PROMinsight

08/08/2023

Vision problems in babies: Signs, causes, and more

This article was published on Medical News Today on January 20, 2022. It was written by Rachel Ann Tee-Melegrito and Medically reviewed by Karen Gill, M.D. It discusses the various vision problems in babies and small children.

Vision plays a vital role in babies development, as it helps them to identify object and provide stimulation. Detecting eye diseases early will help prevent them from becoming more severe and have a better chance of successful treatment. While experts claim that eye and vision problems in babies are rare, complications can still develop along with their visual abilities, such as red eyes, extreme light sensitivity or excessive tearing. Other visual problems like crossed eyes or constant squinting called strabismus is also more common in infants.

Genetics could also play a large role in causing eye problems in children. For example, cataracts, albinism or retinitis pigmentosa are common genetic disorders that affect children’s eyesight. Other congenital causes like infections, excessive alcohol and drug usage during pregnancies can lead to several eye problems in infants, among many other health problems.

There are also other eye diseases that can occur as a child develops. These include retinopathy, which stems from an atypical development of blood vessels in one’s retina. Lazy eye, or amblyopia, is a common cause of vision loss in children, affecting about 3% of them. This occurs when one eye does not develop properly, causing the brain to rely on the better eye for sight. Ophthalmia neonatorum refers to conjunctivitis that develops within the first 28 days of an infant’s life, commonly due to infections.

While many minor eye problems are likely to go away as children grow older, it is still important children receive regular eye checks to ensure they do not have major eye diseases that could worsen as they develop. It would also be good for opticians to detect early warnings for any eye diseases to ensure they can be treated early and prevent them from developing further.

PROMinsight understands the importance of eye health in children, and has developed a unique Impact of Vision Impairment (IVI) questionnaire specially tailored to children, called the IVI-C. This unique questionnaire that is much easier for children to understand helps to assess the quality of life of children with various eye diseases, including myopia. Assessing children’s quality of life is especially important as young children will have their ability to learn impaired by eye diseases, and this will help to pinpoint numerous problems that children may not be aware of.

An infant’s visual skills are still developing until they are over a year old. Read on for common signs to look out for with visual problems, causes, treatments, and more.

12/07/2023

https://www.straitstimes.com/singapore/health/spore-researchers-develop-new-treatment-to-resolve-post-cataract-surgery-eye

S'pore researchers develop new treatment to resolve post-cataract surgery eye inflammation | The Straits Times

This article, written by Zo-Er and published on The Straits Times on 3 August 2021, discusses research aiding post-cataract surgery recovery.

Cataracts are a common eye disease linked to aging. Over half of Americans aged 80 and above have had cataracts, according to the NIH. Age-related changes and factors like diabetes, eye injuries, smoking, drinking, and cataract history increase the risk. Cataracts cloud the eye lens, causing a frosted or fogged-up view (Mayo Clinic).

Cataract surgery is the treatment, followed by applying steroid eye drops every 3-4 hours for a month to control inflammation. However, patients often struggle or forget to apply drops, leading to eye pain, blurred vision, and blindness. Incorrect application can harm the eye and cause infections.

Moreover, steroid eye drops are minimally effective, with less than 5% reaching the inflammation site. Blinking, tears, and rubbing further reduce their effectiveness.

Researchers from Singapore National Eye Centre, Singapore Eye Research Institute (SERI), and Utrecht University (Netherlands) collaborated on a treatment eliminating the need for post-surgery steroid eye drops.

The treatment injects liposomal prednisolone, a steroid in lipid nanoparticles, into the eye after surgery, effectively reducing inflammation with no side effects. Patient feedback was positive, highlighting convenience, comfort, and absence of complications.

However, this treatment requires further research and development, likely becoming available in a few years.

PROMinsight created various PROMs to assess a patient's quality of life during treatment. This helps patients understand their eye disease and treatment better, while fostering improved patient-clinician interactions and aiding clinicians in delivering more effective care.

Read more at straitstimes.com.

23/06/2023

Macular degeneration vs. glaucoma: Signs and more (medicalnewstoday.com)

This article was published on Medical News Today on February 15, 2023. It was written by MaryAnn DePietro, CRT and medically reviewed by Grace Zhang, MD. It discusses the differences between 2 eye diseases – age-related macular degeneration (AMD) and glaucoma.

