RxOne HELP is a new service that helps patients stick to brand name medications, including a number of glaucoma meds at little or no cost increase over generics.

Read the MyToba.com article here.

Click here to go to the RxOne HELP web site.

Retina 2014 Sep 09;[EPub Ahead of Print], HG Maralani, BC Tai, TY Wong, ES Tai, J Li, JJ Wang, P Mitchell

Over a 10-year period, 2218 individuals >49 years of age with metabolic syndrome were followed for the development of early and late AMD. Early AMD developed in 12% and late AMD in 3% of participants. In those <70 years, metabolic syndrome was associated with late AMD. In particular, obesity, hyperglycemia, and elevated triglycerides were associated with increased incidence of late AMD.

European Society of Cardiology, 2014 Sep 02

Coffee increases the risk of prediabetes in young adults with hypertension who are slow caffeine metabolisers (60% of the population), according to results from the HARVEST study presented at ESC Congress today by Dr Lucio Mos from Italy. People who drank more than three cups of coffee per day doubled their risk of prediabetes.

Luxottica (parent company of LensCrafters and Pearle Vision) closed it's Winnipeg optical plant this week. The company has been coy about where their glasses will now actually be made, suggesting they'll be handled by a partner distributor in Ontario. The smart money suggests they'll come from China.

This caught many in the industry by surprise. Companies need to be profitable to survive and create jobs, but Luxottica has profit margins that would make most companies blush. And they've made those profits by convincing people to pay twice as much for their glasses due to perceived quality. One would think that would be a tough sell for glasses coming from China.

'More than 3,000 Canadians are waiting for a life-changing cornea transplant — some for as long as two years — in a system that experts say is patchwork and broken...' Read the full article on the shortage of corneas for transplant in Canada featuring Brandon colleague Dr. Guillermo Rocha here...

Eylea (aflibercept, Regeneron) just received FDA approval for treatment of Wet Macular Degeneration.  It is being billed as better than Lucentis and Avastin because “it lasts longer.”  Is this true?  Will it replace Lucentis and Avastin?  What are early issues with using this medication?

Eylea works by a similar mechanism as Lucentis and Avastin (blocks Vascular Endothelial Growth Factor or VEGF).  Instead of being an antibody to the VEGF molecule, it is a fusion protein consisting of portions of the receptors for the VEGF molecule (VEGFR-1, VEGFR-2), thereby binding and blocking VEGF.

The results of their pivotal FDA studies (VIEW 1 and VIEW 2) showed that 1)Eylea injected every month, 2)Lucentis injected every month, and 3)Eylea injected every month for three months then every two months after that had very similar results at one year.

Just when it looked like all the eye stories in the mainstream media would be about deceptive practices by the large optical companies, a feel good story reported on CTV.

When Taylor Binns slowly began going blind because of complications with his contact lenses, he started to prepare for living the rest of his life without vision. But an innovative treatment using stem cells has changed all that, and returned to him the gift of sight.

See the whole article...

A study published today in the Journal of the American Medical Association (JAMA) linked regularly taking Aspirin (ASA) with an increased risk of developing macular degeneration (AMD) - 14 cases per 1,000 versus 6 cases per thousand.

It's important to note that this study shows a link, but DOES NOT demonstrate a cause and effect relationship. A cause and effect relationship would mean that taking ASA increases the risk of AMD. But, it may well be that these patients had a condition that was commonly treated with ASA and it was the condition not the ASA that increased the risk of AMD. In that case stopping the ASA would NOT reduce the incidence of AMD (the condition would still be present), but would deprive them of the benefit of ASA for their condition creating a double loss.

Even if ASA does increase the risk of AMD, the risk is small compared to the significant health benefits of cardio-protective ASA. The study’s lead scientist, Dr. Barbara Klein, a professor of ophthalmology at the University of Wisconsin School of Medicine and Public Health stated “Coronary heart disease is a killer. If you are convinced that people need to be protected from heart disease with aspirin, you wouldn’t stop it because of this potential risk.”

This posting on Harvard Medical School's health blog does a nice job of addressing the issue.

http://www.health.harvard.edu/blog/aspirins-heart-benefits-trump-possible-small-risk-of-macular-degeneration-201212195686

BE VERY AFRAID — HALLOWEEN COSTUMES WITH NON-PRESCRIPTIVE COSMETIC CONTACT LENSES MASK SERIOUS EYE INJURIES

OTTAWA — Canadians donning a Halloween costume this year should steer clear of cosmetic, non-corrective contact lenses sold directly from retail outlets because of the significant risk of blindness and other eye injuries associated with improper fittings, warned the Canadian Ophthalmological Society (COS) today.

