Dr. Mandelman on You Tube!

I was asked to answer some common questions about eye care for O.S.I. (Optometric Services Inc.)
My video presentations are now appearing on You Tube. I have answered questions on Cataracts, Macular Degeneration, Children's Vision and Ultraviolet Protection.


Here are the links:

Ultraviolet Rays and the Eye

Macular Degneration

Cataracts

Children's Vision



Enjoy!

Toby

VisionCare's eye telescope wins approval

By Steve Johnson

sjohnson@mercurynews.com

Posted: 07/06/2010 09:16:55 PM PDT
Updated: 07/07/2010 08:32:51 AM PDT

In a decision cheered by advocates for the visually impaired, federal regulators Tuesday approved a Saratoga company's first-of-a-kind implantable eye telescope for elderly people with an advanced form of age-related macular degeneration.

The device made by VisionCare Ophthalmic Technologies is aimed at about 750,000 people in the United States who have the most severe and untreatable form of the disease, which causes a blind spot in the center of their vision.

"This innovation has the potential to provide many people with an improved quality of life," said Dr. Jeffrey Shuren, director of the Center for Devices and Radiological Health at the U.S. Food and Drug Administration, which approved VisionCare's device.

Getting the FDA's approval is a big moment for privately held VisionCare, which has been developing the telescope for more than a decade. In 2006, an FDA advisory panel recommended the telescope not be approved because of concerns about its usefulness and safety. But after VisionCare did more studies, the panel unanimously gave the device its blessing.

Although VisionCare has raised $59 million since it was founded in 1997, it has no other products on the market and has consistently lost money. Now the company is planning to roughly double its work force of 23, and "we hope to turn a profit after we launch the product," said Chet Kumar, VisionCare's

vice president for business and market development.

Even though most of the approximately 8 million people suffering from the disease in this country won't qualify to be treated with the device, advocates for patients suffering from the ailment hailed the FDA's approval.

"It's very exciting," said Dan Roberts, founding director of Macular Degeneration Support, a group he founded after he was diagnosed with the illness. "The product needs to be given a chance — anything that is going to give the patients better sight until we have a cure, anything that's going to give hope."

Dziem Nguyen, a supervisor at the Santa Clara Valley Blind Center, also was enthusiastic.

Noting that most of the center's patients suffer from age-related macular degeneration, she called the FDA's action "really good news to our folks here."

The ailment, which primarily afflicts the elderly, damages the center of the retina — or macula — which is the light-sensitive tissue at the back of the eye. The result is deteriorated sight in the center of the visual field, causing blurriness and eventually an inability to recognize faces, read or watch television.

The FDA limited VisionCare's telescope to people 75 or older, whose disease has progressed to a severe state. The device — which is about the size of a pea — is implanted in an outpatient procedure behind the colored portion of the eye known as the iris after the patient's own lens is removed.

By magnifying vision by 2.2 times to 2.7 times, depending on which model is used, the device projects visual images away from the damaged macula and onto the surrounding healthy retinal tissue. It is placed in only one eye, since the patient's other eye is needed for peripheral vision.

In a study involving more than 200 patients implanted with the device, the FDA said, 75 percent "improved their level of vision from severe or profound impairment to moderate impairment."

Although the device is approved for people with advanced wet or dry age-related macular degeneration, patients need to consult with a specialist and be tested to determine whether they are good candidates for the surgery.

In some cases, the implantation can distort the cornea's clarity, the FDA said. As a result, the federal agency is requiring VisionCare to conduct follow-up studies on patents outfitted with the telescope.

Kumar said the company has not set a price for the device because that will depend on how much Medicare will agree to cover. When those details are worked out over the next couple of months, patients can start getting implanted with the telescope, he said, noting that details about when the device will be available will be posted on www.centrasight.com.

Diet, Meds and Smoking Linked to Eye Disease Risks

Good nutrition staved off cataracts; some drugs, smoking increased vision problems, studies found

MONDAY, June 14 (HealthDay News) -- A healthy diet helps guard against cataracts, while certain medications raise the risks of this common cause of vision loss, two new studies suggest.

And a third study finds that smoking increases the risk of age-related macular degeneration, another disease that robs people of their sight.

The first study found that women who eat foods that contain high levels of a variety of vitamins and minerals may be less likely to develop nuclear cataract, which is the most common type of age-related cataract in the United States.

The study is published in the June issue of the Archives of Ophthalmology.