AMD affects the retina and causes one to lose their central vision, but side vision remains normal. It mainly affects people as they grow older. A survey by Bright Focus recorded that only 2% of Americans between the ages of 50-59 have AMD, but this number shoots up to 30% for those aged 75 and above. According to the Centers for Disease Control and Prevention (CDC), AMD is the leading cause of vision loss for people aged 65 and above in USA. There are 2 types of AMD – wet and dry AMD, and around 80% of AMD patients have dry AMD. Symptoms include gradual central vision loss, reduced colour sensitivity and increased light sensitivity.

Glaucoma is a common eye disease that causes one to lose their peripheral vision, leading to tunnel vision, and eventually total blindness. It is the leading cause of preventable blindness, affecting almost 80 million people worldwide, and 112 million by 2040. It is caused by a build-up of pressure in the eye, called intraocular pressure (IOP). Typically, an eye fluid called aqueous humor is produced and flushed out at the same rate. However, IOP will build up if this channel is blocked or the eye produces too much fluid, leading to damage in the optic nerve, and the death of retinal ganglion cells. One is at higher risk of having glaucoma if they are over 60, have a family history of glaucoma or have diabetes.

AMD and glaucoma are progressive eye diseases that affect millions of people’s eyesight worldwide. While both have treatments that can help slow vision loss, both diseases cannot be fully cured. Treatment for AMD includes injecting anti-VEGF drugs into ones eyes periodically, while glaucoma treatment involves eye drops, laser procedures or surgery. It has also been shown that not smoking, reducing exposure to UV light, increasing vitamin C and E intake, and having regular eye checks help reduce the chances of one developing these diseases.

AMD and glaucoma are major causes of irreversible blindness worldwide. PROMinsight understands how these diseases affects many patients quality of life. Thus, we have currently pipelined the MacCAT, and developed the GlauCAT, computerised adaptive tests (CAT) that measure the impact of AMD and Glaucoma and associated vision loss. It also assesses AMD and glaucoma treatments on 7 domains of quality of life. It would help many patients suffering from these diseases assess their quality of life with each treatment and identify which treatment would work best for them.

21/06/2023

New Treatments for Age-Related Macular Degeneration - American Academy of Ophthalmology (aao.org)

This article was published on the American Academy of Ophthalmology on 10 February 2023. It was written by Susanne Medeiros and Reena Mukamal, and reviewed By Rahul Khurana, MD, Sunir Garg, MD, FACS, Jayanth Sridhar. It discusses how age-related macular degeneration (AMD) treatments evolved over time.

AMD causes one to lose their central vision where fine details cannot be seen, but side vision remains normal. It mainly affects people as they grow older. A survey by Bright Focus recorded that only 2% of Americans between the ages of 50-59 have AMD, but this number shoots up to 30% for those aged 75 and above. There are 2 types of AMD – wet and dry AMD, with 80% of patients having the latter.

Previously, ophthalmologists have managed wet AMD with periodic eye injections and dry AMD with antioxidant vitamins. However, these treatments had many problems, such as not receiving treatments regularly, and only having limited efficacy on few people. Patients with AMD were still highly likely to develop permanent blindness.

However, in 2005 the anti-VEGF drug treated many with wet AMD, as these drugs improved the eyesight of the vast majority of patients. However, these drugs still needed to be injected into the eye periodically by ophthalmologists, which was not possible during COVID lockdowns, or when patients suffered from other health problems.

Gene therapy is a potential counter to these problems, as it aims to provide a one-and-done treatment to help the eye make its own anti-VEGF medication. This is done by injecting the gene therapy either underneath the retina via surgery, or into the eye like a normal anti-VEGF treatment. However, long-term effects have yet to be identified, requiring more research.

Dry AMD is harder to treat due to its different stages. Antioxidant vitamins help only in its early and intermediate stages, and there is currently no cure for its late stages. However, drugs to target AMD’s root cause have advanced into late-stage clinical trials, which are also injected into patient’e eyes. Another concept is replacing retinal cells that died from dry AMD with stem cells.

