bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring the Progressing Glaucoma Patient – What Are the Challenges?
Authors: Termote Karolien , Zeyen Thierry ,   Department of Ophthalmology, University Hospitals Leuven,   Department of Ophthalmology, University Hospitals Leuven
Published: October 2015

Diagnosing glaucoma progression is complex. It is essential to assess both structure and function to detect progression. Establishing a reliable baseline is crucial in this process. A functional baseline requires repeated visual field testing. Documentation of the optic disc appearance is necessary for the acquisition of the structural baseline. This can be achieved by the complementary modes of both clinical and imaging devicebased optic disc documentation. Imaging-based methods to assess progression and rate of progression are likely to prove important in the future, but currently more guidance for their use in clinical practice is required. Rate of progression provides important information about the risk of vision loss. Guidelines therefore recommend determining the rate of progression for the individual patient when planning management. Adherence issues need to be addressed before changing treatment strategy, since poor compliance may play a considerable role in the progression of disease in many patients. In conclusion, we must strive to improve the management of glaucoma to limit the impact disease progression has on the patient’s quality of life.
New Technologies for Treating Glaucoma in Patients Undergoing Cataract Surgery
Authors: Lin Joseph L , Mayer Hylton R ,   Ophthalmology Resident,   Assistant Professor, Department of Ophthalmology and Visual Science, Yale University School of Medicine
Published: October 2015

New surgical technologies, such as the ExPRESS™ shunt, iCath™ canaloplasty, Trabectome™ and endoscopic cyclophotocoagulation (ECP), have been developed to provide safe and effective control of intraocular pressure (IOP) while avoiding many of the complications associated with trabeculectomies or traditional glaucoma drainage implants. A benefit of some of the newer technologies, especially for patients for whom traditional glaucoma surgeries may not previously have been considered, is that they can be readily performed at the time of cataract extraction. Many surgeons are combining these new surgical techniques with cataract surgery because of the low rate of serious complications, limited manipulation of ocular tissue (especially the conjunctiva) and/or faster visual recovery than traditional glaucoma surgeries.
Growth Factors and Ocular Scarring
Authors: Ellis James S , Paull Daniel J , Dhingra Sumit , Khalili Ashkan , Notara Maria , Brocchini Steve , Khaw Peng T ,   Pharmaceutics, The School of Pharmacy, University of London,   National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, and University College London Institute of Ophthalmology,   Ocular Repair and Regeneration Biology, University College London Institute of Ophthalmology,   Ocular Repair and Regeneration Biology, University College London Institute of Ophthalmology,   Pharmaceutics, The School of Pharmacy, University of London,   National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, and University College London Institute of Ophthalmology,   Ocular Repair and Regeneration Biology, University College London Institute of Ophthalmology,   Pharmaceutics, The School of Pharmacy, University of London,   National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, and University College London Institute of Ophthalmology,   Ocular Repair and Regeneration Biology, University College London Institute of Ophthalmology,   National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, and University College London Institute of Ophthalmology,   Ocular Repair and Regeneration Biology, University College London Institute of Ophthalmology,   Pharmaceutics, The School of Pharmacy, University of London,   National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, and University College London Institute of Ophthalmology,   Ocular Repair and Regeneration Biology, University College London Institute of Ophthalmology,   Pharmaceutics, The School of Pharmacy, University of London,   National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, and University College London Institute of Ophthalmology,   Ocular Repair and Regeneration Biology, University College London Institute of Ophthalmology
Published: October 2015

Growth factors play a part in every stage of the wound healing process that leads to scar tissue formation. Ocular scarring can cause decreased vision or blindness by virtue of the opaque nature of the new matrix that is deposited as scar tissue (as in the lens or cornea). In addition, the contractile nature of the ocular scar tissue is the most common cause of failed retinal attachment. Scar formation after glaucoma surgery can lead to surgery failure. Growth factors, particularly the transforming growth factor (TGF-βs), play a major role in scar tissue formation in the eye and induce the synthesis of growth factors that control cell migration, proliferation, enzyme production and matrix deposition. Neurotrophins are also neuroprotective and can delay ganglion cell death, thus delaying scar formation in the retina if retinal attachment is restored promptly. Growth factors can be seen as a major target for preventing ocular scarring in the future.
Tensioactive-mediated Transepithelial Corneal Cross-linking – First Laboratory Report
Authors: Pinelli Roberto , El-Shawaf Hytham IB , Al Marzouky Mohammad M ,   Istituto Laser Microchirurgia Oculare, Brescia,   Istituto Laser Microchirurgia Oculare, Brescia,   Istituto Laser Microchirurgia Oculare, Brescia
Published: October 2015

