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Going public- monkey minds moving mental mountains A research article on monkeys using mind control to play video games may not have a lot to do with ophthalmology, but it has wider significance in the world of scientific journal publishing. The article (Nicolelis et al.) is among the first to appear in a new journal, the Public Library of Science Biology. The new journal is the brainchild of Harold Varmus former director of the US National Institutes of Health. The journal boasts all of the features of the best peer-reviewed journals; with one notable exception- it provides immediate, free and unlimited access to its online content. The Public Library of Science offerings will soon include another free journal PLOS Medicine, with several other titles in the works. See it for yourself at www.plos.org Eye disease increasing among elderly A large US study confirms what most ophthalmologists already suspected, the number of elderly people with common eye diseases associated with aging has risen substantially over the past decade. The researchers analysed a random national sample of Medicare beneficiaries 65 years and older who were followed from 1991 to 1999 or until death. During that period diabetic retinopathy among diabetic patients increased from 6.9% to 17.4%. Glaucoma increased from 4.6% to 13.8% and the prevalence of age-related macular degeneration increased from 5.0% to 27.1%. The proportion of patients with at least one of the three diseases studied increased from 13.4% to 45.4%. Noting that the trend will continue to get worse as the population ages, the researchers called for increased efforts to intervene early in cases of treatable or preventable disease. Arch Ophthalmol, Lee, P. et al. ‘Longitudinal Prevalence of Major Eye Diseases', 2003;121:1303-1310. Cataract risk increases with inhaled steroids The risk of cataract associated with inhaled corticosteroid use does appear to be dose-related, a large British population based case-control study suggests. The study analysed data from 15,479 cataract patients and an equal number of controls. The analysis revealed that the risk was relatively modest in patients receiving daily doses of inhaled steroids in the range of 400 mcg, but that the risk increased considerably at daily doses exceeding 1600 mcg. The associated risk also increased with duration of use. The authors advise that patients receive the lowest doses of inhaled steroids that will provide good control of airway disease. British Journal of Ophthalmology, Smeeth L, et al., ‘A population based case-control study of cataract and inhaled corticosteroids' 2003;87:1247-1251 Ketotifen eye drops for allergic conjunctivitis Ketotifen eye drops offer a useful therapeutic option for treatment of patients with seasonal allergic conjunctivitis, an Australian study concludes. Researchers there randomised 519 patients to receive ketotifen fumarate 0.025% ophthalmic solution, vehicle (as placebo), or levocabastine hydrochloride 0.05% ophthalmic suspension, twice daily in each eye for four weeks. Response rates were significantly better with ketotifen than with placebo, 49.5% vs. 33%. Ketotifen also produced significantly better relief of signs and symptoms than levocabastine (p<0.05). British Journal of Ophthalmology, Kidd M, et al., ‘Efficacy and safety of ketotifen eye drops in the treatment of seasonal allergic conjunctivitis' 2003;87:1206-1211 Laser treatment benefits long-lasting Laser treatment of proliferative diabetic retinopathy provides benefits lasting nearly 20 years, a long-term follow-up study shows. US researchers report follow-up data on 214 patients treated in the Early Treatment Diabetic Retinopathy Study (ETDRS) 13 to 19.5 years (mean 16.7 years) after initial laser treatment with early scatter photocoagulation. While only 39% patients were still alive for the analysis, 84% of those maintained visual acuity of 20/40 in the better eye.. Ophthalmology, Chew EY et al, ‘The Long-Term Effects of Laser Photocoagulation Treatment in Patients with Diabetic Retinopathy' 2003;110(9):1683-1689 Endophthalmitis with intravitreal triamcinolone Noninfectious endophthalmitis is a rare but serious complication of intravitreal triamcinolone injection in the treatment of macular conditions, report US retina specialists. They describe seven cases of patients who developed noninfectious endophthalmitis following intravitreal triamcinolone injection for indications including refractory cystoid macular oedema or diffuse macular oedema associated with diabetic retinopathy, macular pucker, branch retinal vein occlusion, or pseudophakia. The patients developed extensive inflammatory responses one or two days after injection. All eyes had an anterior chamber cellular reaction and vitritis. Visual acuity was poor, ranging from 20/400 to hand movements. Cultures were negative for any organisms, the inflammation subsided and visual acuity eventually returned to pre-injection levels. The authors recommend careful observation of potential cases of noninfectious, toxic endophthalmitis in patients treated with intravitreal triamcinolone before assuming it to be infectious, especially in the absence of eye pain. Archives of Ophthalmology, Roth DB et al, ‘Non-infectious Endophthalmitis Associated With Intravitreal Triamcinolone Injection' Sept; 121(9):1279-82. HRT may relieve dry eye Hormone replacement therapy may relieve dry eye symptoms in post-menopausal patients, report Italian researchers. They enrolled 50 healthy post-menopausal women, mean age 53 years, in a prospective, controlled, randomised study. Half of the women received transdermal 17-beta-estradiol (50 µg/day) and medroxyprogesterone acetate (10 mg/day) for 12 days per cycle, while the remaining women received no treatment. Eye examinations conducted at baseline and after three and six months of therapy revealed significant increases in basal and stimulated lachrymal secretion in association with active treatment. The researchers also noted a significant decline in intraocular pressure and a nonsignificant increase in corneal thickness in patients on active treatment. Menopause, Affinito P et al. ‘Effects of hormone replacement therapy on ocular function in postmenopause', 2003; 10(5):482-7.
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