This Issue At A Glance

Abstract

Elevated CRP and Homocysteine Levels Associated with Age-Related Macular DegenerationPrevious epidemiological studies evaluating risk factors common to both age-related macular degeneration (AMD) and cardiovascular disease suggest that the diseases may have similar etiological mechanisms. To explore this hypothesis, Vine et al (p. 2076) evaluated 2 novel markers of cardiovascular disease: high-sensitivity C-reactive protein (CRP), which is a marker of systemic inflammation that has been shown to be an independent risk factor and predictor of cardiovascular disease, and plasma homocysteine, a sulfur-containing amino acid formed during methionine metabolism—another independent risk factor for cardiovascular disease. In a case–control study of 79 affected individuals and 77 unaffected individuals from the AMD Genetic Study Group, elevated CRP and homocysteine levels were found in patients with AMD relative to the unaffected patients. The authors conclude that these data indicate an association between elevated CRP and homocysteine levels and point to the role of chronic inflammation and atherosclerosis in the pathogenesis of AMD. They call for further studies to delineate this role.Long-Term Results of Macular RPE Translocation Surgery in AMD “Disappointing”A 5- to 6-year follow-up of 4 of 9 patients with age-related macular degeneration (AMD) who originally underwent macular retinal pigment epithelium (RPE) translocation surgery for choroidal new vessels (CNVs) has revealed a further decline in visual acuity and loss of foveal fixation—problems that occurred after the original 2-year follow-up results were published. MacLaren et al (p. 2081) also observed late changes in autofluorescence, increasing over the graft donor site and virtually disappearing over the graft itself. Yet the RPE graft itself seemed viable when assessed by optical coherence tomography, fluorescein angiography, and indocyanine green angiography, and no patient suffered a recurrence of CNVs. The authors conclude that although the long-term results of this pilot study were “disappointing,” a detailed analysis of the events occurring after the initial surgery could provide key insight into the mechanisms of AMD and how RPE grafting could be optimized to achieve future success. In the interim, they warned that any findings from shorter-term studies should be viewed with caution.Photodynamic Therapy for Acute Central Serous Chorioretinopathy Associated with Improved VisionA small case series reported by Ober et al (p. 2088) has demonstrated that photodynamic therapy with verteporfin in patients with focal fluorescein leaks secondary to central serous chorioretinopathy (CSC) can cause prompt resolution of leakage from CSC, which in turn can be associated with rapidly improved vision. The series involved 9 eyes of 9 symptomatic patients with acute focal retinal pigment epithelial leaks secondary to CSC. These individuals were treated with photodynamic therapy using verteporfin, with best-corrected visual acuity (VA) recorded at presentation and follow-up visits. The investigators found that neurosensory detachment and fluorescein leakage resolved in all patients within 1 month. At 6 months, mean VA improved from 20/80 to 20/40. Additionally, no patient lost vision or experienced any treatment-related complications. The authors cautioned that although the case study was limited in terms of follow-up and number of patients, the results warrant further investigation to understand the risks and benefits of this therapy for individuals with CSC better.β1-Adrenergic Receptor Polymorphisms May Serve as Determinant of Response of Betaxolol in GlaucomaIn the treatment of systemic hypertension, pharmacogenomic studies of 2 known β1 polymorphisms have shown a correlation between genomic status and response to systemic β1-blocking drugs. Schwartz et al (p. 2131) hypothesized that similar relationships may exist within the eye. They conducted a small pilot study of normal volunteers to record the clinical effectiveness of betaxolol and to correlate these results with the genomic data. Betaxolol was chosen because it is the only available β1-selective agent, so the effects of the β2 receptor theoretically would be minimized. Results indicate that the polymorphisms at codon 389 correlate with baseline intraocular pressure and response to treatment with betaxolol, whereas the polymorphisms at codon 49 of the receptor were not associated with either variable. They conclude that the polymorphism at codon 389 may predict short-term response to betaxolol and may serve as a determinant of response to betaxolol and other adrenergic agents in patients with glaucoma who require treatment.Chromatic Lenses Effective in Modulating Sensory Photophobia in Essential BlepharospasmOne of the most perplexing sensory symptoms of benign essential blepharospasm is photophobia, with up to 79% of patients finding bright light to be the most frequent exacerbating factor of this condition. Yet, its underlying pathophysiology remains a mystery, and no proven noninvasive treatment currently exists. In their nonrandomized case–control study of 34 patients (24 with benign essential blepharospasm and 10 normal controls), Herz and Yen (p. 2208) found that blepharospasm patients can achieve significant relief of sensory photophobia with chromatic modulation. Lenses 4, 5, 6, and 7, which filtered different wavelengths of light, allowed blepharospasm patients to tolerate a significantly higher intensity of light when compared with no lens. Interestingly, although lens 6 allowed patients to endure a higher intensity of light, the majority of patients preferred lens 7 for symptomatic relief. Findings from this study suggest that the photophobia may be more