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Dr. Mark Siegel, MD FAAO

Health, Sea Island Ophthalmology, eyes

Can fish oil help dry eye?

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By Dr. Mark Siegel

While artificial tears or ointments are a common treatment for dry eye, studies suggest consuming omega-3 fatty acid supplements may also provide relief. 

Omega-3 oils appear to improve function in the eye’s meibomian glands, which produce the oily part of tears. Improved function of those glands can ease dry eye symptoms.

Dry eye becomes more common as a person ages. The problem develops when the eye cannot maintain a healthy coating of tears. 

Dry eye can be caused by hormonal changes brought on by menopause. There are also a number of other causes. These include a dry environment or workplace (such as wind or air conditioning); sun exposure; smoking or secondhand smoke exposure; or cold or allergy medicines.

The National Eye Institute notes that in some patients with dry eye, supplements or dietary sources of omega-3 fatty acids (such as tuna fish or salmon) may decrease symptoms of irritation.

Omega-3s in fish oil are believed to reduce inflammation. If inflammation of the eyelids or surfaces of the eye worsens dry eye, it makes sense that a supplement could help the problem. 

Dry eye is pretty complex, and there is no cure. However, treating the inflammation can improve some of the symptoms and there are many studies that support this.

A study of more than 32,000 women from the Women’s Health Study published in 2005 found those who consumed the most omega-3 fats from fish had a 17 percent lower risk of dry eye, compared with women who ate little or no seafood. More recently, a study in the International Journal of Ophthalmology concluded omega-3 fatty acids “have a definite role for dry eye syndrome.”

Omega-3 oils may also help in the treatment of other eye diseases. The oils may reduce growth of abnormal blood vessels that occur in age-related macular degeneration and other retinal vascularization diseases. 

Talk to your doctor to find out whether omega-3 supplements are right for you. 

And as 2017 comes to a close, Sea Island Ophthalmology wishes everyone a safe and happy holiday, good health and vision in the New Year!

Dr. Mark Siegel is the medical director at Sea Island Ophthalmology at 111 High Tide Drive (off Midtown Drive near Low Country Medical Group). Visit www.seaislandophthalmology.com.

Being outdoors may reduce kids’ risk of nearsightedness

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By Dr. Mark Siegel

Spending time outdoors is one of childhood’s delights. Now, eye research suggests it may also be a key to our eye health, as long as we avoid over-exposure to sunlight. 

Although spending too much time outdoors without protection from the sun’s ultraviolet (UV) light can damage eyes and skin, new studies show that natural light may be essential for normal eye development in kids.

Encouraging children to spend more time outdoors may be a simple and cost-effective way to improve their vision as well as general health, according to several recent studies. They add to the growing evidence that spending time outdoors may lower the risk of nearsightedness in children and adolescents. 

Nearsightedness is more common today in the United States and many other countries than it was in the 1970s.

One of the new studies showed that for each additional hour children spent outdoors per week, their risk of being nearsighted dropped by about 2 percent. 

Nearsighted children in this study spent on average 3.7 fewer hours per week outdoors than those who either had normal vision or were farsighted. The study investigated whether children who logged more outdoor time also spent less time performing near work, such as playing computer games or studying, but no such relationship was found.

A second study found that when schoolchildren were required to spend 80 minutes of recess time outdoors every day, fewer of them became nearsighted when compared to children who were not required to spend recess outdoors. 

Another study, with Danish children, was the first to show that the rate of eye growth varies in relation to exposure to daylight. This is important, because if the eye grows too long, as measured from front to back, the child will be nearsighted. The children’s eyes grew normally during the long days of summer in Denmark, but grew too fast during the short days of winter.

Though researchers don’t yet know exactly why outdoor time is beneficial, they think it’s probably related to exposure to daylight rather than to playing sports or other specific activities.