Purpose:The aim of this study was to investigate the possibility of delivering riboflavin into the corneal stroma for cross-linking with the aid of a tensioactive substance (benzalkonium chloride), without removing the epithelium, in order to make corneal cross-linking (CXL) a less invasive technique.Methods:Rabbit corneas were cross-linkedin vivowithout removal of the epithelium, using riboflavin solution 0.1% to which benzalkonium chloride solution was added. The corneas were then examined by light and electron microscopy for evidence of collagen cross-linking. Control non-treated eyes were compared with treated ones.Results:The treated corneas were stiff and yellow in colour, and on light microscope examination they showed straight compact collagen fibres in comparison with control corneas in approximately 50% of the corneal thickness. Electron microscopy revealed regular arrangement of fibres in the outer 200μm with reduced inter-fibre distances in the treated corneas, but with no noticeable differences between control and treated corneas in the inner 100μm.Conclusion:The addition of benzalkonium chloride to the riboflavin solution facilitated its entry to the corneal stroma through the epithelium, and CXL occurred without epithelium removal.
Corneal Epithelial Stem Cell and Disease – Past, Present and Future
Authors: Deng Sophie X ,   Assistant Professor, Jules Stein Eye Institute, University of California, Los Angeles
Published: October 2015

The ocular surface is covered by non-keratinised stratified epithelial cells that provide the first line of defence against external insults. Under normal conditions, the superficial layer of the corneal epithelium undergoes constant desquamation and is maintained by the basal layer through the regenerative process of self-renewal. This regeneration capacity depends on the corneal epithelial stem cells that are believed to reside at the basal layer of the limbal epithelium and hence are called limbal stem cells (LSCs). Deficiency of LSCs seen in many ocular diseases leads to the loss of vision as a result of invasion of the conjunctival epithelium and neovascularisation of the corneal surface. In this article, the aetiology, clinical presentation, diagnosis and current management of LSC deficiency are discussed, with an emphasis on new tissueengineering techniques to expand and regenerate LSCs for transplantation.
Canon CX-1 Combines Mydriatic and Non-mydriatic Multiple-mode Digital Retinal Imaging in One System
Authors: Wijk Chris van ,   Medical Division, Canon Europa NV
Published: October 2015

Canon’s CX-1 digital retinal camera is the latest innovation in its eye-care portfolio. Incorporating Canon’s electro-optical system (EOS) camera technology, the compact, fully portable system is synergised for mydriatic and non-mydriatic imaging in five modes, including fundus autofluorescence (FAF).
easyPhaco® Technology – A Quantum Leap
Authors: Gandorfer Arnd ,   Professor of Ophthalmology, Ludwig Maximilian University Eye Hospital, Munich
Published: October 2015

The requirements of modern cataract surgery are greater safety, efficiency and ease. Recently, several new technologies such as additional lateral movements of phaco tips or new software have been introduced to the market to increase safety and speed in cataract surgery; however, we may not need to go as far as this.easyPhaco®, a new device for cataract surgery, uses the laws of physics to create an entirely new fluidics concept with powerful fluidic settings and fail-safe surge suppression. Chamber collapses are practically eliminated thanks to strong inflow. Ultrasound transmission occurs in the axial direction only, and energy coupling efficiency is much greater than with traditional phaco. Since high vacuum strength and an optimised tip mouth result in easy occlusion and strong holdability, repulsion is eliminated and all energy is absorbed by the core material, with no lateral energy radiation.
Epithelial Debridement for Epithelial Basement Membrane Abnormalities Associated with Endothelial Disorders
Authors: Qian Ying , Dupps William J , Meisler David M , Jeng Bennie H ,   Cole Eye Institute, Cleveland Clinic,   Cole Eye Institute, Cleveland Clinic,   Cole Eye Institute, Cleveland Clinic,   Cole Eye Institute, Cleveland Clinic
Published: October 2015

Epithelial basement membrane dystrophy (EBMD) is a corneal condition most commonly observed as a primary disease; less commonly it can also be seen as secondary to endothelial cell dysfunction. Epithelial debridement with or without polishing of the Bowman layer is a safe and effective way of removing the dystrophic basement membrane and promoting a smoother epithelial surface. Indications for debridement include symptoms of recurrent corneal erosions and vision loss attributable to epithelial irregularity. In this article we also present follow-up data on patients for whom we have previously performed epithelial debridement for EBMD in the setting of Fuchs endothelial dystrophy and iridocorneal endothelial syndrome, with favourable visual outcomes. We also present two new cases of EBMD that limited visual acuity after Descemet stripping automated endothelial keratoplasty, who responded successfully to epithelial debridement.
Realtime Imaging of Retinal Ganglion Cell Apoptosis
Authors: Cordeiro Maria Francesca , Guo Li , Coxon Katy M , Duggan James , Nizari Shereen , Normando Eduardo , Russo-Marie Francoise , Migdal Clive , Bloom Philip , Fitzke Frederick W , Moss Stephen E ,   Glaucoma and Retinal Neurodegeneration Research Group, University College London Institute of Ophthalmology,   Visual Neurosciences, University College London Institute of Ophthalmology,   The Glaucoma Research Group, Western Eye Hospital, London,   Glaucoma and Retinal Neurodegeneration Research Group, University College London Institute of Ophthalmology,   Visual Neurosciences, University College London Institute of Ophthalmology,   Glaucoma and Retinal Neurodegeneration Research Group, University College London Institute of Ophthalmology,   Visual Neurosciences, University College London Institute of Ophthalmology,   Glaucoma and Retinal Neurodegeneration Research Group, University College London Institute of Ophthalmology,   Visual Neurosciences, University College London Institute of Ophthalmology,   Glaucoma and Retinal Neurodegeneration Research Group, University College London Institute of Ophthalmology,   Visual Neurosciences, University College London Institute of Ophthalmology,   Glaucoma and Retinal Neurodegeneration Research Group, University College London Institute of Ophthalmology,   Visual Neurosciences, University College London Institute of Ophthalmology,   Cell Biology Departments, University College London Institute of Ophthalmology,   The Glaucoma Research Group, Western Eye Hospital, London,   The Glaucoma Research Group, Western Eye Hospital, London,   Visual Neurosciences, University College London Institute of Ophthalmology,   Cell Biology Departments, University College London Institute of Ophthalmology
Published: October 2015