“The real danger here is that Canadians have been able to buy decorative or cosmetic lenses without a prescription and proper fitting by an eye health specialist,” said Dr. Paul Rafuse, President of the COS Board of Directors. “These lenses change the appearance of the eye but in doing so they can produce corneal ulcers than can quickly lead to internal ocular infection and permanent loss of vision if left untreated.”

Read the full statement here...

A number of you pointed this out. Luxottica/Lenscrafters seems to be a favourite of the investigative news programs both north and south of the border this year.

If our American neighbours think prices are out of line at LensCrafters in the US, they're considerably higher here.

CBS's 60 Minutes reports...

From the National Institutes of Health: At two years, Avastin (bevacizumab) and Lucentis (ranibizumab injection), two widely used drugs to treat age-related macular degeneration (AMD), improve vision when administered monthly or on an as needed basis, although greater improvements in vision were seen with monthly administration for this common, debilitating eye disease, according to researchers supported by the National Institutes of Health.

Read the rest of the NIH press release here...

Read more on Avastin and Lucentis here.

The cost of foldable intraocular lenses for cataract surgery is now covered by Manitoba Health. Previously Manitoba Health only covered the cost of the older style rigid implants. Patients had to pay an additional cost of approximately $300 per implant for the foldable/soft lenses. Although the rigid lenses were perfectly fine, the foldable lenses hold many benefits.

Click here for more information on cataracts and cataract surgery.

CBC Marketplace purchased online and compared them with those from LensCrafters. The online glasses were hundreds of dollars cheaper even with a LensCrafters sale. That wasn't a surprise. The big surprise was that the online glasses were also better.

To view the story and see what this really means to you click here.

Health Canada is actively reviewing the drug Avastin (generic name: bevacizumab) to determine whether the benefits outweigh the risks as a treatment for advanced breast cancer. The Food and Drug Administration has already revoked it's approval for this use in the United States. Avastin is an anti-VEGF treatment that is used to treat a number of diseases including cancers of the colon, brain, kidney, and lung. What does this have to do with Ophthalmology?

The production of new blood vessels is controlled by complex signalling mechanisms within the body. Vascular endothelial growth factor (VEGF) is a signal protein produced by cells that stimulates vessel growth. It is part of the system that restores the oxygen supply to tissues when blood circulation is inadequate. However, overexpression of VEGF can contribute to disease by promoting the proliferation of blood vessels which a tumour would require for example to grow rapidly. Interfering with the ability to produce those new vessels inhibits tumour growth.

In the eye, wet macular degeneration, diabetic retinopathy, and retinal vein occlusions are diseases with a vascular component. The production of new vessels in these conditions is often associated with sight threatening complications. Anti-VEGF treatment can prevent or slow these complications.

Avastin is an anti-VEGF that is widely used in ophthalmology in the United States and Canada. The revocation of its approval for use in metastatic breast cancer by the FDA had to do with questions about its effectiveness and not its safety. This has no bearing on its use in ophthalmology.

Interestingly, although Avastin is widely used in Ophthalmology in Canada and the United States it is not officially approved for such use. Say what??? See Avastin vs. Lucentis

Xalatan (latanoprost), one of the most popular glaucoma medications, has lost it's patent protection in Canada. Xalatan is a very effective medication with a very low incidence of side effects. We are sure to see generic versions soon. Generic medications are often therapeutically equivalent to name brand drugs, but not in all patients. They can present significant cost savings, but patients will need to monitor with their ophthalmologists whether the generic version is appropriate for them.

Health Canada has approved Lucentis (ranibizumab) as a treatment for vision loss resulting from diabetic macular edema (DME), one of the major causes of adult vision loss.

Canadian approval was based on data from the RESTORE study in which patients treated with either Lucentis* alone or in combination with laser gained significantly more letters in visual acuity at 12 months compared to baseline  versus  patients treated with laser alone.

Lucentis was previously approved as a treatment for the wet form of age-related macular degeneration and for the treatment of visual impairment due to macular edema secondary to retinal vein occlusion (RVO)