At this time, scientists think that UV light is not needed for normal eye development. So, they think kids can gain the eye health benefits and other pluses of playing outdoors and at the same time protect their eyes from long-term UV damage. Just make sure they wear UV-blocking sunglasses and hats when out in the sun. This goes for teens and young adults, as well.

Future studies are planned to learn more about how time outdoors supports healthy vision. Questions include whether time spent on near work should be limited, and whether there are factors — like parents’ attitudes, access to safe playgrounds, or others — that may result in nearsighted children spending less time outdoors. More research is also needed to explain how much of the outdoor time benefit comes from daylight exposure and how much from exercising distance vision, since both of these may be key factors in preventing nearsightedness. 

Dr. Mark Siegel is the medical director at Sea Island Ophthalmology at 111 High Tide Drive (off Midtown Drive near Low Country Medical Group). Visit www.seaislandophthalmology.com.

Laser or traditional cataract surgery?

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By Dr. Mark Siegel

Are you planning to have cataract surgery? If so, you may be offered a choice of two surgical options: traditional manual cataract surgery or laser-assisted cataract surgery.

Traditional cataract surgery is one of the most common surgeries in the world. It is recognized as being safe and effective. 

Laser cataract surgery, which is not covered by insurance plans, costs more than traditional cataract surgery but provides some advantages in terms of precision and accuracy — in the proper situation. 

So how do you decide which type of cataract surgery to have?

Here are some things you should understand about both kinds of cataract surgery. Talk with your ophthalmologist to determine the best type of surgery for you.

Traditional cataract surgery

With traditional cataract surgery, called phacoemulsification, the eye surgeon creates a small incision in the side of the cornea by hand with a scalpel blade. 

An instrument is inserted through this incision into the area behind the pupil where the eye’s lens sits in a capsule or bag. The surgeon uses a cystatome (bent needle) instrument to create a circular opening in the lens capsule. Then a special pen-shaped probe is inserted through that opening to apply sound waves (ultrasound) to break up the cloudy center of the lens. 

Then the broken-up pieces of lens are suctioned out of the eye. An artificial intraocular lens (IOL) is implanted to replace the cloudy natural lens. 

The side walls of the corneal incision will be filled with a special liquid and self-seal after surgery, so most commonly stitches are not needed.

Laser-assisted cataract surgery

With laser-assisted cataract surgery, a camera/ultrasound imaging device (OCT) is placed over your eye to map its surface and gather information about the lens. 

The device sends detailed information to a computer that programs the laser for the exact location, size and depth of the incisions. 

The surgeon uses the laser to make the corneal incisions, especially astigmatic incisions, and the opening in the lens capsule. 

Energy from the laser is also used to soften the cataract into fragments. Then the ultrasound probe used in traditional cataract surgery is used to gently suction them out of the eye. The IOL is implanted. 

As with traditional cataract surgery, the corneal incision usually does not require stitches.

What’s best for you

Under today’s Medicare guidelines, only certain patients may be offered laser-assisted cataract surgery.

Specifically, your ophthalmologist can offer it if you have astigmatism diagnosed during your cataract consultation and would like to have that refractive error corrected during cataract surgery. 

In this situation, the laser is used to create specific incisions, called limbal relaxing incisions in the cornea to reshape it, treating the astigmatism.

You may also be offered laser cataract surgery if you choose to have a premium lens implanted, such as an astigmatism-correcting toric IOL or a multifocal IOL.

Ophthalmologists who use laser cataract removal technology recognize that it allows them to see and map the lens capsule better and place the opening in the capsule more precisely, allowing for better centering and placement of the IOL.

Can you choose to have laser-assisted cataract surgery if you don’t have either of the conditions above?

Current Medicare guidelines say that a surgeon may not offer and charge for the laser-assisted cataract surgery unless one of the two conditions above is met.

Recovery from surgery

The recovery period for both laser-assisted cataract surgery and traditional cataract surgery is the same. 

Some people can see clearly almost immediately, while others may find their vision clears within about a week or two. 