Retinal ganglion cell apoptosis has long been highlighted as an important early event in glaucoma. Recent work from our group has shown that it is possible to visualise its occurrencein vivousing detection of apoptosing retinal cells (DARC), a recently devised non-invasive realtime imaging technique using fluorescently labelled annexin V and ophthalmoscopy. To date, DARC has been used only experimentally, but phase I clinical trials are due to start shortly in glaucoma patients. Extrapolation of these initial studies suggests that DARC may provide a new and meaningful clinical end-point in glaucoma, enabling early identification before the onset of irreversible vision loss as well as quantitative tracking of cellular degeneration and response to treatment.
Intraocular Pressure Contact Lenses – Suitable for Everyday Use Yet?
Authors: Faschinger Christoph , Mossböck Georg ,   Medical Doctors, University Eye Clinic, Medical University Graz,   Medical Doctors, University Eye Clinic, Medical University Graz
Published: October 2015

The importance of intraocular pressure (IOP) as a relevant and treatable risk factor for the development or progression of glaucoma is evident. In managing this disease, to take only a single or a few measurements of this crucial parameter is definitely suboptimal. Technical research has developed contact lenses with embedded structures that are able to measure the IOP or surrogates over a longer period of time. One such system measures changes of the peripheral corneal curvature by means of strain gauges, and another measures the IOP by means of a piezoresistant membrane. Comfort is increased by wireless data transmission and miniaturisation of devices that do not influence visual acuity or daily/nightly activities. The safety and tolerability of the Triggerfish®contact lens is good and proved by several clinical observational studies. Missing are studies that confirm the reliability and reproducibility of the results. So far, no device can be recommended for everyday use in an ophthalmological office.
Presbyopic Intraocular Lenses – Managing Unhappy Patients
Authors: Barsam Allon , Donnenfeld Eric D ,   Appointed Ophthalmic Surgeon, Luton and Dunstable University Hospital, UK,   Partner, Ophthalmic Consultants of Long Island and Clinical Professor of Ophthalmology, New York University, US
Published: October 2015

We describe a system for improving patient satisfaction with presbyopic intraocular lenses (IOLs). Pre-operative education to set realistic expectations for the pros and cons of various IOL options are described. Each presbyopic IOL in widespread use in the US is then described in turn. Finally we lay out the seven Cs for improved patient satisfaction with presbyopic IOL surgery. The seven Cs are: consecutive treatment, cylinder and residual refractive error, capsular opacification, cystoid macular oedema, cornea and ocular surface disease, centration and circumference of the pupil relative to the IOL.
Glaucoma Pharmacogenetics
Authors: Pharmacogenetics Glaucoma , Faschinger Christoph ,   Department of Ophthalmology, Medical University Graz, Graz, Austria,   Department of Ophthalmology, Medical University Graz, Graz, Austria
Published: October 2015

An individuals’ reaction to a specific drug is influenced by various factors including environmental, systemic and genetic factors. In most cases the reactions of a group of individuals are of the Gaussian type with non- to low responders at the lower end of the curve and high- to ultra-high responders at the upper end of the curve. As these extraordinary reactions to a drug are at least partly genetically determined pharmacogenetics is set to decipher the underlying genetic constitution and to establish an individualised genotype-based drug therapy. Candidate genes in pharmacogenetics include genes of receptors as well as their downstream pathway and genes of drug metabolising or activating enzymes. Most prominent examples from the medical literature are warfarin, clopidogrel and various psychotropic and oncological drugs. Regarding glaucoma therapy studies investigating the role of polymorphisms in the genes of β-adrenergic receptors, the important metabolising enzymeCYP2D6and the prostaglandin F2〈 receptor have been performed. Results of these studies are presented and an outlook on the role of pharmocogenetics in glaucoma therapy will be provided.
Beyond Anti-VEGFs – Anti-Insulin Receptor Substrate-1 Oligonucleotides as a Novel Approach to Ocular Neovascular Disorders
Authors: Bainbridge James W , Loroch Vanya , Viaud Eric , Cursiefen Claus ,   Professor of Retinal Studies, National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and University College London (UCL), London, UK,   CEO, Loroch Communications, Essertines-sur-Rolle, Switzerland and Swiss Biotech Association, Zürich, Switzerland,   CEO, Gene Signal International SA, Lausanne, Switzerland,   Chairman and Professor, Department of Ophthalmology, University of Cologne, Cologne, Germany
Published: October 2015

