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Browning D.J.,NC Associates | Kaiser P.K.,Cleveland Clinic | Rosenfeld P.J.,Bascom Palmer Eye Institute
American Journal of Ophthalmology | Year: 2012

• PURPOSE: To describe the pharmacokinetics, preclinical studies, and clinical trials of the newly approved anti-vascular endothelial growth factor (VEGF) drug aflibercept (Eylea (VEGF Trap-Eye); Regeneron; and Bayer). • DESIGN: Review with editorial commentary. • METHODS: A review of the medical literature and pertinent Internet postings combined with analysis of key studies with expert opinion regarding the use of aflibercept for the treatment of exudative age-related macular degeneration. • RESULTS: Aflibercept, a fusion protein with binding domains from native VEGF receptors, binds VEGF-A, VEGF-B, and placental growth factors 1 and 2 with high affinity. Preclinical ophthalmologic studies demonstrated that aflibercept suppresses choroidal neovascularization in several animal models. The results of phase 1 and 2 trials showed excellent short-term suppression of choroidal neovascularization in patients with exudative agerelated macular degeneration and suggested a longer durability of aflibercept compared with other anti-VEGF drugs. The pivotal phase 3 Vascular Endothelial Growth Factor (VEGF) Trap-Eye: Investigation of Efficacy and Safety in Wet Age-Related Macular Degeneration 1 and 2 trials showed that monthly and bimonthly aflibercept were noninferior to monthly ranibizumab at preventing vision loss (< 15-letter loss) with comparable vision gains and safety. Year 2 treatment involved monthly pro re nata injections with required injections every 3 months and maintained vision gains from the first year, with an average of 4.2 injections of aflibercept and 4.7 injections of ranibizumab. • CONCLUSIONS: Aflibercept promises to deliver excellent visual outcomes for exudative age-related macular degeneration patients while undergoing fewer injections compared with ranibizumab. With a wholesale cost of $1850 per dose, the cost per patient with aflibercept treatment promises to be lower than with ranibizumab. © 2012 by Elsevier Inc. All rights reserved.


News Article | February 21, 2017
Site: www.24-7pressrelease.com

BOSTON, MA, February 21, 2017-- Bascom Palmer Eye Institute has installed the Ceeable Visual Field Analyzer (CVFA) digital health technology. Bascom Palmer Eye Institute is a world class teaching and research institution for ophthalmology. CVFA was designed to offer caregivers the ability to perform visual field testing of patients in non-traditional test locations such as, primary clinics, geriatric clinics, and adult care centers.The CVFA is a cloud-based digital platform for the detection and characterization of visual field distortions due to retinal disease, which includes patients with AMD and diabetic retinopathy. Moreover, CVFA allows monitoring progression of diseases affecting vision. The CVFA will deliver rapid, accurate and low-cost visual field testing to patient populations that may not have access to traditional vision testing services."We have selected the Ceeable system to deliver visual field testing technology to a large portion of the patient population who are unable to access care at traditional test locations," says Dr. Delia DeBuc, research associate professor of ophthalmology at Bascom Palmer Eye Institute. CVFA will be used in a clinical research study sponsored by the Finker Frenkel Legacy Foundation, Inc. The study is investigating retinal features that have been associated with cognitive decline and brain alternations in relation to aging and brain abnormalities in early Alzheimer's disease.CVFA has successfully tested thousands of patients in the United States and across the globe, delivering and enabling much-needed efficient and effective eye care services to a diverse patient population.Bascom Palmer Eye Institute is ranked the nation's best in ophthalmology by U.S. News & World Report, for 12 consecutive years. The Institute serves as the Department of Ophthalmology for the University of Miami Miller School of Medicine, www.bascompalmer.org About CeeableCeeable, Inc. is a leader in digital mobile health for ophthalmology. The Ceeable Visual Field Analyzer (CVFA) is cloud-based digital platform used to detect and diagnose retinal disease. There are more than 300 million people worldwide that suffer from retinal disease. The Ceeable technology can reach more people worldwide than any currently available retinal diagnostic technology. Better patient management of eye disease will reduce healthcare costs and help prevent blindness, www.ceeable.com


Zarbin M.A.,Rutgers University | Casaroli-Marano R.P.,University of Barcelona | Rosenfeld P.J.,Bascom Palmer Eye Institute
Developments in Ophthalmology | Year: 2014