Studies have shown that laser cataract surgery reduces the amount of ultrasonic energy required to break up the cataract which may reduce post-operative swelling. 

Remember that it takes about three months to fully recover from cataract surgery.

Benefits of surgery

What benefits does laser cataract surgery offer that traditional cataract surgery does not?

Using a laser to do cataract surgery allows the surgeon to make very precise incisions in less time. It can improve accuracy and precision in the surgical steps. And laser-assisted cataract surgery can provide a higher degree of correction for a refractive error, such asastigmatism, than traditional cataract surgery.

However, it is important to be aware that studies have not shown that laser-assisted cataract surgery results in fewer complications or better visual outcomes than traditional cataract surgery. 

With any type of cataract surgery, your outcome depends in large part on the skill and experience of your eye surgeon.

For some people, simply replacing a cloudy lens with a clear implant and wearing glasses for some activities is perfect. For others, achieving the best possible vision without glasses after cataract surgery is the goal. 

Your vision needs and expectations can help you and your ophthalmologist decide the best surgical option for you.

Dr. Mark Siegel is the medical director at Sea Island Ophthalmology at 111 High Tide Drive (off Midtown Drive near Low Country Medical Group). Visit www.seaislandophthalmology.com.

Early detection key to treating cataracts in kids

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By Dr. Mark Siegel

Many people think cataracts only happen to older people, but children can get cataracts too. Both pediatric cataracts and cataracts from aging are a clouding in the lens of the eye that can cause blurry vision or blindness.

In adults, cataracts occur after the eyes and vision are developed and stable. Most adults can have good vision again after the cataracts are removed. Because children’s eyes are still developing until they’re 8 or 10 years old, untreated cataracts can have serious long-term effects on their vision. But early detection and prompt treatment can prevent permanent vision loss in children with cataracts.

Types, causes vary

Pediatric cataracts can be congenital (present at birth) or acquired (develop after birth).

They can occur in one eye (unilateral) or both eyes (bi-lateral). Bi-lateral cataracts can be asymmetric (one cataract is more severe than the other).

Cataracts may appear in different parts of the lens and range in size from tiny dots to dense clouds.

They can be caused by genetic predisposition, metabolic disorders such as diabetes or trauma to the eye that damages the lens. Sometimes they occur spontaneously.

A traumatic cataract in a child's eye. The injury also damaged the iris.
A traumatic cataract in a child’s eye. The injury also damaged the iris.

Early detection

An eye’s lens must be clear to focus the images it sees onto the retina, which then transmits the images to the brain. A cataract can prevent light from reaching the retina or cause light rays to scatter as they pass through the cloudiness. This distorts the retinal image.

For children, whose eyes and brain are still learning to see, distortion can lead to amblyopia (lazy eye). Without proper treatment, pediatric cataracts can cause abnormal connections between the brain and the eye. Once made, these connections are irreversible.

Most pediatric cataracts are detected when the child is examined at birth, before they even leave the hospital. Many more are detected by pediatricians at well-baby exams and some are noticed by parents. They are often noticed as a missing or irregular red reflex test on pediatric screening exams.

Acquired cataracts are most often diagnosed at vision screenings by the pediatrician or after an eye injury.

Pediatric cataract in a child born with aniridia (missing iris).
Pediatric cataract in a child born with aniridia (missing iris).

Long-term strategy

Treatment for pediatric cataracts can vary depending on the type and severity. But the vast majority of children need surgery to remove the cataracts. 

Unlike adults with full-sized eyes, children require specialized surgical instrumentation and techniques. When performed by an experienced pediatric cataract surgeon, cataract removal is generally safe. The most common risks include glaucoma, retinal detachment, infection and the need for more surgeries.

For most children, surgery is just the first step to rehabilitate the eyes. Ongoing treatment must repair eye-brain connections. This involves teaching the eyes how to focus properly.