Angiogenesis is a complex process that is vital to health but is also a driving factor behind a broad range of malignant, ischaemic, inflammatory, infectious and immune disorders. For optimal efficacy and safety, therapies aimed at preventing angiogenic-mediated disorders must differentiate between healthy and pathological angiogenesis or neovascularisation. Aganirsen is an antisense oligonucleotide that inhibits the insulin receptor substrate (IRS)-1 angiogenic pathway by targeting the IRS-1 messenger RNA. To date, studies of aganirsen have focused mainly on ocular disorders because of the ability to assess non-invasively the effect of the drug on neovascularisation and to address the unmet need for effective therapies in these blinding disorders. Aganirsen (GS-101) eye drops inhibit progressive corneal neovascularisation and appear to be well tolerated. The drug may offer an alternative and/or adjunct to intraocular anti-vascular endothelial cell growth factor (VEGF) agents, which are the current reference standards to prevent neovascularisation in retinal diseases. This is because it has a different and potentially complementary mechanism of action and can be administered topically. Antisense oligonucleotides targeting IRS-1 may present a valuable new approach to control pathological angiogenesis in the eye and elsewhere.
Optical Coherence Tomography ? Automatic Retina Classification Through Support Vector Machines
Authors: Bernardes, Rui , Serranho Pedro , Santos Torcato , Gonçalves Valter , Vaz José Cunha ,   Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal,   Institute of Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra, Coimbra, Portugal,   Mathematics Section, Department of Sciences and Technology, Open University, Lisbon, Portugal,   Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal,   Institute of Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra, Coimbra, Portugal;,   Institute of Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra, Coimbra, Portugal,   Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal,   Institute of Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Published: October 2015

Optical coherence tomography (OCT) is becoming one of the most important imaging modalities in ophthalmology due to its non-invasiveness and by allowing the visualisation the human retina structure in detail. It was recently proposed that OCT data embeds functional information from the human retina. Specifically, it was proposed that blood-retinal barrier status information is present within OCT data from the human retina. Besides this ability, the authors present data supporting the idea of having the OCT data encoding the ageing of the retina in addition to the disease (diabetes) condition from the healthy status. The methodology followed makes use of a supervised classification procedure, the support vector machine (SVM) classifier – based solely on the statistics of the distribution of OCT data from the human retina (i.e. OCT data between the inner limiting membrane and the retinal pigment epithelium). Results achieved suggest that information on both the healthy status of the blood–retinal barrier and on the ageing process co-exist encoded within the optical properties of the human retina.
Topical Bromfenac for Pseudophakic Cystoid Macular Edema ? Case Reports
Authors: Voyatzis George , Pitalia Anil , Vize Colin , Rajan Madhavan ,   Addenbrooke’s Hospital, Cambridge; UK,   SpaMedica, Manchester, UK,   Hull and East Yorkshire Eye Hospital, Hull, UK,   Addenbrooke’s Hospital, Cambridge,   Anglia Ruskin University, Cambridge, UK
Published: October 2015

Cystoid macular edema (CME) is the most common cause of visual loss following uncomplicated cataract surgery and although the condition usually resolves itself within several months, it can result in permanent vision loss in a minority of patients. There is a lack of consensus in diagnostic methods and definition of the condition and as a result, estimates of its incidence vary greatly, ranging from 4 to 41 %. There is also a scarcity of randomised controlled trial data to support the efficacy of ophthalmic agents in the prophylaxis and treatment of CME. However, a growing body of evidence supports the use of topical non-steroidal anti-inflammatory drugs (NSAIDs) both pre-and post-surgery. The importance of the prophylactic use of NSAIDs should be emphasized as many cases of CME are preventable. The combination of corticosteroids and NSAIDs may be more effective than either class of agents alone. The use of bromfenac for the treatment and prevention of CME is growing. Its unique chemical structure makes it highly lipophilic with rapid penetration of ocular tissues; it has sustained anti-inflammatory action and allows less frequent dosing (twice a day as opposed to three or four times a day). This article presents four case studies detailing rapid CME resolution following topical administration of bromfenac.
Long-term Therapies for Diabetic Macular Edema
Authors: Lotery Andrew J ,   Professor, University of Southampton, Southampton General Hospital, UK
Published: October 2015