Age-related macular degeneration (AMD) is the most common cause of blindness among people over age 55 years in industrialized countries. Known major risk factors for AMD include: age >55 years, history of smoking, white race, and mutations in various components of the complement system. Early AMD is characterized by the presence of drusen and pigmentary abnormalities. Late AMD is associated with central visual loss and is characterized by the presence of choroidal neovascularization and/or geographic atrophy. Early AMD is associated with a number of biochemical abnormalities including oxidative damage to retinal pigment epithelium (RPE) cells, complement deposition in the RPE-Bruch's membrane-choriocapillaris complex, lipidization of Bruch's membrane, and extracellular matrix abnormalities (e.g. collagen crosslinking, advanced glycation end product formation). Antiangiogenic drugs block the vascular leakage associated with choroidal new vessels, thus reducing retinal edema and stabilizing or restoring vision. At this time, there are no proven effective treatments for the nonexudative complications of AMD. Modern ocular imaging technologies (including spectral domain and phase variance optical coherence tomography, short- and long-wavelength fundus autofluorescence, adaptive optics-scanning laser ophthalmoscopy, and near-infrared reflectance) enable one to follow changes in the RPE, photoreceptors, and choriocapillaris quantitatively as the disease progresses. In addition, one can quantitatively assess the volume of drusen and areas of atrophy. These data, when correlated with the known histopathology of AMD, may provide useful measures of treatment efficacy that are likely to be more sensitive and reproducible than conventional end points such as visual acuity and rate of enlargement of geographic atrophy. As a result, these imaging technologies may be valuable in assessing the effects of cell-based therapy for patients with AMD. © 2014 S. Karger AG, Basel.


News Article | February 16, 2017
Site: www.marketwired.com

BAR HARBOR, ME--(Marketwired - February 16, 2017) - In mice genetically predisposed to glaucoma, vitamin B added to drinking water is effective at preventing the disease, a research team led by Jackson Laboratory Professor and Howard Hughes Medical Investigator Simon W.M. John reports in the journal Science. Glaucoma is one of the most common neurodegenerative diseases, affecting an estimated 80 million people worldwide. In most glaucoma patients, harmfully high pressure inside the eye or intraocular pressure leads to the progressive dysfunction and loss of retinal ganglion cells. Retinal ganglion cells are the neuronal cells that connect the eye to the brain via the optic nerve. Increasing age is a key risk factor for glaucoma, contributing to both harmful elevation of intraocular pressure and increased neuronal vulnerability to pressure-induced damage. The vitamin administration was surprisingly effective, eliminating the vast majority of age-related molecular changes and providing a remarkably robust protection against glaucoma. It offers promise for developing inexpensive and safe treatments for glaucoma patients. "We wanted to identify key age-related susceptibility factors that change with age in the eye," John says, "and that therefore increase vulnerability to disease and in particular neuronal disease." By understanding general age-related mechanism, there is the potential to develop new interventions to generally protect from common age-related disease processes in many people. Conducting a variety of genomic, metabolic, neurobiological and other tests in mice susceptible to inherited glaucoma, compared to control mice, the researchers discovered that NAD, a molecule vital to energy metabolism in neurons and other cells, declines with age. "There's an analogy with an old motorbike," John says. "It runs just fine, but little things get less reliable with age. One day you stress it: you drive it up a steep hill or you go on really long journey and you get in trouble. It's less reliable than a new bike and it's going to fail with a higher frequency than that new bike." The decrease in NAD levels reduces the reliability of neurons' energy metabolism, especially under stress such as increased intraocular pressure. "Like taking that big hill on your old bike, some things are going to fail more often," John says. "The amount of failure will increase over time, resulting in more damage and disease progression." In essence, the treatments of vitamin B (nicotinamide, an amide form of vitamin B , also called niacinamide) boosted the metabolic reliability of aging retinal ganglion cells, keeping them healthier for longer. "Because these cells are still healthy, and still metabolically robust," says JAX Postdoctoral Associate Pete Williams, first author of the study, "even when high intraocular pressure turns on, they better resist damaging processes." The researchers also found that a single gene-therapy application of Nmnat1 (the gene for an enzyme that makes NAD from nicotinamide) prevented glaucoma from developing in this mouse model. "It can be a problem for patients, especially the elderly, to take their drugs every day and in the correct dose," Williams says. "So gene therapy could be a one-shot, protective treatment." He notes that gene therapies, through injections into the eye, have been approved for a handful of very rare, human genetic eye disorders, and their demonstration of an important age-dependent factor may enable gene therapy for more common eye disease. John says that the team is pursuing clinical partnerships to begin the process of testing the effectiveness of vitamin B treatment in glaucoma patients. They are also exploring potential applications for the treatment in other diseases involving neurodegeneration. Collaborating with the John lab was Vittorio Porciatti of the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, and the late Nobel Laureate Oliver Smithies of the University of North Carolina, Chapel Hill. Funding sources for the research included National Eye Institute grant EY11721, the Barbara and Joseph Cohen Foundation, and National Heart, Lung and Blood Institute grant HL49277. Simon John is an Investigator of the Howard Hughes Medical Institute, and a research assistant professor in the opthalmology department of Tufts University School of Medicine. The Jackson Laboratory is an independent, nonprofit biomedical research institution based in Bar Harbor, Maine, with a National Cancer Institute-designated Cancer Center, a facility in Sacramento, Calif., and a genomic medicine institute in Farmington, Conn. It employs 1,800 staff, and its mission is to discover precise genomic solutions for disease and empower the global biomedical community in the shared quest to improve human health. Williams et al.: Vitamin B modulates mitochondrial vulnerability and prevents glaucoma in aged mice. Science, February 16, 2017, doi:10.1126/science.aal0092.