After surgery, children often need some combination of contact lenses, intraocular lenses implanted in the eye or glasses. If amblyopia has developed, the child may need patching. This treatment involves covering the stronger eye to stimulate vision in the weaker eye.

Children who receive timely treatment and follow-up have a good prognosis. Successful outcomes may require years of individualized visual rehabilitation.

Dr. Mark Siegel is the medical director at Sea Island Ophthalmology at 111 High Tide Drive (off Midtown Drive near Low Country Medical Group). Visit www.seaislandophthalmology.com.

Take care when watching eclipse of the sun

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By Dr. Mark Siegel

On Monday, Aug. 21, the entire United States will see a partial eclipse of the sun. Parts of 11 states will experience a total solar eclipse, including South Carolina. 

If you get a chance to see it, make sure to take care of your vision during the eclipse. 

To see a complete eclipse of the sun, you need to be in the right place. The area that will have a complete eclipse – the path of totality – is only 70 miles wide and will move across the continent very quickly. Plan now for where you want to be. You may want a backup plan in case weather gets in the way of your view of the sky. Beaufort County is NOT in the path of totality, therefore we will only see a partial eclipse.

The only time it is safe to look directly at the sun is when it is completely covered by the moon during the totality phase of the eclipse. You must protect your eyes during the rest of the eclipse or you could damage your retina, possibly causing blindness.

Areas outside the path of totality will have a partial eclipse. Only part of the sun is blocked even at the peak of the eclipse. In those areas, there is no safe time to look at the sun with the naked eye. 

You must protect your eyes while watching the entire eclipse. This would include those of us in Beaufort County.

A truly awe-inspiring event, a solar eclipse is when the moon blocks any part of the sun from our view. The bright face of the sun is covered gradually by the moon during a partial eclipse, lasting a few hours. 

During the brief period of a total eclipse when the moon fully covers the sun (only a couple of minutes), the light of day gives way to a deep twilight sky. The sun’s outer atmosphere (called the solar corona) gradually appears, glowing like a halo around the moon in front of it. Bright stars and planets become more visible in the sky.

Watching a solar eclipse is a memorable experience, but looking directly at the sun can seriously damage your eyes. Staring at the sun for even a short time without wearing the right eye protection can damage your retina permanently. It can even cause blindness, called solar retinopathy.

There is only one safe way to look directly at the sun, whether during an eclipse or not: through special-purpose solar filters. These solar filters are used in “eclipse glasses” or in hand-held solar viewers. They must meet a very specific worldwide standard known as ISO 12312-2.

Keep in mind that ordinary sunglasses, even very dark ones, or homemade filters are not safe for looking at the sun.

Here are some steps to follow for safely watching a solar eclipse:

• Carefully look at your solar filter or eclipse glasses before using them. If you see any scratches or damage, do not use them.

• Always read and follow all directions that come with the solar filter or eclipse glasses. Help children to be sure they use handheld solar viewers and eclipse glasses correctly.

• Before looking up at the bright sun, stand still and cover your eyes with your eclipse glasses or solar viewer. After glancing at the sun, turn away and remove your filter — do not remove it while looking at the sun.

• The only time that you can look at the sun without a solar viewer is during a total eclipse. When the moon completely covers the sun’s bright face and it suddenly gets dark, you can remove your solar filter to watch this unique experience. Then, as soon as the bright sun begins to reappear very slightly, immediately use your solar viewer again to watch the remaining partial phase of the eclipse.

• Never look at the uneclipsed or partially eclipsed sun through an unfiltered camera, telescope, binoculars or other similar devices. This is important even if you are wearing eclipse glasses or holding a solar viewer at the same time. The intense solar rays coming through these devices will damage the solar filter and your eyes.

• Talk with an expert astronomer if you want to use a special solar filter with a camera, a telescope, binoculars or any other optical device.

For information about where to get the proper eyewear or handheld viewers, check out the American Astronomical Society. 