related to wavelength than to intensity of light exposure. The authors recommend prescribing commercially available lens tint as an adjunct therapy for these patients. Elevated CRP and Homocysteine Levels Associated with Age-Related Macular DegenerationPrevious epidemiological studies evaluating risk factors common to both age-related macular degeneration (AMD) and cardiovascular disease suggest that the diseases may have similar etiological mechanisms. To explore this hypothesis, Vine et al (p. 2076) evaluated 2 novel markers of cardiovascular disease: high-sensitivity C-reactive protein (CRP), which is a marker of systemic inflammation that has been shown to be an independent risk factor and predictor of cardiovascular disease, and plasma homocysteine, a sulfur-containing amino acid formed during methionine metabolism—another independent risk factor for cardiovascular disease. In a case–control study of 79 affected individuals and 77 unaffected individuals from the AMD Genetic Study Group, elevated CRP and homocysteine levels were found in patients with AMD relative to the unaffected patients. The authors conclude that these data indicate an association between elevated CRP and homocysteine levels and point to the role of chronic inflammation and atherosclerosis in the pathogenesis of AMD. They call for further studies to delineate this role. Previous epidemiological studies evaluating risk factors common to both age-related macular degeneration (AMD) and cardiovascular disease suggest that the diseases may have similar etiological mechanisms. To explore this hypothesis, Vine et al (p. 2076) evaluated 2 novel markers of cardiovascular disease: high-sensitivity C-reactive protein (CRP), which is a marker of systemic inflammation that has been shown to be an independent risk factor and predictor of cardiovascular disease, and plasma homocysteine, a sulfur-containing amino acid formed during methionine metabolism—another independent risk factor for cardiovascular disease. In a case–control study of 79 affected individuals and 77 unaffected individuals from the AMD Genetic Study Group, elevated CRP and homocysteine levels were found in patients with AMD relative to the unaffected patients. The authors conclude that these data indicate an association between elevated CRP and homocysteine levels and point to the role of chronic inflammation and atherosclerosis in the pathogenesis of AMD. They call for further studies to delineate this role. Long-Term Results of Macular RPE Translocation Surgery in AMD “Disappointing”A 5- to 6-year follow-up of 4 of 9 patients with age-related macular degeneration (AMD) who originally underwent macular retinal pigment epithelium (RPE) translocation surgery for choroidal new vessels (CNVs) has revealed a further decline in visual acuity and loss of foveal fixation—problems that occurred after the original 2-year follow-up results were published. MacLaren et al (p. 2081) also observed late changes in autofluorescence, increasing over the graft donor site and virtually disappearing over the graft itself. Yet the RPE graft itself seemed viable when assessed by optical coherence tomography, fluorescein angiography, and indocyanine green angiography, and no patient suffered a recurrence of CNVs. The authors conclude that although the long-term results of this pilot study were “disappointing,” a detailed analysis of the events occurring after the initial surgery could provide key insight into the mechanisms of AMD and how RPE grafting could be optimized to achieve future success. In the interim, they warned that any findings from shorter-term studies should be viewed with caution. A 5- to 6-year follow-up of 4 of 9 patients with age-related macular degeneration (AMD) who originally underwent macular retinal pigment epithelium (RPE) translocation surgery for choroidal new vessels (CNVs) has revealed a further decline in visual acuity and loss of foveal fixation—problems that occurred after the original 2-year follow-up results were published. MacLaren et al (p. 2081) also observed late changes in autofluorescence, increasing over the graft donor site and virtually disappearing over the graft itself. Yet the RPE graft itself seemed viable when assessed by optical coherence tomography, fluorescein angiography, and indocyanine green angiography, and no patient suffered a recurrence of CNVs. The authors conclude that although the long-term results of this pilot study were “disappointing,” a detailed analysis of the events occurring after the initial surgery could provide key insight into the mechanisms of AMD and how RPE grafting could be optimized to achieve future success. In the interim, they warned that any findings from shorter-term studies should be viewed with caution. Photodynamic Therapy for Acute Central Serous Chorioretinopathy Associated with Improved VisionA small case series reported by Ober et al (p. 2088) has demonstrated that photodynamic therapy with verteporfin in patients with focal fluorescein leaks secondary to central serous chorioretinopathy (CSC) can cause prompt resolution of leakage from CSC, which in turn can be associated with rapidly improved vision. The series involved 9 eyes of 9 symptomatic patients with acute focal retinal pigment epithelial leaks secondary to CSC. These individuals were treated with photodynamic therapy using verteporfin, with best-corrected visual acuity (VA) recorded at presentation and follow-up visits. The investigators found that neurosensory detachment and fluorescein leakage resolved in all patients within 1 month. At 6 months, mean VA improved from 20/80 to 20/40. Additionally, no patient lost vision or experienced any treatment-related complications. The authors cautioned that although the case study was limited in terms of