Diabetic macular edema (DME) is one of the main causes of visual loss in diabetic patients. Although photocoagulation and intensive control of systemic metabolic factors have achieved improved outcomes, improvement is slow and some patients with DME continue to lose vision despite treatment. Pharmacological treatment options for DME include vascular endothelial growth factor (VEGF) antagonists such as ranibizumab, bevacizumab and pegaptanib and corticosteroids, whose multiple mechanisms of action include reduction of VEGF expression. Intravitreal delivery of these agents has shown efficacy in the treatment of DME but is associated with adverse effects including cataract progression and sustained rises in intraocular pressure. The physical characteristics and potent anti-inflammatory properties of fluocinolone acetonide (FAc) have led to its use in intravitreal implants. A number of intravitreal implants have been evaluated, of which the most effective at providing sustained drug release with an acceptable safety profile is the ILUVIEN® implant. This FAc intravitreal implant provides significant, long-lasting improvements in visual acuity for patients with chronic DME and has a manageable safety profile.
Can We Optimise the Medical Therapy of Glaucoma?
Authors: Gilbart James , Baudouin Christophe , Erb Carl , Pillunat Lutz ,   Principal Medical Writer, Touch Medical Media, London, UK,   Professor of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, Paris, France,   Professor, Eye Clinic Wittenbergplatz, Berlin, Germany,   Professor, Universitäts-Augenklinik, Dresden, Germany
Published: October 2015

The use of glaucoma medications containing the preservative benzalkonium chloride (BAK) is associated with a number of ocular symptoms including ocular surface disease and dry eye syndrome. These are debilitating conditions and current strategies of therapeutic escalation compound the problem. The effects are greater in sensitive patients and rises as the number of eye drops used increases. Preservative-free antiglaucoma medications are available and should be considered in patients with primary dry eye syndrome, ocular allergy, meibomian gland dysfunction, contact lens wearing, corneal and conjunctival adverse reactions to antiglaucoma medication and pre-operative to trabeculectomy. The importance of elevated diurnal variations in intraocular pressure (IOP) in glaucoma patients was also considered.
Anti-vascular Endothelial Growth Factor Pharmacotherapy in the Treatment of Subretinal Choroidal Neovascularisation
Authors: Barak Yoreh , Ihnen Mark A , Schaal Shlomit ,   Vitreo-Retinal Fellow,   Ophthalmology Resident,   Vitreo-Retinal Specialist, Director, Diabetic Retinopathy Service and Assistant Professor, Department of Ophthalmology and Visual Sciences, University of Louisville, Kentucky, US
Published: October 2015

Vascular endothelial growth factor (VEGF) plays a pivotal role in stimulating the growth of pathological subretinal choroidal neovascularisation (CNV). The increased production of VEGF and subsequent CNV formation can occur in degenerative, inflammatory and vascular diseases of the retina and choroid, often leading to severe visual impairment. Anti-VEGF agents which are readily available today are much better, more potent and longer acting in comparison with previous treatment modalities and therefore have dramatically improved the prognosis of patients with CNV. There are four intravitreal anti-VEGF pharmacotherapies proven by large prospective, multicentre, randomised trials to be effective in the treatment of age-related macular degeneration (AMD)-related CNV: pegaptanib (Macugen®, Eyetech Pharmaceuticals, Palm Beach Gardens, FL), ranibizumab (Lucentis®, Genentech, Inc., South San Francisco, CA), bevacizumab (Avastin®, Genentech, Inc., South San Francisco, CA) and VEGF Trap-Eye (Eylea® Regeneron, Tarrytown, NY). However, there are still many challenges and unanswered questions regarding the optimal anti-VEGF pharmacotherapy agent, the best clinical treatment regimen, the most effective dosage, the optimal injection frequency and the duration of treatment. The heavy burden of frequent injections on the elderly patient population and physicians begs for a simpler way of drug administration or development of more potent compounds.
Detecting Visual Field Progression in Glaucoma – Using the Right Tools for the Job
Authors: Saunders Luke J , Russell Richard A , Crabb David P ,   PhD Student, Department of Optometry and Visual Science, City University London,   Post-doctoral Research Fellow, Department of Optometry and Visual Science, City University London and NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London,   Professor of Statistics and Vision Research, Department of Optometry and Visual Science, City University London
Published: October 2015

Monitoring disease progression is at the centre of managing a patient with glaucoma. This article focuses specifically on how visual field measurements from standard automated perimetry (SAP) can be monitored over time. Various options for analysis on the Humphrey and Octopus perimeters are discussed, from summary indices to event and trend-based analyses; their respective merits and flaws evaluated. It is strongly recommended that quantitative analysis methods and software are used in assessing progression, as variability in threshold measurements makes detecting true deterioration non-trivial. Recommendations on the frequency of visual fields that should be taken per year are also discussed. The article concludes by putting the spotlight on new research being undertaken to improve the methods of measuring and predicting progression, as well as relating visual fields to patient visual disability and quality of life.
Ocular Surface Morbidities in Glaucoma
Authors: Benitez-del-Castillo Javier , Cantu-Dibildox Jorge , Galbis-Estrada Carmina , Pinazo-Duran Maria D ,   Glaucoma Department, UGC Oftalmología, Hospital General del S.A.S de Jerez de la Frontera,   Glaucoma Department, UGC Oftalmología, Hospital General del S.A.S de Jerez de la Frontera,   Ophthalmic Research Unit Santiago Grisolia, University Hospital Dr Peset, Valencia, Spain,   Ophthalmic Research Unit Santiago Grisolia, University Hospital Dr Peset, Valencia, Spain
Published: October 2015