NASA will have a live stream of the eclipse that can be watched online, which is exactly what we’ll be doing.

Dr. Mark Siegel is the medical director at Sea Island Ophthalmology at 111 High Tide Drive (off Midtown Drive near Low Country Medical Group). Visit www.seaislandophthalmology.com.

Enjoy summer sun, but protect eyes from UV rays

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By Dr. Mark Siegel

We all use sunscreen to protect our skin, but don’t forget to protect your eyes as well. 

Summertime means more time spent outdoors, and studies show that exposure to bright sunlight may increase the risk of developing cataracts and growths on the eye, including cancer. 

The same risk applies when using tanning beds, so be sure to protect your eyes from indoor UV light as well. Sunlight reflected off sand and water can cause photokeratitis, the condition responsible for snow blindness, so beach- and pool-goers take note.

UV radiation, whether from natural sunlight or indoor artificial rays, can damage the eye’s surface tissues as well as the cornea and lens.

Unfortunately, many people are unaware of the dangers UV light can pose. 

By wearing UV-blocking sunglasses, you can enjoy the summer safely while lowering your risk for potentially blinding eye diseases and tumors. 

It is important to start wearing proper eye protection at an early age to protect your eyes from years of ultraviolet exposure.

According to a national Sun Safety Survey conducted by the American Academy of Ophthalmology, only about half of people who wear sunglasses say they check the UV rating before buying. The good news is that you can easily protect yourself. 

In order to be eye smart in the sun, the American Academy of Ophthalmology recommends the following:

• Wear sunglasses labeled “100 percent UV protection”: Use only glasses that block both UV-A and UV-B rays and that are labeled either UV400 or 100 percent UV protection.

• Choose wraparound styles so that the sun’s rays can’t enter from the side.

• If you wear UV-blocking contact lenses, you’ll still need sunglasses.

• Wear a hat along with your sunglasses; broad-brimmed hats are best.

• Remember the kids: It’s best to keep children out of direct sunlight during the middle of the day. Make sure they wear sunglasses and hats whenever they are in the sun.

• Know that clouds don’t block UV light: The sun’s rays can pass through haze and clouds. Sun damage to the eyes can occur any time of year, not just in summer.

• Be extra careful in UV-intense conditions: Sunlight is strongest mid-day to early afternoon, at higher altitudes and when reflected off of water, ice or snow.

By embracing these simple tips you and your family can enjoy the summer sun safely while protecting your vision.

Dr. Mark Siegel is the medical director at Sea Island Ophthalmology at 111 High Tide Drive (off Midtown Drive near Low Country Medical Group). Visit www.seaislandophthalmology.com.

Avoid unlicensed clinics offering unapproved stem cell therapy

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By Dr. Mark S. Siegel

Stem cell therapies are getting headlines for their potential to cure diseases, including those that affect vision. But an important message is missing: the therapies are not yet proven to be safe and effective for your eyes.

Stem cell treatments appear to offer hope to people with few options to recover vision. This includes people with forms of age-related macular degeneration (AMD), retinitis pigmentosa (RP) and Stargardt disease. 

Some clinics across the United States offer “stem cell therapy” to people outside of clinical trials. But the U.S. Food and Drug Administration (FDA) has not approved the treatments they offer. These treatments often use unproven products that may be ineffective or dangerous. These products may carry serious risks, including tumor growth.

Questions to ask

It is important that you know that there are no stem cell products approved by the FDA for eye disease right now. 

If you want stem cell therapy, look for a clinical trial and discuss the matter with your ophthalmologist. A clinic should not expect you to pay thousands of dollars for an unproven, unapproved therapy. Your health insurance will not cover the cost of an unapproved treatment.

Before agreeing to a stem cell treatment, ask:

• Is the stem cell treatment approved by the FDA?

• Is the stem cell treatment part of an FDA-approved clinical trial?

• Is the stem cell treatment covered by your health insurance?

