News

The annual conference of the Association for Research in Vision and Ophthalmology (ARVO) took place earlier this month in Fort Lauderdale, Florida. As the major conference for researchers in vision science it provides the main platform for the initial presentation of much ground-breaking research which eventually filters down to impact on the way we practise.

Where many international conferences, such as those of the American Academies, concentrate on matters clinical, the scope of ARVO is much broader and has over 11,000 members from research units in over 70 countries. This year's event included upwards of 6,000 paper and poster presentations, as well as associated events and exhibitions representing a record number of 132 organisations.

This short piece can only represent a snapshot. Interested readers would be well advised to visit www.arvo.org for a more comprehensive review.

Glaucoma

All too often UK optometrists refer suspect glaucoma patients on the basis of one single tonometry event. The diurnal fluctuation of IOP makes this a less than useful parameter as it is difficult to know where on the curve any one particular reading is based. A leading panel of glaucoma experts, led by Dr George Cioffi (Portland, Oregan), met throughout the preceding months to discuss IOP control and assessment. They presented their conclusions at ARVO. While there was little consensus on many IOP parameters and their interpretation, all suggested that, as IOP is the only approach demonstrated to prevent or delay glaucoma, reducing peak IOP needs to be combined with reducing long-term IOP fluctuation. So, in other words, while reducing the mean IOP is important, it is also important to look to reduce the difference between the peak and trough of the IOP cycle. An elevated mean with a low fluctuation need not necessarily be worse than a low mean with a large fluctuation range.

In similar territory, the Xalatan Lumigan Travatan study presented results from a group of 410 patients and showed that treatment with the prostaglandin drugs was effective at reducing IOP fluctuation, with latanoprost showing the most significant effect. To emphasise the importance not to rely on just one reading, project leader Dr Rohit Varma (Southern California) said 'just looking at mean IOP reduction may not provide the complete picture of what is important in IOP control'.

As a timely reminder of the effect of the disease on quality of life, the group from Dalhousie, Canada, showed that glaucoma patients are three times more likely to have been involved in falls and motor accidents than patients of the same age without the condition. The strongest risk factor was, of course, impaired field of view.

Seasons of change

A study of patients presenting at a New York clinic and emergency department has found that uveitis peaks in the spring. Researchers at the New York Ear and Eye Infirmary found that spikes in the number of patients presenting with uveitis peaked in May, at exactly the same time as tree pollen levels peak. Head researcher Dr Samir Tan was quick to point out that this does not necessarily mean pollen is the culprit, but indicates that further research may throw light on an unrecognised link with environmental factors or even number of daylight hours. Commenting on the findings, Dr Russell Read (Alabama) postulated that a 'revving up' of the immune system by the pollen might trigger further autoimmune responses such as uveitis.

Drops

Management of dry eye with topical cyclosporine, perhaps yet to be established in the UK as a treatment, is as effective with one daily treatment as the usual twice-daily application. The topical drops (known as Restasis) are likely to become more familiar over here in the coming years. Eighty-five per cent of dry eye patients in the study by Weil Cornell School of Medicine using single daily application showed the same tear stability as those using the drug twice, a fact that may have important repercussions for drug budgets in the future.

A study on diabetic rats by Pennsylvania College has revealed that subconjunctival delivery of human insulin shows improvement in early retinopathy. Lead research Dr Ravi Singh suggested that the low dose periocular delivery of insulin had no effect on blood glucose levels yet may help to treat early diabetic retinopathy.

Uvea and colon link

Researchers at Ohio University have shown that patients with uveal melanoma are at higher risk of other cancers, most significantly cancer of the colon. The study looked at 130 uveal melanoma patients who each provided extensive family histories. A small but significant proportion of the patients and their families are at a higher risk of colon cancer. 'Ophthalmologists need to advise patients about the necessity of screening for colon cancer both for themselves and their families,' stated team leader Dr Frederick Davidorf.

Children

Finally, another paper to question the muddled reasoning that childhood vision screening is not cost effective because amblyopia is unlikely to affect a child's educational development. Something often quoted as school screening programmes are wound down in the UK. A study from Queensland, Australia has identified that fine motor skills are significantly worse and perception of social acceptance much lower in amblyopic children. Researcher Ann Webber stated 'in addition to treating a child's eye condition, practitioners may be able to advise parents of potential functional consequences'.

Perhaps this may be added to the growing body of evidence which might be used to argue for a UK nationwide optometrist-led children vision screening programme.

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