The researchers looked at 1,808 women in Iowa, Oregon and Wisconsin who took part in a study about age-related eye disease. Overall, 736 (41 percent) of the women had either nuclear cataracts evident from lens photographs or reported having undergone cataract extraction.

"Results from this study indicate that healthy diets, which reflect adherence to the U.S. dietary guidelines . . . are more strongly related to the lower occurrence of nuclear cataracts than any other modifiable risk factor or protective factor studied in this sample of women," Julie A. Mares, of the University of Wisconsin, Madison, and colleagues said in a news release from the journal.

The second study found that medications that increase sensitivity to the sun -- including antidepressants, diuretics, antibiotics and the pain reliever naproxen sodium (commonly sold over-the-counter as Aleve) -- increase the risk of age-related cataract.

Researchers followed-up with 4,926 participants over a 15-year period and concluded that an interaction between sun-sensitizing medications and sunlight (ultraviolet-B) exposure was associated with the development of cortical cataract.

"The medications [active ingredients] represent a broad range of chemical compounds, and the specific mechanism for the interaction is unclear," Dr. Barbara E.K. Klein and colleagues at the University of Wisconsin, Madison, said in the news release. Their report was released online in advance of publication in the August print issue of the Archives of Ophthalmology.

Because the lens of the eye develops from the same tissue layer as the skin, sun-sensitizing medications may affect the eyes as well as the skin, the researchers explained.

"Our results need to be evaluated in other populations, especially in view of the increasing frequency of sun-sensitizing medications," they concluded. "If our findings are confirmed, it would be important to examine whether the effect is greater in those with higher levels of ambient sunlight (UV-B) exposure and if dose or duration of medication use is also important."

The third study, also published online and in the August print issue of Archives of Ophthalmology, found that smoking and cholesterol levels affect the risk for early-stage age-related macular degeneration (AMD).

AMD is uncommon before age 55 but the risk increases after that age, therefore most studies focus on AMD in middle-aged and older adults, according to background information in the report.

"To our knowledge, accurate estimates of prevalence of AMD among adults younger than 40 years are lacking. Such information is important for understanding the relationships of risk factors to AMD across the age spectrum and for identifying factors that might affect this disease earlier in life," Dr. Ronald Klein, of the University of Wisconsin, Madison, and colleagues said in the news release.

The study included 2,810 people, aged 21 to 84, who were assessed for the presence and severity of drusen. These yellow or white deposits in the retina are an early sign of AMD.

Overall, early AMD was detected in 3.4 percent of the participants, with rates ranging from 2.4 percent among those aged 21 to 34 to 9.8 percent for those aged 65 and older. Besides age, additional risk factors associated with increased risk for AMD included being male, heavy smoking for a long period of time, and being hearing impaired. Elevated levels of HDL ("good") cholesterol were associated with a lower risk for AMD, the study authors noted.

The findings "demonstrate that early AMD onset may occur in midlife. Some modifiable factors [smoking status and serum HDL cholesterol level] associated with AMD in older cohorts were associated with early AMD in this cohort of middle-aged adults," the researchers concluded.

Saffron may help reverse Macular Degeneration

From the UK's Daily Mail:
By Fiona Macrae
Last updated at 12:01 AM on 06th February 2010

It is one food colouring that you won't mind giving to the family.
Research has shown that saffron, which gives chicken korma and paella their yellow colour, helps keep vision sharp.
Test findings suggest the spice reverses age-related macular degeneration, or AMD, the most common cause of blindness in old people.
'Patients' vision improved after taking the saffron pill,' said Professor Silvia Bisti, of the University of Sydney, who carried out the research.
'When they were tested with traditional eye charts, a number of them could read one or two lines smaller than before, while others reported they could read newspapers and books again.'
The finding is timely as it is thought the number of AMD sufferers will treble in the next 25 years as the population ages.
It currently affects a quarter of over-60s in the UK and more than half of over-75s.
There are few treatments for the condition - and no cure.
While peripheral vision is not affected, the damage to central vision leads to many sufferers being registered as blind or partially sighted.
Saffron has actually been used in traditional medicine for centuries to treat a range of ailments, though Professor Bisti is the first to look at its effects on eyesight.

In tests carried out in Italy - where saffron is widely cultivated - pensioners with AMD were given a daily saffron pill for three months followed by a dummy drug for a further three months.
A second group took the supplements in the reverse order. Twenty-five took part in all.
'All patients experienced improvements in their vision while taking the saffron pill,' Professor Bisti said. 'But when they stopped taking it, the effect quickly disappeared.'