It is frustrating and frightening to face the loss of vision while waiting for potential treatments. However, choosing to pursue an unproven treatment in an unlicensed clinic is an unacceptable risk to your vision and your overall health.

Dr. Mark S. Siegel is the medical director at Sea Island Ophthalmology on Ribaut Road. Visit www.seaislandophthalmology.com.

Study: Alzheimer’s patients benefit from eye surgery

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By Dr. Mark S. Siegel

Researchers at Tenon Hospital in Paris have found that patients with mild Alzheimer’s disease whose vision improved after cataract surgery also showed improvement in cognitive ability, mood, sleep patterns and other behaviors.

This is the first study to specifically assess whether cataract surgery could benefit Alzheimer’s patients, although earlier research had shown that poor vision is related to impaired mood and thinking skills in older people and that cataract surgery could improve their quality of life. 

Thirty-eight patients, average age 85 and all exhibiting mild dementia due to Alzheimer’s disease, completed the study. 

All participants had debilitating cataract in at least one eye and were appropriately treated with standard cataract surgery and implantation of intraocular lenses, which replace the eyes’ natural lenses in order to provide vision correction. 

After surgery, distance and near vision improved dramatically in all but one of the Alzheimer’s patients.

A neuropsychologist assessed the Alzheimer’s patients for mood and depression, behavior, ability to function independently and cognitive abilities at one month before and three months after cataract surgery. 

Cognitive status, the ability to perceive, understand and respond appropriately to one’s surroundings, improved in 25 percent of patients. Depression was relieved in many of them, and the level of improvement was similar to what commonly occurs after cataract surgery in elderly people who do not have dementia. 

No changes were found in patients’ level of autonomy, that is, their ability to function independently.

Sleep patterns improved and nighttime behavior problems decreased in most study patients. 

Other studies have shown that when cataracts are removed, levels of the sleep-regulating hormone melatonin become normalized. Dr. Girard notes that this may have been a key factor in the Alzheimer’s patients’ improved sleep patterns.

Since removing cataracts can improve the ability of patients with Alzheimer’s disease to function, improve their mood, cognition and sleep patterns, then this is another means to help those we love with this debilitating disease.

Dr. Mark S. Siegel is the medical director at Sea Island Ophthalmology on Ribaut Road in Beaufort. 

Visit www.seaislandophthalmology.com for more information.

New treatments for dry age-related macular degeneration

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By Dr. Mark S. Siegel

Macular degeneration is currently the leading cause of visual impairment in the U.S.

Breakthrough treatment with anti-VEGF eye injections such as Avastin (bevacizumab, Genentech), Lucentis (ranibizumab, Genentech) and Eylea (aflibercept, Regeneron) has almost arrested the progression of the wet form of the disease.

However, almost 80 percent of people diagnosed with age-related macular degeneration (AMD) have the non-neovascular (dry) or atrophic subtypes.

The American Academy of Ophthalmology notes that the most advanced form of non-neovascular AMD, known as geographic atrophy (GA), can occur as early as in intermediate AMD or (more typically) in advanced AMD.

Estimates predict advanced AMD will impact as many as 3 million people in at least one eye by 2020.

The growing number of aging Americans underscores the need for treatments that can prevent progression of and/or treat advanced AMD.

Trials underway 

Surprisingly, no treatments are currently available for the prevention of GA. Evidence from the Age-Related Eye Disease Study (AREDS) suggests antioxidant vitamin and mineral supplementation may help prevent the progression to neovascular AMD, but the study failed to show that vitamin supplementation decreased progression to geographic atrophy.

Even in AREDS2, when beta-carotene was replaced with lutein/zeaxanthin to decrease the risk of lung cancer, the new formulation also failed to show decreased progression to GA.

Clinical studies are underway to further elucidate and understand the mechanisms of dry AMD and to evaluate new therapeutics directed at slowing the progression.

