ICU, and can be used without ever touching an infant's eye. Researchers now say that it's time to determine what role the imaging could play in treatment decisions.

Duke Eye Center ophthalmologist Cynthia Toth compares the process to inspecting fish from the side of an aquarium instead of through an ocean's murky surface.

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