follow-up and number of patients, the results warrant further investigation to understand the risks and benefits of this therapy for individuals with CSC better. A small case series reported by Ober et al (p. 2088) has demonstrated that photodynamic therapy with verteporfin in patients with focal fluorescein leaks secondary to central serous chorioretinopathy (CSC) can cause prompt resolution of leakage from CSC, which in turn can be associated with rapidly improved vision. The series involved 9 eyes of 9 symptomatic patients with acute focal retinal pigment epithelial leaks secondary to CSC. These individuals were treated with photodynamic therapy using verteporfin, with best-corrected visual acuity (VA) recorded at presentation and follow-up visits. The investigators found that neurosensory detachment and fluorescein leakage resolved in all patients within 1 month. At 6 months, mean VA improved from 20/80 to 20/40. Additionally, no patient lost vision or experienced any treatment-related complications. The authors cautioned that although the case study was limited in terms of follow-up and number of patients, the results warrant further investigation to understand the risks and benefits of this therapy for individuals with CSC better. β1-Adrenergic Receptor Polymorphisms May Serve as Determinant of Response of Betaxolol in GlaucomaIn the treatment of systemic hypertension, pharmacogenomic studies of 2 known β1 polymorphisms have shown a correlation between genomic status and response to systemic β1-blocking drugs. Schwartz et al (p. 2131) hypothesized that similar relationships may exist within the eye. They conducted a small pilot study of normal volunteers to record the clinical effectiveness of betaxolol and to correlate these results with the genomic data. Betaxolol was chosen because it is the only available β1-selective agent, so the effects of the β2 receptor theoretically would be minimized. Results indicate that the polymorphisms at codon 389 correlate with baseline intraocular pressure and response to treatment with betaxolol, whereas the polymorphisms at codon 49 of the receptor were not associated with either variable. They conclude that the polymorphism at codon 389 may predict short-term response to betaxolol and may serve as a determinant of response to betaxolol and other adrenergic agents in patients with glaucoma who require treatment. In the treatment of systemic hypertension, pharmacogenomic studies of 2 known β1 polymorphisms have shown a correlation between genomic status and response to systemic β1-blocking drugs. Schwartz et al (p. 2131) hypothesized that similar relationships may exist within the eye. They conducted a small pilot study of normal volunteers to record the clinical effectiveness of betaxolol and to correlate these results with the genomic data. Betaxolol was chosen because it is the only available β1-selective agent, so the effects of the β2 receptor theoretically would be minimized. Results indicate that the polymorphisms at codon 389 correlate with baseline intraocular pressure and response to treatment with betaxolol, whereas the polymorphisms at codon 49 of the receptor were not associated with either variable. They conclude that the polymorphism at codon 389 may predict short-term response to betaxolol and may serve as a determinant of response to betaxolol and other adrenergic agents in patients with glaucoma who require treatment. Chromatic Lenses Effective in Modulating Sensory Photophobia in Essential BlepharospasmOne of the most perplexing sensory symptoms of benign essential blepharospasm is photophobia, with up to 79% of patients finding bright light to be the most frequent exacerbating factor of this condition. Yet, its underlying pathophysiology remains a mystery, and no proven noninvasive treatment currently exists. In their nonrandomized case–control study of 34 patients (24 with benign essential blepharospasm and 10 normal controls), Herz and Yen (p. 2208) found that blepharospasm patients can achieve significant relief of sensory photophobia with chromatic modulation. Lenses 4, 5, 6, and 7, which filtered different wavelengths of light, allowed blepharospasm patients to tolerate a significantly higher intensity of light when compared with no lens. Interestingly, although lens 6 allowed patients to endure a higher intensity of light, the majority of patients preferred lens 7 for symptomatic relief. Findings from this study suggest that the photophobia may be more related to wavelength than to intensity of light exposure. The authors recommend prescribing commercially available lens tint as an adjunct therapy for these patients. One of the most perplexing sensory symptoms of benign essential blepharospasm is photophobia, with up to 79% of patients finding bright light to be the most frequent exacerbating factor of this condition. Yet, its underlying pathophysiology remains a mystery, and no proven noninvasive treatment currently exists. In their nonrandomized case–control study of 34 patients (24 with benign essential blepharospasm and 10 normal controls), Herz and Yen (p. 2208) found that blepharospasm patients can achieve significant relief of sensory photophobia with chromatic modulation. Lenses 4, 5, 6, and 7, which filtered different wavelengths of light, allowed blepharospasm patients to tolerate a significantly higher intensity of light when compared with no lens. Interestingly, although lens 6 allowed patients to endure a higher intensity of light, the majority of patients preferred lens 7 for symptomatic relief. Findings from this study suggest that the photophobia may be more related to wavelength than to intensity of light exposure. The authors recommend prescribing commercially available lens tint as an adjunct therapy for these patients.