Wednesday 22 December 2010

Yoga for eyes

MDS is organising a FREE yoga session for all members. It is known that there is a deep correlation between the eyes and the mind. Our vision occupies 40 percent of the brain’s capacity.


Therefore, eye health corresponds to the level of relaxation the brain experiences. Yoga helps to do that. Yoga is also a great way to stay healthy, as it strengthens our core muscles which weaken as we grow older. It is also very suitable for MDS patients as it is non-strenuous yet gives the body a good workout.

Venue: All About Yoga Studio, 605B MacPherson Road, #05-11 Citimac

Date: 23 Jan 2011, Sunday

Time: 9 - 10AM

Transport: Shuttle services will be provided to and from Paya Lebar MRT Station. Meet at 8.15am at the MRT station's pick-up point, which is opposite the Singapore Post Centre.

Things to bring: Towel and a bottle of water

What to wear: Anything comfortable. Tights, shorts, T-shirt

Space is very limited, so please register early. Call Anne at 6238-7387, or e-mail alleyes@singnet.com.sg to reserve your places now! This event is free for all MDS members.





Tuesday 7 December 2010

AMD can increase risk of stroke

Dec 4, 2010
The Business Times

By Cheah Ui-Hoon

SO you think eye problems are confined to the eyes? It turns out that having age-related macular degeneration (AMD) can increase your risk of stroke. AMD is a chronic degenerative disease of the macula – the central part of the retina.

In the Atherosclerosis Risk In Communities (ARIC) Study, people with early AMD signs had double the risk of incident stroke over 10 years. This was based on a population study done in the US. The results were published in the Journal of Stroke a few years ago, but it’s a fact that’s rarely known, says Peter Kaiser, a retinal specialist and principal investigator of over 30 clinical trials on AMD and other retinal disorders. 

“This is a new finding. It’s not something we thought about in the past,” says Prof Kaiser who was in Singapore for the 5th Congress of the Asia-Pacific Vitreo-Retina Society last month.

It’s a situation that makes sense however, as a lot of the risk factors for AMD are similar to cardiovascular disease, says the professor. “Factors like increased cholesterol levels and high LDL, a large waist circumference and high body mass index are factors for both AMD and stroke.”

If one just looks at the AMD population, there isn’t an increased risk of stroke in that population; only in the population-based study. But it correlates with other studies that suggest there is an increased risk of stroke in AMD patients. “And the risk is two-fold, as suggested by another study of Medicare patients in the US,” says Prof Kaiser.

Risk factors
Previously, AMD was seldom highlighted as a condition because there were few solutions for it. But the situation is different now, as there is an effective gold standard treatment for wet AMD. There are dry and wet forms of AMD, with the wet form being more dangerous because it means blood vessels are growing in the eye, which then bleed and leave scars if left untreated. This can lead to a severe loss of vision and cause blindness. 

“It’s the leading cause of blindness in the West,” the professor adds. In dry AMD, there are underlying inflammatory conditions, but it doesn’t cause loss of vision. AMD affects those above 50 years old, and while one may have a genetic propensity for it, smoking increases risk. Caucasian females are also more prone to getting AMD. But all the other risk factors for cardiovascular disease apply, such as being overweight, having high cholesterol and low intake of Omega 3 fatty acids.

Blindness can be avoided, however, if risk factors are modified through diet and exercise. “It’s not a death sentence . . . as you can work on improving the odds. The majority of wet AMD patients need not go blind,” says Prof Kaiser. One in four people in Singapore above 60 years old has AMD.

The causes of AMD are not known, except for general conditions such as a poor diet and low levels of anti-oxidants. “The eye is one of the most active structures in the body as it’s constantly converting light into neural waves. And that takes a lot of energy,” the professor explains.

“If one smokes or is low on anti-oxidants, that lowers the ability to deal with the excess energy, so this causes damage to the eye itself. Because of genetics, there’s baseline inflammatory damage in the eye . . . that is exacerbated by light damage.”

In the beginning, symptoms may not be very noticeable. Only in advanced AMD does one notice distortion and reading becomes more difficult, starting from the centre of vision. By changing lifestyle, and taking dietary supplements such as anti-oxidants, one can reduce the risk of progression from the dry to the wet form of AMD. The condition can’t be reversed however, and there’s no operation that can be done at this time.

AMD is directly related to nutrition, diet and other modifiable risk factors. The treatments for it include laser and photodynamic therapy, and the new anti-VEGF therapy from Lucentis. Lucentis’s new anti-VEGF therapy can now stabilise and even improve vision in about 90 per cent of AMD patients. Some 30 to 40 per cent of patients see significant improvement, so it’s a huge step forward compared with other treatments.

Anti-VEGF (anti-vascular endothelial growth factor) treatment helps reduce vessel formation, bleeding and swelling in the eyes. Lucentis was specifically designed for injection in the eye and is generally safe and well tolerated. Eye specialists usually do three monthly injections first and post frequent monitoring to see if subsequent injections are needed.

It doesn’t hurt, Prof Kaiser assures. “Flu shots hurt more than this,” he adds. The solution blocks the growth factor responsible for the growth of the new blood vessels. The treatment has been available in the US for a while now, and in Singapore since 2008.