Introduction:Ocular surface disease (OSD) is a major cause of ophthalmological consultation. Within this group, glaucoma patients constitute an important percentage due to the nature of their chronic topical treatment. Advances in the understanding of ocular surface pathology on both a cellular and molecular level, and the interaction to the toxic nature of some topical medication solution compounds, are stimulating the development of better alternatives in topical treatment.Materials and Methods:Extensive review of available literature and current research on topical ophthalmological treatments in both OSD and glaucoma was performed. Emphasis was made on inflammatory modulators of the ocular surface and pathological changes associated with the use of preservatives in solutions, in particular benzalkonium chloride (BAK). Independent research is been also performed by the authors, using a rubbing-induced reflex tears collecting method with capillary tubes. Cytokines in tear samples were subsequently analysed with the multi-Plex System (Luminex® R-200). The 12 cytokines analysed using this method are the interleukins (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, the tumour necrosis factor alpha (TNFα), the vascular endothelial growth factor (VEGF), the granulocyte-macrophage-colony stimulating factor (GM-CSF) and the interferon gamma (IFg).Results:Our unpublished, preliminary results trend to show higher values in IL-5 and IL-6 in glaucoma patients than in normal controls. Also, higher values in IL-2, IL-5 and IL-12 in dry eye syndrome (DES) patients were found versus normal controls.Conclusions:Inflammation is an important element in OSD and strong association seems to exist between this and the use of BAK preservative. New kinds of preservative molecules, as well as single-dose eye drops and sophisticated dispensing bottle mechanisms, are currently available on the market in order to avoid the secondary effects of this topical treatments, increasing patient compliance and adherence to chronic topical glaucoma treatment.
Disease Update on Human Tear Proteome
Authors: Versura Piera , Campos Emilio C ,   Lab Head, Laboratory for Ocular Surface Analysis,   Emilio Campos, Professor and Chief of Ophthalmology, Ophthalmology Unit, Alma Mater Studiorum University of Bologna, S Orsola-Malpighi Teaching Hospital, Bologna, Italy
Published: October 2015

Tear film is a thin layer of non-newtonian fluid covering and protecting cornea and conjunctiva epithelia. The multifaced functions of tears are reflected by their complex structure and advances in proteomics/metabolomics/lipidomics technologies have greatly deepened the knowledge of the chemical composition of tears. The purpose of this article is to survey recent advances in proteomic analysis of human tears and to summarise the most relevant proteins proposed as biomarkers in dry eye. Besides, the potential clinical application of these biomarkers is discussed.
Intravitreal Bevacizumab for Treatment of Diabetic Macular Oedema
Authors: Ramin Ramin , Azarmina Mohsen , Soheilian Masoud ,   Assistant Professor of Ophthalmology,   Associate Professor of Ophthalmology,   Professor of Ophthalmology, Ophthalmology Department and Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran,   Professor of Ophthalmology, Negah Eye Hospital, Tehran, Iran
Published: October 2015

Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Numerous early studies suggest an important role for intravitreal anti-VEGF agents such as bevacizumab in the management of DMO. We reviewed manuscripts that had investigated pharmacokinetic, efficacy, safety, dose and frequency of intravitreal bevacizumab (IVB) injections as well as effect of macular ischaemia, initial macular thickness and optical coherence tomography (OCT) patterns of DMO on the final results of treatment with IVB. In summery literature searches disclosed that almost all studies published up to now provided evidence supporting use of IVB for treatment of either naïve or persistent DMO in short and long term up to 2 years.
The Evidence Supporting Ranibizumab in the Treatment of Neovascular Age-related Macular Degeneration
Authors: Kelly Simon P , Amoaku Winfried ,   Consultant Ophthalmic Surgeon, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK,   Associate Professor/Reader and Hon Consultant Ophthalmologist, Academic Division of Ophthalmology and Visual Sciences, Eye and ENT Centre, University Hospital, Queens Medical Centre, Nottingham, UK
Published: October 2015