Currently, AMD is a major cause of irreversible blindness worldwide that affected almost 196 million people in 2020. PROMinsight understands how AMD treatments affects many patient’s quality of life. Thus, we have currently pipelined the MacCAT, a computerised adaptive test (CAT) system that measures the impact of AMD and associated vision loss. It also assesses AMD treatments on 7 domains of quality of life. Speculated to be done by 2023, it would help many patients suffering from AMD assess their quality of life with each treatment and identify which treatment would work best for them.

13/06/2023

Blurry vision and diabetes: What's the connection? (medicalnewstoday.com)

This article was published on Medical News Today on February 17, 2023. It was written by Markus MacGill and medically reviewed by Kelly Wood, MD. It discusses how certain diabetic complications can lead to blurry vision in both the short and long term.

Patients with diabetes often suffer from high blood sugar, causing fluid to move in and out of the eye more frequently and the eye to swell. Alternatively, those who use insulin could have low blood sugar. Both situations lead to blurry vision that resolves when blood sugar levels return to normal.

Long-term blurry vision stems from progressive diabetic complications. One common complication is diabetic retinopathy (DR). The The National Institutes of Health reports it affects over one-third of all diabetes patients. It is caused by high blood sugar, leading to blockage of blood vessels in the retina. This can cause the eye to grow new abnormal blood vessels, which have a high chance of leaking. The chances of developing DR continue to increase the longer one has diabetes. Modern Optometry has recorded that diabetic retinopathy was present in 25% of patients who had diabetes for 5 years, 60% at 10 years, and 80% after 15 years of diabetes.

Symptoms of diabetic retinopathy often do not manifest in the early stages. But in its late stage, called proliferative diabetic retinopathy (PDR), there will be floating spots in ones field of vision, and difficulty seeing faraway objects. There will be bleeding from ones eye’s blood vessels. PDR can lead to further complications like diabetic macular edema, glaucoma, or diabetic papillopathy.

There are several treatments available for patients with proliferative diabetic retinopathy. PROMinsight is one of few that offer patient-reported outcome measures (PROMs) that specifically target patients suffering from diabetic eye diseases, including DR. For example, our Diabetic Retinopathy Utility Instrument (DR-U) is a preference-based utility measure for assessing utilities relating to diabetic retinopathy and associated vision loss, and for economic evaluation of treatment therapies for DR and diabetic macular edema (DME). Also, PROMinsight is a proud developer of smart PROMs like our unique RetCAT, a computerised adaptive test (CAT) that measures the impact of DR and DME, and their associated vision loss and treatments. PROMinsight has also pipelined DiabCAT, which will measure the impact of diabetes, diabetes complications, and diabetes management and treatments on multiple domains of quality of life. It is expected to be available by 2024. These PROMs will be able to help patients understand their own eye disease more and help clinicians better know their patients and how to better treat them.

26/05/2023

https://tvst.arvojournals.org/article.aspx?articleid=2785649

This article was published by the Association for Research in Vision and Ophthalmology (ARVO) on the May 2023 issue of translational vision science & technology (tsvt). It was written by PROMinsight’s founders, Dr Eva Fenwick and Prof Ecosse Lamoureux. It discusses how to select the right questions to measure the Quality-of-Life (QoL) impact of Myopia Refractive Interventions (MyoRI).

Otherwise known as nearsightedness, myopia is a common eye disease that makes objects farther away look blurry, but near objects remain clear. It occurs when the cornea or lens in ones eye causes light to be refracted inaccurately, and thus inaccurate focusing of the light passing into the eye. It usually develops during childhood and stabilises at around 20-40 years of age. It is estimated around 2.6 billion people worldwide have myopia. Myopia is easily corrected with spectacles or contact lenses, and sometimes refractive surgery for adults.

The purpose of the research was to report on the content generation and item refinement phases for MyoRI-specific QoL item bank that will be operationalised using computerised adaptive testing (CAT).

These items were generated using 3 methods:
- a literature search of existing refractive–intervention QoL questionnaires;
- interviews with 32 myopic patients where 12 used spectacles, 7 used contact lenses and 20 had refractive surgery
- consulting 9 myopia experts from the Singapore National Eye Centre

Initially, 912 items within 7 independent QoL domains (Activity Limitation, Emotional, Comfort, Convenience, Concerns, Mobility and Work) were identified. After thematic analysis, items were systematically refined and 204 items were retained, including those relating to mobility challenges and work-related difficulties that were not well-represented in current MyoRI-specific questionnaires. These questions were tested using cognitive interviews with 24 additional patients with corrected myopia.