Lucentis’s anti-VEGF treatment is now the gold standard for wet AMD. “It prevents loss of vision, but it doesn’t reduce risk of stroke, which can’t be prevented unless the risk factors are improved upon,” says Prof Kaiser.

For the dry version of AMD, there is no proven treatment for it now, but what slows it down is supplemental vitamins, especially anti-oxidants, which can reduce the risk of progression by 30 per cent.




Wednesday 1 December 2010

Two Treatments Make Gains

Nov 22, 2010
The New York Times

By Andrew Pollack

LOS ANGELES — Elderly people losing their vision from age-related macular degeneration might one day have a treatment option that requires fewer injections into the eye than the standard drug now used. In testing, an experimental drug being developed by Regeneron Pharmaceuticals, when injected every eight weeks, proved as effective as the standard treatment, Lucentis from Genentech, which was injected every four weeks. The findings are from two clinical trials that Regeneron is expected to announce on Monday. 

In a separate development, Advanced Cell Technology is expected to announce Monday that it has won regulatory approval to test a therapy derived from human embryonic stem cells in people with Stargardt’s macular dystrophy, another retina disease.It is only the second trial of a therapy derived from human embryonic stem cells to be cleared by the Food and Drug Administration. The first involves a treatment for spinal cord injury developed by Geron

Age-related macular degeneration is the leading cause of blindness in the elderly. Lucentis can restore a person’s ability to drive and read, in some cases. But the drug works best when given every four weeks, which can be inconvenient for patients and doctors. Doctors often give Lucentis less frequently, but even if that regimen produces good results, patients must still get checkups every month to make sure their vision is not deteriorating.

Regeneron’s drug, which is called VEGF Trap-Eye, “gives us the opportunity to not have to see them monthly,” said Dr. Jeffrey Heier of Boston, an investigator in one of the trials and a consultant to Regeneron. That would be “very meaningful to patients and their families,” he said. Regeneron and its partner, Bayer, said they planned to apply for approval of the drug in the first half of 2011. 

The two similar trials involved a total of 2,457 patients who were randomly chosen to receive either Lucentis every four weeks or VEGF Trap-Eye either every four weeks or every eight weeks. In the eight-week arm, the first three doses were given every four weeks. After a year, roughly 95 percent of the patients in all the arms of the trial maintained their vision, meaning their ability to read an eye chart declined by no more than 15 letters, or three lines. 

VEGF Trap-Eye was also “noninferior” to Lucentis in terms of the average change in vision after one year. Lucentis recipients had a mean gain of 8.1 letters and 9.4 letters in the two trials. Those getting Regeneron’s drug every eight weeks had gains of 7.9 letters and 8.9 letters. 

Regeneron said the two drugs were equally safe. Both VEGF Trap-Eye and Lucentis block a protein called vascular endothelial growth factor that causes blood vessels to grow and leak into the eye. 

VEGF Trap-Eye could become the first big product for Regeneron, which was founded in 1988 and is based in Tarrytown, N.Y. It sells one drug for a rare disease and has garnered hundreds of millions of dollars from licensing deals with big pharmaceutical companies. 

Regeneron’s drug is likely to face competition from off-label use of Genentech’s cancer drug Avastin. When used in the eye, Avastin costs about $50 a dose, compared with about $2,000 for Lucentis. Still, even with such low-priced competition, Lucentis has sales exceeding $2 billion globally. 

Meanwhile, Advanced Cell Technology, of Marlborough, Mass., said it would test its stem cell therapy on 12 adults with severe vision loss caused by Stargardt’s, an inherited disease. The company has turned human embryonic stem cells into retinal pigment epithelial cells, which will be surgically implanted into the eye. The hope is that the implanted cells will replace those injured by the disease. 

Human embryonic stem cells are controversial because their creation usually entails the destruction of human embryos, although Advanced Cell Technology is working on a technique to avoid that. 

Embryonic cells can also form tumors if injected into the body. Dr. Robert Lanza, chief scientist at Advanced Cell, said the company had to prove to the F.D.A. that its retinal cells contained virtually no residual embryonic stem cells. It took a year for the company to get clearance for the trial from the F.D.A. It is likely to be several years before such a treatment can reach the market, if it works. Still, even starting the trial could be a boost to Advanced Cell, which often makes headlines but has struggled to raise money. Its shares closed at 5 cents on Friday. 

Dr. Peter J. Francis, an associate professor at the Oregon Health and Science University, which will be a site for the trial, says the eye is a good place to test stem cell therapy because it is accessible. Also, he said, there is less chance of rejection of the implanted cells because the eye is shielded somewhat from the body’s immune system. There is no treatment for Stargardt’s, which affects more than 25,000 people in the United States. The disease is usually diagnosed during childhood and it causes a loss of central vision, though not usually peripheral vision. 

Ryan Rapoport of Newcastle, Wash., who has the disease, “basically went from normal vision to legally blind in seven months,” said his father, Darrin. Ryan, now 10, cannot be in the trial because, for safety reasons, it is confined to adults. Still, Mr. Rapoport said, “It gives us some hope, because up until recently there was no hope.”