She added: 'The chemistry of saffron is quite complex. It is well-known as an anti- oxidant but no one has explored its effects on eyesight before.'
She believes saffron, which is widely used in Spanish and Indian cooking, affects the amount of fat stored by the eye, making vision cells 'tougher and more resilient'.
Saffron is used in traditional medicine for treating conditions including cancerous tumours and depression. The spice also has properties which encourage oxygen flow and prevents cell death.
Researchers are now hoping to discover the ideal dosage. They will also look at saffron's ability to treat genetic eye diseases that can cause life-long blindness.

The one-off, one-hour treatment that can cure blindness

From the UK's Daily Mail
By Oona Mashta
Last updated at 10:04 PM on 19th December 2009

Early symptoms of wet AMD can be as terrifying as they are debilitating - faces are blurred, blind spots appear in the centre of vision and straight lines seem to waver. If left untreated, patients can lose their sight within three months.
Wet AMD (age-related macular degeneration) is an aggressive, rapidly developing condition in which abnormal blood vessels form in the macula, the part of the eye responsible for vision, resulting in scarring.
It is also the leading cause of blindness in those over 60. Wet AMD is usually seen in this age group and genetics are thought to play a major role, although smoking and exposure to sunlight are also risk factors.
However, a new NHS treatment is offering hope to the 250,000 UK sufferers. The revolutionary surgical procedure uses beams of radiation to destroy the abnormal blood vessels at the back of the eye that are the cause of sight loss.
Currently, patients suffering from AMD are treated with regular injections of a drug into the eyeball.
These are required up to every month, usually for the rest of their life.
With the new procedure, called epimacular brachytherapy, surgeons thread a probe into the eye until it reaches the abnormal area in the retina. They then give a precisely timed dose of radiation in a beam just 5.4mm wide.
Research into epimacular brachytherapy shows the radiation is safe. Unlike previous forms of radiation therapy for wet AMD, the peak dose is targeted directly to the abnormal vessels, minimising damage to healthy surrounding tissue.
The one-hour operation is carried out as a day-case ophthalmology surgical procedure under local anaesthetic.
Tim Jackson, consultant eye surgeon at King's College Hospital in London, says: 'This is a relatively straightforward procedure. And unlike the injections, which need repeating on a regular basis, the beauty of this technique is that it is a one-off treatment.
'By killing the abnormal blood vessels that cause the problem, you can produce a permanent benefit rather than just suppressing the disease.'
The most common side effect is that it can speed up the development of cataracts in patients who have not undergone cataract

The technique, now available on the NHS, is being trialled on 363 patients at 15 hospitals around the country. Researchers are appealing for more participants. The radiation therapy costs about £6,000 privately. So far, the results have been encouraging. Preliminary studies show that 91 per cent of patients maintain vision.
One success story is that of Margaret Findlay, 84, from South London. Margaret had always been staunchly independent, so when two years ago she rapidly started to lose her sight, it was all the more difficult to come to terms with.
Within weeks, she had to give up driving and ask family and friends for help with chores, especially shopping.
'My eyesight deteriorated so quickly it was devastating. I had to ask for lots of help,' she says. 'I also had to give up my other passion of reading, which was a great pity because all my life I've loved books - I'll read anything in print.'
When she saw her GP in February 2007, he referred her to Mr Jackson, who diagnosed wet AMD. He offered her epimacular brachytherapy.
'I jumped at the chance,' says Margaret. 'My attitude is that if you get the opportunity of a potential remedy, you take it. I went straight ahead and signed the consent forms.'
After the procedure, in May 2007, Margaret could see perfectly straight away, and within weeks she was back behind the wheel. She says: 'I suffered no pain. It was such a relief to get my independence back.'
• Patients who want to participate in the trial should visit www.merlotstudy.com

Advanced Cell Technology seeks to test embryonic stem cells to treat blindness.

From the Los Angeles Times:
November 19, 2009 10:00 am

Stem cells could be used to remedy

formerly incurable eye defects which

cause blindness.