There are currently two large phase 3 trials underway for the treatment of GA. The FILLY study assesses the safety, tolerability and evidence of activity of multiple intravitreal (IVT) injections of APL-2 (Apellis Pharmaceuticals) for patients with GA. The second is a multicenter, randomized, double-masked, sham-controlled study to investigate IVT injections of lampalizumab in patients with GA.

The discovery of complement byproducts in drusen led to associations between complement dysregulation and AMD.

Thus, several researchers are evaluating the complement cascade as a clinical therapeutic target for non-neovascular AMD.

Factor D is considered a critical early component of the alternative pathway that involves complement factor H. Factor D is an upstream of factor B and other AMD-associated proteins, making it a potential powerful target for treatment.

Anti-inflammatory agents under development include lampalizumab, fluocinolone, glatiramer acetate, sirolimus, eculizumab and ARC-1905.

These are but the tip of the iceberg of compounds under development for advanced AMD or GA.

Visual cycle inhibitors are among those in latter-stage development and include fenretinide, ACU-4429 and ALK-001.

These compounds down-regulate the visual cycle to decrease the accumulation of the toxic waste products of retinal metabolism. Amyloid-beta has been found in drusen, and RN6G and GSK933776 are in development to regulate amyloid-beta accumulation.

Neuroprotective drugs are also under development, including UF-021, ciliary neurotrophic factor and brimonidine tartrate intravitreal implant.

Topical agents such as MC-1101 are attempting to slow AMD by increasing choroidal perfusion.

Stem cell therapies including HuCNS-SC and MA09-hRPE are also under investigation as potential treatments for GA.

At this point, it is too early to tell which — if any — of these treatments will become a standard of care.

Dr. Mark S. Siegel is the Medical Director at Sea Island Ophthalmology on Ribaut Road in Beaufort. 

Visit www.seaislandophthalmology.com for more information.

New class of glaucoma drugs in development

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By Dr. Mark S. Siegel

Primary Open Angle Glaucoma is the most common type of glaucoma. An increase in eye pressure, intraocular pressure (IOP), occurs slowly over time, leading to vision loss. Higher IOP is thought to be the result of changes in the eye that lead to an obstruction in the outflow of fluid, called aqueous humor.

Large clinical studies have shown that, with reduction in IOP, optic nerve damage and progressive visual loss can be slowed or minimized.

Glaucoma therapies

Current drug treatments are directed towards lowering IOP. Treatments to reduce IOP rely on topical eye drop medications, laser and or conventional surgery.

Many patients require more than one drug to control IOP, and despite effective current therapies, they don’t work for all patients.

Current glaucoma medications reduce IOP by either reducing the production of fluid in the eye, or by increasing its outflow. Prostaglandins, which increase outflow, are now the most prescribed glaucoma treatment worldwide.

Glaucoma drugs

A new class of glaucoma drugs promises to act specifically on the eye’s drainage canals, called the trabecular meshwork, a main outflow and blockage site in glaucoma.

Rho kinase (ROCK) inhibitors target cells in the trabecular meshwork to enhance aqueous humor outflow. Aqueous humor is a clear fluid that maintains the intraocular pressure.

In research models of glaucoma, ROCK inhibitors have been shown to reduce cellular “stiffness” and enhance outflow through the trabecular meshwork, thereby reducing IOP. No drugs currently on the market enhance the eye’s fluid outflow in this way. Therefore this is a novel and unique target and approach to lowering IOP.

ROCK inhibitors are not yet approved and available for glaucoma patients.

Two U.S. companies, Aerie and Altheos, are currently in clinical research development with topical ROCK inhibitors to lower IOP.

Research data has shown that ROCK inhibition has the potential to offer neuroprotective and anti-inflammatory effects as well as enhance blood flow to the optic nerve, all of which could benefit glaucoma patients.

The ophthalmic community looks forward to and awaits the clinical research data as it becomes available for this potentially exciting class of drug compounds.

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