The research team has developed a 204-item and 7-domain MyoRI-specific item bank that will proceed to undergo rigorous psychometric testing to generate item calibrations for the validation of novel computerised adaptive test instruments designed for use in research and routine clinical practice. It is hoped that this instrument will enable researchers and clinicians to assess the impact of myopic refractive interventions quickly and comprehensively across these 7 QoL domains.

PROMinsight will use this data to further develop the MyoRI-CAT pipeline instrument. It is hoped this will help patients better understand the different types of treatments used for myopia and which one would work best for them.

Ryan E. K. Man, Kodi J. L. Goh, Ester P. X. Lee, Joshua H. X. Lim, Marcus Ang, Quan V. Hoang, Chee Wai Wong, Seang Mei Saw, Eva K. Fenwick, Ecosse L. Lamoureux; Identifying Content for an Item Bank to Measure the Quality-of-Life Impact of Myopia Refractive Interventions. Trans. Vis. Sci. Tech. 2023;...

23/05/2023

New Genetic Mutation Behind Childhood Glaucoma Identified (masseyeandear.org)

This article was published on Massachusetts Eye and Ear on December 1, 2022. It describes a new potential cause of childhood glaucoma, and how it can be more easily identified.

Glaucoma is caused by a build-up of pressure in the eye, which is caused by fluid in the eyes. Typically, it is produced and flushed out through a canal at the same rate. However, if this channel is blocked, or if the eye produces too much fluid, the fluid, and hence pressure, builds up. This blockage is often hereditary.

Childhood glaucoma affects approximately 1 in every 30 000 children in Australia and is responsible for around 5-7% of childhood vision impairment worldwide. It can cause children to become blind by 3.

An international team of scientists led by Mass Eye and Ear, a member of Mass General Brigham, and Boston Children's Hospital, found a mutation in the thrombospondin-1 (THBS1) gene in three ethnically and geographically diverse families with childhood glaucoma histories. The researchers then confirmed their findings in a mouse model that possessed the genetic mutation and went on to develop symptoms of glaucoma driven by a previously unknown disease mechanism. This could lead to improved screening for childhood glaucoma and earlier and more targeted treatments to prevent vision loss in children with the mutation, according to the study’s authors.

Quoted from Janey L. Wiggs, MD, PhD, “with this new knowledge, we can offer genetic testing to identify children in a family who may be at risk for the disease and start disease surveillance and conventional treatments earlier to preserve their vision. In the future, we would look to develop new therapies to target this genetic mutation.”

Knowledge of this gene mutation can lead to earlier treatments with conventional therapies. This new research could also lead to new therapies that would target the accumulation of abnormal proteins. The researchers also aim to determine if other THBS1 mutations are involved in adult-onset disease, like primary open-angle glaucoma, or milder forms of the disease if the mutation is not as pronounced.

Currently, glaucoma is treated by eye drops, oral medication, or laser surgery. The most effective treatment will differ from person to person, and how much it affects one quality of life will greatly differ as well. PROMinsight has created the GlauCAT, a computerized adaptive testing (CAT) system that measures the impact of glaucoma, and associated vision loss and glaucoma treatments on multiple domains of quality of life. Personalised and valid questions will be asked to patients to allow them to see how their quality of life is affected by different treatments, and can then identify which treatment works best for them.

18/05/2023

https://medicalxpress.com/news/2022-12-neuroprotection-optic-nerve-regeneration-mouse.html

This article was published in Medical Xpress on 20 December 2022. It was written by the Tokyo Metropolitan Institute of Medical Science, and discusses new research that opens a new treatment for glaucoma.

Glaucoma is a common eye disease that causes loss of peripheral vision, leading to tunnel vision, and eventually total blindness. It is the leading cause of preventable blindness, affecting almost 80 million people worldwide, and 112 million by 2040. It is caused by a build-up of pressure in the eye, called intraocular pressure (IOP). Typically, an eye fluid called aqueous humor is produced and flushed out through a canal called the drainage angle at the same rate. However, IOP will build up if this channel is blocked or the eye produces too much fluid, leading to damage in the optic nerve, and the death of retinal ganglion cells.