Patients with a rare eye disease could be the first to be treated with human embryonic stem cells.
Advanced Cell Technology Inc., a Santa Monica-based biotech company with labs in Massachusetts, announced today that it has asked the U.S. Food and Drug Administration for approval to test retinal cells grown from stem cells in 12 people with Stargardt’s macular dystrophy.
The disease is a childhood version of macular degeneration and affects about one in 10,000 kids. Patients typically begin to lose their central vision between the ages of 6 and 20. As SMD progresses, things may look blurry and distorted, and patients may have trouble adjusting to low light. About half of victims are legally blind by age 50. There is no cure.
Most cases occur when children inherent a faulty version of the ABCA4 gene or the CNGB3 gene from both parents. As a result, the photoreceptor cells in the retina don’t get enough fuel, and they atrophy.
ACT hopes to reverse this by supplying patients with new retinal pigment epithelium cells derived from human embryonic stem cells. The RPE cells have been shown to improve vision in animals, with one study restoring eye function in sick rats and mice to “near-normal” levels. Another study boosted rats’ vision to 70% that of healthy animals. No adverse side effects were found in any of the company’s pre-clinical studies, Dr. Robert Lanza, ACT’s chief scientific officer, said in an interview.
ACT proposes a Phase I/II trial designed to assess the safety and tolerability of its RPE cells. The company and its collaborators would like to recruit a dozen patients with advanced SMD at three sites: the Casey Eye Institute in Portland, Ore.; the University of Massachusetts Memorial Medical Center in Worcester; and the UMDNJ – New Jersey Medical School in Newark.
Amid much fanfare, Geron Corp. received FDA approval in January to use specialized nerve cells made out of human embryonic stem cells to treat a handful of patients paralyzed by spinal cord injuries. Those plans are on hold while the company conducts pre-clinical studies to address some safety concerns about its cells, known as GRNOPC1. Last month, Geron said it expected to initiate its clinical trial in the third quarter of 2010.
Since their creation in 1998, human embryonic stem cells have been a highly controversial area of medical research. The cells are derived from days-old human embryos, which gives them the ability to grow into any type of cell in the body. Some scientists – like those at ACT and Geron – envision using them to grow replacement tissues to treat sick patients. But many people are troubled by the fact that the stem cells are typically made by dismantling and destroying human embryos.
ACT has tried to sidestep the ethical debate by using a different method to create its stem cell lines. Instead of using an entire embryo, the company figured out a way to remove only a single blastomere cell from a three-day-old embryo and turn it into a cell line. Such single-cell biopsies are routinely performed in fertility clinics to screen embryos for devastating genetic diseases, and the procedure leaves the embryo intact. The RPE cells that would be used in the clinical trial were grown from one of the company’s single-blastomere cell lines, Lanza said.
The company is also making and testing RPE cells derived from induced pluripotent stem cells. So-called iPS cells behave like embryonic stem cells but are made by reprogramming mature cells taken from children or adults, not from embryos. However, the reprogramming process currently involves viruses and genetic manipulation techniques that make the cells unsuitable for human therapies.
Lanza said ACT decided to target Stargardt’s macular dystrophy first because it has been designated an “orphan disease” and could benefit from a faster regulatory review. The FDA has 30 days to respond to the company’s filing, made Wednesday, and the clinical trial could begin early next year.
If all goes well, the company plans to seek permission to use its RPE cells to treat age-related macular degeneration, Lanza said. That disorder is much more common, and it destroys the central vision of an estimated 1.75 million Americans.
-- Karen Kaplan
Photo: Scientists from Advanced Cell Technology remove a single cell from a days-old embryo, which was used to create a line of human embryonic stem cells. Stem cells made this way were grown into eye cells that the company hopes will treat patients with Stargardt's macular dystrophy. Credit: Associated Press photo/Advanced Cell Technology

Macular Degeneration online self test

The Bedford Eye Care Centre and AMD Alliance International want you to know that millions of people are at risk of vision loss from macular degeneration. Click on the link below to test your vision and pass this email on to family and friends to make them aware of the need for early detection through regular eye exams.

Click on this link to begin.

www.testyourvisionforamd.com/opto.php

Yellowish spots (drusen) that form in the back of the eye or retina are an early sign of "dry" macular degeneration

"Wet" macular degeneration occurs with formation of abnormal blood vessels and leakage in the back of the eye (retina), affecting the macula where fine focusing occurs.

Macular degeneration mainly affects central vision, causing "blind spots" directly ahead.