News Article | February 16, 2017
Site: www.eurekalert.org

In mice genetically predisposed to glaucoma, vitamin B3 added to drinking water is effective at preventing the disease, a research team led by Jackson Laboratory Professor and Howard Hughes Medical Investigator Simon W.M. John reports in the journal Science. The vitamin administration was surprisingly effective, eliminating the vast majority of age-related molecular changes and providing a remarkably robust protection against glaucoma. It offers promise for developing inexpensive and safe treatments for glaucoma patients. Glaucoma is one of the most common neurodegenerative diseases, affecting an estimated 80 million people worldwide. In most glaucoma patients, harmfully high pressure inside the eye or intraocular pressure leads to the progressive dysfunction and loss of retinal ganglion cells. Retinal ganglion cells are the neuronal cells that connect the eye to the brain via the optic nerve. Increasing age is a key risk factor for glaucoma, contributing to both harmful elevation of intraocular pressure and increased neuronal vulnerability to pressure-induced damage. "We wanted to identify key age-related susceptibility factors that change with age in the eye," John says, "and that therefore increase vulnerability to disease and in particular neuronal disease." By understanding general age-related mechanism, there is the potential to develop new interventions to generally protect from common age-related disease processes in many people. Conducting a variety of genomic, metabolic, neurobiological and other tests in mice susceptible to inherited glaucoma, compared to control mice, the researchers discovered that NAD, a molecule vital to energy metabolism in neurons and other cells, declines with age. "There's an analogy with an old motorbike," John says. "It runs just fine, but little things get less reliable with age. One day you stress it: you drive it up a steep hill or you go on really long journey and you get in trouble. It's less reliable than a new bike and it's going to fail with a higher frequency than that new bike." The decrease in NAD levels reduces the reliability of neurons' energy metabolism, especially under stress such as increased intraocular pressure. "Like taking that big hill on your old bike, some things are going to fail more often," John says. "The amount of failure will increase over time, resulting in more damage and disease progression." In essence, the treatments of vitamin B3 (nicotinamide, an amide form of vitamin B3, also called niacinamide) boosted the metabolic reliability of aging retinal ganglion cells, keeping them healthier for longer. "Because these cells are still healthy, and still metabolically robust," says JAX Postdoctoral Associate Pete Williams, first author of the study, "even when high intraocular pressure turns on, they better resist damaging processes." The researchers also found that a single gene-therapy application of Nmnat1 (the gene for an enzyme that makes NAD from nicotinamide) prevented glaucoma from developing in this mouse model. "It can be a problem for patients, especially the elderly, to take their drugs every day and in the correct dose," Williams says. "So gene therapy could be a one-shot, protective treatment." He notes that gene therapies, through injections into the eye, have been approved for a handful of very rare, human genetic eye disorders, and their demonstration of an important age-dependent factor may enable gene therapy for more common eye disease. John says that the team is pursuing clinical partnerships to begin the process of testing the effectiveness of vitamin B3 treatment in glaucoma patients. They are also exploring potential applications for the treatment in other diseases involving neurodegeneration. Collaborating with the John lab was Vittorio Porciatti of the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, and the late Nobel Laureate Oliver Smithies of the University of North Carolina, Chapel Hill. Funding sources for the research included National Eye Institute grant EY11721, the Barbara and Joseph Cohen Foundation, and National Heart, Lung and Blood Institute grant HL49277. Simon John is an Investigator of the Howard Hughes Medical Institute, and a research assistant professor in the opthalmology department of Tufts University School of Medicine. The Jackson Laboratory is an independent, nonprofit biomedical research institution based in Bar Harbor, Maine, with a National Cancer Institute-designated Cancer Center, a facility in Sacramento, Calif., and a genomic medicine institute in Farmington, Conn. It employs 1,800 staff, and its mission is to discover precise genomic solutions for disease and empower the global biomedical community in the shared quest to improve human health.