Managing ones glaucoma currently revolves around reducing ones IOP levels, but this only helps to slow down the damage glaucoma does. It is also ineffective for many glaucoma patients, specifically for those with normal tension glaucoma.

This research suggests reducing the degeneration of ones retinal cells instead, such as through the activation of neurotrophic factor signaling. This means stimulating protection of the retinal cells through its high-affinity receptor TrkB. However, the effectiveness of this treatment is also limited by the transient nature of lignad-dependent activation limits.

Hence, the research team invented a system that forced membrane localization of the intracellular domain of TrkB through farneylation, resulting in constructive TrkB activation despite the absence of ligands. This enhanced the survival of retinal cells significantly in both high and normal IOP levels, and lead to increased optic nerve regeneration, showing how the effects of glaucoma can actually be treated. With further research and enhancement of the delivery, this could lead to new research to help improve treatments for certain neurodegenerative diseases through gene therapy.

Currently, there are treatments that can help reduce glaucoma’s effects, such as eye drops, oral medication, and laser surgery. The most effective method to dealing with glaucoma will differ from person to person, and how much it affects one quality of life will greatly differ as well. PROMinsight has created the GlauCAT, a computerized adaptive testing (CAT) system that measures the impact of glaucoma, and associated vision loss and glaucoma treatments on multiple domains of quality of life. Personalised and valid questions will be asked to patients to allow them to see how their quality of life is affected by different treatments, and can then identify which treatment works best for them.

Glaucoma is the leading cause of irreversible blindness due to optic nerve damage and the death of retinal ganglion cells (RGCs). Presently, reducing intraocular pressure is the sole evidence-based therapy for glaucoma patients, but this therapy is ineffective in a considerable proportion of glaucom...

16/05/2023

https://medicalxpress.com/news/2023-01-video-eyesight-glaucoma.html

This article was published on the Medical Xpress on 27 January 2023. It was written by Marty Hames, representing Mayo Clinic. It talks about the dangers of glaucoma, and what one should do to maintain their eye health.

Quoted from Dave Patel, MD, an ophthalmologist at Mayo Clinic, glaucoma is termed the “silent thief of sight”, as many patietns do not even know they have glaucoma until much later. Recent studies have indicated around 50% of patients suffering from glaucoma are unaware they have it in the first place. It causes one to lose peripheral vision very quickly, until one has tunnel vision, and it can develop until one has total blindness.

Glaucoma is caused by a build-up of pressure in the eye, which is caused by fluid in the eyes. Typically, it is produced and flushed out through a canal at the same rate. However, if this channel is blocked, or if the eye produces too much fluid, the fluid, and hence pressure, builds up, damaging the optic nerve in the eye. If one is over 60 or has a family history of glaucoma, the risk of getting it is much higher.

While there is no treatment for glaucoma, there are numerous methods to help slow its progress, including medication, laser surgeries and more. Early detection of glaucoma can lead to faster recoveries and better outcomes, thus it was recommended one should have regular eye exams to discover if one has glaucoma or other eye diseases quickly.

The most effective method to dealing with glaucoma will differ from person to person, and how much it affects one quality of life will greatly differ as well. PROMinsight has created the GlauCAT, a computerized adaptive testing (CAT) system that measures the impact of glaucoma, and associated vision loss and glaucoma treatments on multiple domains of quality of life. Personalised and valid questions will be asked to patients to allow them to see how their quality of life is affected by different treatments, and can then identify which treatment works best for them.

Glaucoma is one of the world's leading causes of blindness, according to the Centers for Disease Control and Prevention. January is Glaucoma Awareness Month. Half of people with glaucoma don't even know they have it. If you're over 60 or have a family history of glaucoma, your risk is higher.

10/05/2023

Children with Type 2 Diabetes at Risk of Eye Disease - American Academy of Ophthalmology (aao.org)

This article was published on the American Academy of Ophthalmology on 5 July, 2022. It was written by Reena Mukamal, and reviewed by G. Atma Vemulakonda, MD. It highlights the relationship between type 2 diabetes and eye disease in youths.

A recent study by The JAMA Network revealed the risk of youths aged 22 and below with type 2 diabetes were 88% more at risk to develop diabetic retinopathy (DR) than those with type 1 diabetes within the first 15 years of suffering from it. Type 1 diabetes is linked more closely to genetics, while type 2 diabetes is often associated with one’s lifestyle.