The laser that can halt blindness and offer hope for millions

By David DerbyshireLast updated at 8:00 AM on 06th July 2009

A revolutionary laser treatment could save the sight of millions, British experts claim.
The process is said to stop the onset of age-related macular degeneration, one of the commonest forms of blindness, which leaves victims unable to read, drive or live independently.
It can be carried out in just ten to 15 minutes by any ophthalmologist. While it does not cure sight loss, its creators say it could prevent a generation from having to put up with declining vision in old age.




A sight for sore eyes: Professor John Marshall announced a new laser technique which could prevent millions of older people from going blind







People with a family history of the disease could have pre-emptive treatment in their thirties.
The technique is said to be safe and painless and could save the NHS millions of pounds in treating age-related macular degeneration (AMD). It could even stop the disease getting worse in existing patients.
Medical charities welcomed the breakthrough but warned that it might not be available to the public for several years.
AMD is caused by damage to an area about 5mm across at the centre of the retina called the macula, which is responsible for our central vision.
The disease is the leading cause of blindness in the over- sixties, and around 200,000 Britons are registered as blind or partially sighted because of it.

























There is no treatment for the most common 'dry' form. The more aggressive 'wet' version, in which new blood vessels cause bleeding and scarring behind the retina, can be stabilised with drugs.
The technique is the brainchild of Professor John Marshall, an ophthalmologist at King's College London who pioneered laser surgery to correct shortsightedness.
Professor Marshall, who hopes the treatment could be available in a couple of years, said: 'It is really exciting news. It won't bring back damaged eyesight but it may prevent AMD.'
The technique rejuvenates the 'Bruch's membrane' - a thin layer that lies behind the retina.
This provides the retina's light-sensitive cells with nutrients and removes waste created as a by-product of the way retina cells renew themselves.
But the membrane's cells eventually lose the ability to take waste away, allowing deposits to build up.
It can then become so damaged that the retina's lightsensitive cells start to die off. In a trial involving more than 100 diabetics, Professor Marshall found that using a laser stimulated the membrane's tired, ageing cells into action.
After the cells were ' energised' by the laser, they began to clean up the waste again.
Patients also said the treatment led to a ' marked improvement' in their sight.
The non-invasive operation uses a laser modified to give pulses of light that do not damage the eye's light-sensitive cells or cause any dangerous heating of the target area.
Professor Marshall will now treat up to 200 people with AMD in one eye as part of a second trial. Such patients usually get the disease in the other eye within three years.
He wants to see if the laser prevents the good eye losing its sight. 'If you can delay the onset by three, four, six, seven or ten years, it's proof of the principle,' he said.
Tom Pey, of Guide Dogs for the Blind, which funded the research, said: 'This is potentially a huge breakthrough for millions. The science behind it is proven.'
The Macular Disease Society said: 'If this works, then it's very exciting. However, it will be years before this could be ready for use.'

Optomap Retinal Exam Can Help Detect Diabetes, High Blood Pressure, Retinal Holes, Eye Tumors and More…Featured on The Doctors TV Show

Excerpts from Visionary Eye Care Blog:
The Optomap Retinal Examination is currently available at the Bedford Eye Care Centre in Sunnyside Mall in Bedford, N.S.

This incredible technology allows your Eye Doctor to scan the internal lining of your eye called the retina and save this image on the computer for year to year comparisons. The retina has about 1 million nerve fibers in it and is an extension of your brain. The retina is also the ONLY place in the human body where a doctor can observe working nerve fibers and blood vessels WITHOUT cutting into the body. Subtle eye health changes can be documented, monitored and compared each year.

Your retina can show early signs of systemic problems that can cause damage to nerves and blood vessels such as Diabetes, High Blood Pressure, High Cholesterol and more. Your retina can also demonstrate eye health issues such as Glaucoma, Retinal Detachment, Macular Degeneration and Eye Tumors and/or Eye Cancer.

The TV show called “The Doctors” aired a segment discussing the Optomap Retinal Scan and the benefits of this technology during your yearly eye examination to preserve BOTH your eye health and your systemic health.

At the Bedford Eye Care Centre, we have found the Optomap Retinal Scanner to be invaluable in the detection and documentation of many eye and systemic diseases. I have personally found a number of pathologies that I would not have been able to see well enough without the assistance of this incredible technology. It also allows me to more accurately follow the progression of a disease or improvements after treatment. In addition, it’s wonderful to be able to educate the patient properly about their eye condition by showing them their image and we also email the images to specialists when making referrals.

Sample pictures:

Macular Degeneration Retinal Detachment