Chang T.C.,Bascom Palmer Eye Institute | Cavuoto K.M.,Bascom Palmer Eye Institute
Current Opinion in Ophthalmology | Year: 2014

PURPOSE OF REVIEW: This article reviews the potentially adverse neurodevelopmental effects of early exposure to general anesthesia and examines a changing paradigm in the management of pediatric glaucoma. RECENT FINDINGS: Literature across multiple subspecialties has examined the potentially neurotoxic effects of general anesthesia on the developing childs brain. Associations between general anesthesia exposure early in life and attention deficit hyperactivity disorder, language processing, and cognition have been suggested but not confirmed. Several population studies support the conclusion that early anesthetic exposure may increase the risk of neurodevelopmental deficits, although this is unsupported in sibling cohorts. Newer technology such as rebound tonometry may decrease the frequency of examination under anesthesia in the long-term management of patients with pediatric glaucoma and may decrease the risk of these potentially adverse neurodevelopmental outcomes. SUMMARY: As the potential long-term adverse neurodevelopmental effects of general anesthesia become better understood, pediatric glaucoma specialists should be cognizant of the relative lifelong risks and benefits of repeat examinations under anesthesia in young patients. © 2014 Wolters Kluwer Health.


Aziz H.A.,Bascom Palmer Eye Institute
Journal of pediatric ophthalmology and strabismus | Year: 2011

A 3-year-old girl with Down syndrome presented with a macular lesion in both eyes. With intraoperative optical coherence tomography confirmation, the patient was diagnosed as having bilateral macular coloboma. These findings were previously reported in two patients with Down syndrome. The documentation of similar findings in three separate patients suggests that macular coloboma may be a rare ophthalmic pathology associated with Down syndrome. Moreover, optical coherence tomography imaging may be a useful adjunct in diagnosing macular coloboma in the pediatric population. Copyright 2011, SLACK Incorporated.


Galor A.,Bascom Palmer Eye Institute | Galor A.,University of Miami | Lee D.J.,University of Miami
Current Opinion in Ophthalmology | Year: 2011

Purpose of review: To review recent data on the effects of smoking on ocular health. RECENT FINDINGS: Smoking has been associated with a myriad of negative ocular health effects including age-related macular degeneration (ARMD) and cataract. Most recently, several papers have demonstrated a connection between smoking and ocular inflammation. Smokers are both more likely to develop ocular inflammation and to have more severe disease as manifested by poorer presenting vision and a higher risk of recurrent disease compared to nonsmokers. Smoking has also been shown to enhance the effect of genetic susceptibility with regards to the presence and development of ARMD. Finally, the negative effects of smoking on ocular disease have been increasingly documented in nonwhite populations outside of the USA. However, despite the abundance of data, public awareness on the adverse consequences of smoking on vision is lacking in the USA. In contrast, Australia improved public knowledge by launching a successful antitobacco health campaign highlighting the effects of smoking on ocular health. SUMMARY: These findings suggest that eye care professionals should discuss and offer options for smoking cessation as part of the management of patients with ocular diseases, especially in those with ocular inflammation, ARMD, lens opacities/cataract, and thyroid-associated orbitopathy. Health campaigns using existing medical data can improve public awareness on the connection between tobacco and visual impairment. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Aziz H.,Bascom Palmer Eye Institute
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye | Year: 2011

The authors report the histopathologic features of a human enucleated eye with an Ex-PRESS shunt (Optonol, Ltd., Neve Ilan, Israel). An 86-year-old man with a blind painful eye underwent enucleation. He had a history of glaucoma with an Ex-PRESS shunt implanted. Histopathologic evaluation of the specimen showed a thin layer of fibrotic tissue surrounding the implant. In this case, the Ex-PRESS shunt was relatively well tolerated in the human eye. Copyright 2011, SLACK Incorporated.


Suk K.K.,Bascom Palmer Eye Institute
Journal of pediatric ophthalmology and strabismus | Year: 2010

Posterior retinopathy of prematurity (ROP) is unusual in its atypical features and its aggressive, rapidly progressive course. It is more difficult to recognize and to treat, with many of these eyes progressing to retinal detachment despite multiple treatments with laser or cryotherapy. The authors present a case of aggressive posterior ROP refractory to multiple laser treatment. This patient was successfully treated with intravitreal bevacizumab, but required repeat treatment 4 months later. The second injection with bevacizumab was followed by progression to retinal detachment requiring surgery. The patient remains stable after surgery. Copyright 2010, SLACK Incorporated.

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