New public beta of MyVisionTest entoptic perimetry program A new, totally overhauled version of the original "video static" MyVisionTest entoptic perimetry vision testing program is in the works. A beta version of the new test is now available for users to evaluate.

Unlike earlier versions of the entoptic perimetry program, the new vision test is written in Flash. This change will make it technically easier for users to setup their computers and configure their web browsers to use the vision test.

The new program is essentially the same vision test, but with some enhancements. One significant change in that users can draw vision defects of any shape, rather than being limited to only round shapes. A new in-program help system is now present, allowing users to get assistance with using the program while using it. Finally, we have reinstituted full-screen mode, permitting the vision test to take full advantage of your computer monitor's real estate.

Give it a try and let us know what you think. Your feedback is very important to us. Please let us know about any bugs that you encounter. Your comments and suggestions for improvement are also welcome.

MyVisionTest version 4 - Public Beta   (change log)

Sunlight exposure increases risk of AMD in people with low antioxidant levels A new European population-based study finds that sunlight exposure increases the risk of wet AMD in those people with low serum antioxidant levels.

It has been suggested that high-energy blue light from sunlight may be damaging to the retina. However, this is the first study to find an adverse association of blue light exposure with neovascular AMD in humans with low serum levels of antioxidants.

The European Eye Study is a large population-based study of 4753 persons aged 65 years or older. Participants underwent fundus photography, were interviewed for adult lifetime sunlight exposure, and gave blood for antioxidant analysis. Blue light exposure was estimated by combining meteorologic and questionnaire data.

No association was observed between blue light exposure and neovascular AMD unless antioxidant levels are taken into account. Nor was there any association between neovascular AMD and antioxidant levels unless sunlight exposure was taken into account. However, when both blue light exposure and antioxidant levels are analyzed a consistent pattern was observed of increased risk of neovascular AMD with increased blue light exposure among participants in the lowest serum levels of antioxidants.

Interestingly, low levels of certain combinations of antioxidants, especially participants with low levels of vitamin C, vitamin E, and zeaxanthin, showed highest risk associated with blue light exposure compared with participants that had low levels of just a single antioxidant.

High levels of vitamin C appeared to confer a protective effect from blue light exposure, but high levels of other antioxidants did not offer any level of protection.

The observed association between blue light exposure, antioxidant level, and neovascular AMD was not affected by smoking status.

Risk associated with blue light exposure appeared to increase from early adult life to middle age and older for those participants with low antioxidant levels, with the highest risk occurring at ages 50 to 59.

The researchers conclude that the combination of blue light exposure in the presence of low levels of zeaxanthin, vitamin E, and vitamin C was associated with a nearly 4-fold increased risk of neovascular AMD. They report that blue light exposure in middle age might be more damaging than at younger ages, reaching a peak at ages 50 to 59 years.

They write "lowering retinal exposure to blue light and ensuring that intake of key antioxidant nutrients is sufficient are the main recommendations from our study." They also note that any benefit from reducing sun exposure has to be balanced against the benefits of sunlight, in particular its role in vitamin D production. They advise reducing ocular exposure when outdoors by wearing broad-brimmed hats and sunglasses.

Because high levels of antioxidants were generally not protective, no special antioxidant supplement was recommended. Instead, the researchers recommend that people follow standard dietary guidelines to ensure that antioxidant levels are above those associated with increased risk from blue light exposure.

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Arch Ophthalmol. 2008;126(10):1396-1403

No link between parapapillary atrophy and AMD Parapapillary atrophy and age-related macular degeneration share similar histologic features, but there appears to be no significant association between the two disorders, a large population-based study found.

Jost B. Jonas and colleagues examined fundus images obtained for 3,874 participants in the Beijing Eye Study to evaluate the possible correlation between parapapillary atrophy and AMD. All participants were 40 years or older, had normal IOPs, refractive errors greater than –8 D and showed no signs of glaucomatous optic neuropathy.

According to multivariate analysis, the beta zone of parapapillary atrophy was significantly associated with age, optic disc size and myopic refractive error.

However, the investigators uncovered no significant associations between the beta zone of parapapillary atrophy and the presence of retinal pigment depigmentation, hyperpigmentation, drusen size and the presence of early or late AMD, according to the study.

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Graefes Arch Clin Exp Ophthalmol. 2008 Oct;246(10):1391-4

Combination therapy as effective as monotherapy, but with fewer treatments needed Triple therapy followed by an as-needed regimen is a viable first-line treatment for wet age-related macular degeneration, according to results of a 12-month trial.

At the American Society of Retina Specialists, Subhransu K. Ray said that there were no significant differences in visual acuity - the primary endpoint - between the combination therapy and monotherapy groups in this masked, randomized, prospective phase 2b study.

Sixty treatment-naive patients were initially enrolled. Combination therapy consisted of photodynamic therapy, intravitreal dexamethasone and Lucentis (ranibizumab). Monotherapy consisted of monthly injections of Lucentis.

"However, the big difference to note is in total treatments," Dr. Ray said. The monotherapy group received 12 treatments, whereas the triple therapy group required fewer treatments overall, with 10% of those patients not requiring any subsequent treatment.

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OSN SuperSite

Study shows fellow eye unaffected by anti-VEGF treatments for AMD A protective effect was not observed for the fellow eye when unilateral neovascular age-related macular degeneration was treated with anti-VEGF agents, a retrospective study showed.

The retrospective study looked at 445 patients from both the ANCHOR and MARINA trials, according to K. Bailey Freund. In data presented to the American Society of Retina Specialists, Dr. Freund said, in either study, no difference was found in conversion of the fellow eye from dry to wet AMD.

In the MARINA study, patients were randomly assigned to receive monthly injections of Lucentis or sham therapy. In the ANCHOR study, patients received Lucentis or photodynamic therapy. Conversion rates were based on angiography and were calculated at 12 and 24 months of follow-up.

"Perhaps the sample size was inadequate to detect a small treatment effect," Dr. Freund said of the study's limitations.

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OSN SuperSite

Lucentis superior to laser in treatment of diabetic macular edema Treatment of diabetic macular edema for 6 months with Lucentis (ranibizumab) produced greater gains in visual acuity and greater reductions in retinal thickness than treatment with laser photocoagulation or a combination of Lucentis plus laser, according to preliminary data analyses presented here.

Diana Do, presented data at the American Society of Retina Specialists annual meeting of the READ-2 study, a phase 2 randomized clinical trial initially involving 126 participants.

Patients taking Lucentis had the greatest change retinal thickness, a decrease of 57%, whereas patients treated with laser had the least change, a decrease of 11%. Similarly, visual acuity improved the most in patients on Lucentis, with 24% of patients achieving a gain of three lines or more, compared with 11% in patients on combination therapy and 0% in patients treated with laser alone.

"We felt comfortable using ranibizumab since we conducted the READ-1 study, which did show a beneficial effect in improving retinal thickness and improving visual acuity," Dr. Do said.

Long-term follow-up is needed to determine whether benefits can be sustained, she said.

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OSN SuperSite