DR is a common diabetes complication that affects the eyes, with The National Institutes of Health of health reporting it affects over one-third of all diabetes patients. It is caused by excessive sugar in the blood, leading to blockage of blood vessels in the retina, the light-sensitive tissue at the back of the eye. This can cause the eye to grow new abnormal blood vessels, which have a high chance of leaking as they did not develop properly. The chances of developing this condition continue to increase the longer one has diabetes. Modern Optometry has recorded that diabetic retinopathy was present in 25% of patients who had diabetes for 5 years, 60% at 10 years, and 80% after 15 years of diabetes.

It is recommended that patients with diabetes see an ophthalmologist annually for a dilated eye exam, to help identify DR before it manifests symptoms like dark empty spots in one’s vision which appear in its later stages. In the final stages of DR, known as proliferative DR, it can lead to total blindness.

There are several treatments available for patients with proliferative diabetic retinopathy, such as injecting anti-VEGF into one’s eyes using tiny needles. PROMinsight is one of few companies that offer patient-reported outcome measures (PROMs) that specifically target patients suffering from diabetic eye diseases, including DR. For example, our Diabetic Retinopathy Utility Instrument (DR-U) is a preference-based utility measure for assessing utilities relating to diabetic retinopathy and associated vision loss and for economic evaluation of treatment therapies for DR and diabetic macular edema (DME). We have developed smart PROMs like our unique RetCAT, a computerised adaptive test (CAT) that measures the impact of DR and DME, and their associated vision loss and treatments. We are currently developing DiabCAT, measuring the impact of diabetes, its complications, management and treatments on multiple domains of quality of life. Available by 2024, these PROMs will be able to help patients understand their own eye disease more and help clinicians better understand and treat their patients.

03/05/2023

Measuring glaucoma quality of life in an Asian population using item banking: psychometric evaluation and computerized adaptive testing simulations - PubMed (nih.gov)

This is an abstract of a research paper published on 28 April 2023, on PubMed. It is linked to the The National Institutes of Health, the National Library of Medicine (NLM), and the National Center for Biotechnology Information (NCBI). Authored by PROMinsight’s own founders Dr Eva Fenwick and Prof Ecosse Lamoureux, amongst others, it highlights how using psychometric evaluation and computerised adaptive tests helped in measuring glaucoma quality of life in an Asian population.

This research aimed to assess the psychometric properties of glaucoma-specific health-related quality-of-life item banks (IB) and explore their efficiency using computerized adaptive testing (CAT) simulations. IBs refer to a set of test questions pertaining to a particular area, while CATs refer to an online testing system that decides the next question asked depending on the response provided in the previous question.

In this cross-sectional, clinical study, 300 Asian glaucoma patients of mean age 67.2 ± 9.2 years (62% male; 87% Chinese) answered 221 items within seven IBs: Ocular Comfort Symptoms; Activity Limitation; Lighting; Mobility; Glaucoma Management; Psychosocial; and Work.

Rasch analysis was conducted to assess each IB's psychometric properties (e.g., item "fit" to the construct; unidimensionality), and a set of analytic performance criteria guiding decision-making relating to retaining or dropping domains and items was employed. CAT simulations were used to determine the mean number of items for 'high' and 'moderate' measurement precision.

The results were promising. Lighting, Mobility, and Glaucoma Management item banks displayed good psychometric properties overall. However, it was discovered that several questions in IB’s of Activity Limitation, Psychological and Comfort Symptoms had to be reworked due to being outdated and having item bias. Work IB was not considered further due to its poor measurement precision and low applicability.

CAT simulations on the seven IBs required an average of 12.1 and 15.7 items per IB for moderate and high precision measurement, respectively.
After reengineering the seven IBs, they displayed robust psychometric properties and good efficiency in CAT simulations.

This research was done to further develop PROMinsight’s pipeline CAT GlauCAT™-Asian. Once finalized, GlauCAT™-Asian may enable comprehensive assessment of the health-related quality of life impact of glaucoma and associated treatments. GlauCAT™-Asian is anticipated to be available by the end of 2023.

After reengineering our seven IBs, they displayed robust psychometric properties and good efficiency in CAT simulations. Once finalized, GlauCAT™-Asian may enable comprehensive assessment of the HRQoL impact of glaucoma and associated treatments.