The efficacy and safety of ranibizumab in neovascular age-related macular degeneration (AMD) or wet AMD has been demonstrated in the large phase III ANCHOR and MARINA trials. Further studies including the PIER, PrONTO, EXCITE and SUSTAIN trials have also evaluated the optimal dosing regimen of ranibizumab. Various head-to-head studies have compared the anti-angiogenic treatments for wet AMD. The CATT and IVAN trials compared the safety and efficacy of ranibizumab with off-label use of bevacizumab and raised concern about an increased risk of ocular and systemic adverse events (AEs) in patients receiving bevacizumab compared with those receiving ranibizumab. Studies such as SAILOR and HORIZON have shown that ranibizumab has a good safety profile and is well tolerated for over 4 years with few serious ocular and systemic AEs.
Ranibizumab in Treatment for Age-related Macular Degeneration
Authors: Araiz Javier , Arias Luis , García-Layana Alfredo , Ruiz-Moreno José María ,   Department of Ophthalmology, University of the Basque Country Medical School, Bilbao,   Instituto Clínico Quirúrgico de Oftalmología (ICQO), Bilbao,   RETICS OFTARED (RD12/0034) Prevention, early detection and treatment of the prevalent degenerative and chronic ocular pathology Institute of Health Carlos III, Madrid, Spain,   RETICS OFTARED (RD12/0034) Prevention, early detection and treatment of the prevalent degenerative and chronic ocular pathology Institute of Health Carlos III, Madrid, Spain,   Department of Ophthalmology, Bellvitge University Hospital,   Associate Professor of Ophthalmology, University of Barcelona Medical School,   RETICS OFTARED (RD12/0034) Prevention, early detection and treatment of the prevalent degenerative and chronic ocular pathology Institute of Health Carlos III, Madrid, Spain,   Department of Ophthalmology, Clínica Universidad de Navarra, University of Navarra Medical School, Pamplona,   RETICS OFTARED (RD12/0034) Prevention, early detection and treatment of the prevalent degenerative and chronic ocular pathology Institute of Health Carlos III, Madrid, Spain,   Department of Ophthalmology, University of Castilla la Mancha Medical School, Albacete,   Visum Corporation, Alicante, Spain
Published: October 2015

Ranibizumab is an antibody fragment (Fab) that binds and inhibits all isoforms of vascular endothelial growth factor (VEGF), which is considered the main target in neovascular age-related macular degeneration (nAMD). Based on scientific evidence of the Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD (ANCHOR)/Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD (MARINA) studies, intravitreal ranibizumab is indicated in all typical types of nAMD. Nevertheless, specific forms such as retinal angiomatous proliferation (RAP), polypoidal choroidal vasculopathy (PCV) and bad or non-responders may need combination therapies to increase the efficacy and reduce the number of injections. Due to the frequent office visits and injections required with a monthly ranibizumab therapy, several dosing strategies have been evaluated to maintain optimal efficacy while reducing the number of injections and visits in the clinical practice.Pro re nata(PRN) and Treat and Extend are the most popular individualised therapeutic regimens. Few studies address long-term results of ranibizumab. It remains controversial whether initial good results can be maintained over time. AMD is a chronic disease and a significant proportion of patients require continued treatment.
Management of Diabetic Macular Oedema – Challenges and Solutions Along the Patient Journey
Authors: Augustin Albert J , Lightman Sue , Loewenstein Anat , Cunha-Vaz José
Published: October 2015

A symposium hosted by the European Society of Ophthalmology discussed challenges in the management of diabetic macular oedema (DMO). Clinical evidence suggests that the longer the duration of DMO, the worse the response to anti-vascular endothelial growth factor (anti-VEGF) agents and better the response to corticosteroids. This is explained by the fact that inflammation is involved in the perpetuation of retinal changes in diabetes. At early disease stages, VEGF is primarily responsible for retinal changes; however, chronic microglia activation resulting from retinal damage leads to cytokine production by retinal cells and subsequent inflammatory cascades. Steroids are most effective at this stage. Clinical trial data have demonstrated the efficacy of the Iluvien® fluocinolone acetonide (FA) intravitreal implant, which retains its efficacy in disease of long duration. However, it is important to remember two things: that diabetes is a multifactorial disease with potential complications and to monitor for safety effects. In terms of the latter, anti-VEGF agents are associated with potential systemic effects, whereas steroids raise intraocular pressure and are associated with increased incidence of cataract.
Intravitreal ILUVIEN® Implant for Diabetic Macular Oedema – Early Case Experiences
Authors: Bertelmann Thomas , Messerschmidt-Roth Anke ,   Senior Physician,   Study Co-ordinator, Department of Ophthalmology, Philipps University, Marburg, Germany
Published: October 2015

Diabetic macular oedema (DMO) is an important cause of vision loss and challenges remain in the treatment of this progressive disease. Corticosteroids provide a comprehensive treatment approach, lowering the concentration of inflammatory cytokines and growth factors such as vascular endothelial growth factor (VEGF). However, intravitreal injections are often short-lived and are associated with intraocular side effects. The ILUVIEN® intravitreal implant contains fluocinolone acetonide and is administered by injection into the vitreous cavity. Its efficacy and safety have been demonstrated in clinical studies, and a subgroup analysis has shown that it is particularly beneficial in patients with long-standing DMO  a group with poor visual outcomes and limited treatment options. As a result, the ILUVIEN implant has been approved in Europe for the treatment of visual impairment due to chronic DMO considered insufficiently responsive to available therapies. These data have been supported by real-use clinical experience and two cases are presented that demonstrate the effectiveness of the ILUVIEN implant in two patients where prior therapies including ranibizumab have not produced a sustained beneficial effect.
Navigated Laser Therapy for Diabetic Macular Oedema
Authors: Kernt Marcus , Ulbig Michael , Kampik Anselm , Neubauer Aljoscha S ,   Consultant and Retina Specialist, Department of Ophthalmology,   Consultant and Retina Specialist, Department of Ophthalmology,   Head of Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Germany,   Consultant and Retina Specialist, Department of Ophthalmology
Published: October 2015

Navigated laser therapy introduces computerised assistance systems to retinal laser photocoagulation treatment. As main benefits over conventional laser, the Navilas system offers high precision and safety and provides additional advantages regarding standardisation of planning, execution, documentation, quality assurance and better overall treatment comfort for the patient. Navigated laser therapy is being used with good success in the treatment of diabetic macular oedema (DMO), retinal vein occlusions (RVO) and fast-pattern navigated panretinal photocoagulation in proliferative diabetic retinopathy (PDR). In centre-involving DMO, a combination of anti-vascular endothelial growth factor (VEGF) and macular laser may provide advantages over anti-VEGF monotherapy. In terms of navigated laser therapy, recent study data from our clinic and other institutions indicate that combined initial anti-VEGF and navigated macular laser therapy allows treatment success to be achieved and maintained with a significantly reduced number of interventions.
Evaluation of Corneal Vessels
Authors: Anijeet Deepa R , Tey Adrian , Zheng Yalin , Sueke Henri , Ahmed Sajjad , Kaye Stephen B ,   Consultant in Ophthalmology, Greater Glasgow and Clyde NHS Trust, UK,   Consultant in Ophthalmology, St Pauls Eye Unit, Liverpool, UK,   Lecturer, Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, UK,   Academic Clinical Fellow, St Pauls Eye Unit, Liverpool, UK,   Senior Lecturer and Consultant in Ophthalmology, St Pauls Eye Unit and Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, UK,   Consultant and Honorary Professor in Ophthalmology, St Pauls Eye Unit and Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, UK
Published: October 2015

Corneal new vessels can result in significant loss of vision as well as reduce graft survival. Recently, newer treatment modalities have been introduced. However, attempts to meet the challenge of evaluating corneal vessels by quantification are evolving.In vivoevaluations range from computer-aided analysis of colour images to determination of area, diameter and tortuousity of blood vessels on indocyanine green angiography images. Attempts at developing a fully automated process of evaluation and quantification are hampered by the anatomical variations of limbus, random nature of blood vessels and multiple levels of involvement of the corneal stroma. Currently, semi-automated methods require manually fixing the limbus prior to quantification of vessels. Using indocyanine green angiography, the full extent of corneal vessels even in the presence of scarring can be determined. With the evolution of new techniques, it is hoped that a robust corneal vessel quantifying tool will be described in the near future that will aid the effectiveness of treatment strategies.
Anti–vascular Endothelial Growth Factor Therapy for Myopic Choroidal Neovascularisation
Authors: Badal Josep , Amselem Luis , Aleman Ricardo , Huste Frederic ,   Retinal and Vitreous Surgery, Ophthalmology Department, Moises Broggi Hospital, Barcelona, Spain,   Retinal and Vitreous Surgery, Ophthalmology Department, Moises Broggi Hospital, Barcelona, Spain,   Retinal and Vitreous Surgery, Ophthalmology Department, Moises Broggi Hospital, Barcelona, Spain,   Retinal and Vitreous Surgery, Ophthalmology Department, Moises Broggi Hospital, Barcelona, Spain
Published: October 2015

Pathological myopia represents the most common cause of choroidal neovascularisation in young patients. Its natural course has a devastating prognosis. Several treatments have been assessed, but photodynamic therapy is currently the only approved treatment for subfoveal choroidal neovascularisation related to pathological myopia. Anti-vascular endothelial growth factor therapy has demonstrated promising results in any form and localisation of choroidal neovascularisation, although there is an absence of data obtained from randomised clinical trials. The aim of this article is to compare different treatment options, combinations and retreatment criteria for the management of choroidal neovascularisation in eyes with high myopia.
Psychophysical Exams as Early Indicators of Diabetic Retinopathy
Authors: Pescosolido Nicola , Buomprisco Giuseppe ,   Professor, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences,   Resident Physician (Intern), University Sapienza of Rome, Faculty of Medicine and Dentistry, Department of Sense Organs, Rome, Italy
Published: October 2015

Retinopathy is a serious and common complication of diabetes that represents the leading cause of blindness, among people of working age, in developed countries. It is estimated that the number of people with diabetic retinopathy (DR) will increase from 126.6 million in 2011 to 191 million by 2030. The visual function that seems to be affected first in the course of DR is probably the contrast sensitivity; in addition, being mainly a macular function, the perception of colour is also compromised. Moreover, the duration of the disease, the levels of glycated haemoglobin (HbA1c) and the presence of cystoid macular oedema are strongly associated with the impairment of fixation stability in patients with diabetes with clinically significant macular oedema, suggesting the possible diagnostic role of microperimetry. The test of contrast sensitivity and the microperimetry and the chromatic sensitivity tests have proved to be useful, safe, reproducible and inexpensive tools to diagnose the disease early.