Macular Degeneration Research News: Spring 2017
Macular Degeneration Research News: Spring 2017
Published on:
In This Issue
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Repurposed Cancer Drug Could Lead to New Treatment - President’s Corner
The Future is Bright - Implantable Miniature Telescope Enhances Sight in AMD Patient
- How the Implantable Miniature Telescope Works
- Spring Cleaning
Making your home safer for people with low vision - Feel Good About Your Gift
Planned giving can help fight AMD - Register for BrightFocus Chats!
Free monthly calls about AMD
Research Shows Hope for Dry AMD
Repurposed Cancer Drug Could Lead to New Treatment
In a major advance, Macular Degeneration Research-funded scientists have found that a repurposed cancer drug called xaliproden could help prevent the advanced stage of dry age-related macular degeneration (AMD), known as geographic atrophy.
Currently there is no treatment for dry AMD, the most common form of the disease. According to the National Institutes of Health, nearly 2.1 million Americans have late-stage AMD, which can result in irreversible blindness, and that number is on the rise.
Over a lifetime, accrued damage caused by smoking, excessive sun exposure, waste buildup in the eye, and other factors results in oxidative stress and chronic inflammation. This affects the retinal pigmented epithelium (RPE), a layer of cells that nourishes the eye’s delicate light-sensing photoreceptors.
In animal models, Alfred Lewin, PhD, and Manas Biswal, PhD, of the University of Florida, found that daily doses of xaliproden protected the RPE from damage. It increased the RPE’s thickness and also reduced the number of small abnormal cavities in its tissues. Moreover, the treated animals showed improved visual acuity, according to the study published in Molecular Vision.
“Treatment with xaliproden increased the production of antioxidant enzymes in the retina, and that is how we believe it is protecting the retina,” the researchers noted. These early results are encouraging, although further research is needed before this could become a treatment for people with dry AMD.
The RPE is considered the “birthplace” of AMD, so new drugs to fight the disease are urgently needed. Drugs typically require years of testing before they can be approved for use. However, because xaliproden has already been tested in advanced human clinical trials for other diseases, its repurposing for dry AMD could proceed faster than most drug development.
Macular Degeneration Research is currently funding a related study by Drs. Lewin and Biswal to expand on this important research.
Implantable Miniature Telescope Enhances Sight in AMD Patient
Dan Dunbar first realized something was wrong when spots blocked his straight-ahead vision. He was diagnosed with AMD and began treatment. But by age 81, his vision had diminished to the point where he was legally blind.
All that changed in 2011 when his retinologist called to tell him he was a candidate for the implantable miniature telescope (IMT), newly approved by the Food and Drug Administration (FDA).
Before the operation, Dunbar received training from physical therapists. They put a patch over the eye that was going to receive the implant so he could learn how to navigate with his other eye using peripheral vision. He also practiced using an external test telescope to prepare for the IMT.
Dunbar was awake through the 90-minute operation and left the hospital with a patch over his left eye. “A couple hours later, I took the patch off and I could see! Sort of,” he said. “I couldn’t see very well because the eye was highly dilated.” That typically lasts for about a
month. “Once the dilation ends, then you can begin to really use the telescope,” he explained.
Physical therapy and training are critical to recovery after the procedure. “AMD can cause the loss of sight over a long period of time, and your mind is working all the time trying to compensate for this loss. So now you have to train your mind to do it correctly and that’s where the physical therapist comes in,” he said.
“The telescope is [nearly] 3-power,” Dunbar said, so patients must adjust to seeing objects magnified almost three times their normal size. “You’re used to moving your eye a certain way. Now, if you do it that way, it’s three times more than what you had experienced before. It is like any kind of training—you have to keep doing it until you’ve got it.” Today, he doesn’t even notice the IMT. “The eye isn’t heavier and it doesn’t move any slower. It’s no different than your regular eye.
”The IMT allowed Dunbar to regain lost hobbies, including working on model trains and skiing. “I can ski great. I can see the snow on the skis. I don’t run into things.” He can also use his computer and smartphone, although he needs a magnifier if the font size is under 12. Dunbar is now 85, and the IMT has had a huge impact on his life. “It’s great,” he said. “I can see!”
How the Implantable Miniature Telescope Works
Even when patients with AMD lose central vision in both eyes, they usually still retain their peripheral vision. The implantable miniature telescope (IMT) works by enlarging objects in the center of a person’s visual field so they can be seen by remaining undamaged areas of the retina.
The IMT has been approved by the FDA for patients with a corrected vision between 20/160 and 20/800 caused by end-stage AMD in both eyes. Patients must also achieve at least a 5-letter improvement on the visual acuity chart using a trial external telescope because it helps predict how much they will benefit from an IMT.
Patients with active wet AMD are not eligible for the procedure. They must also have their natural lens, meaning they can’t have had cataract surgery in the eye in which the IMT is implanted.
During the procedure, the eye’s natural lens is removed (much like in routine cataract
surgery) and replaced with the pea-sized IMT. There are two models: one with 2.2- times magnification, the other with 2.7-times. Higher magnification provides sharper vision but a slightly smaller visual field.
It’s important to work with a low-vision specialist and occupational therapist before and after surgery to determine if the IMT is suitable for each patient and learn how to use it. Patients must practice looking at moving objects while sitting still, or looking at stationary objects while walking. IMTs reduce depth perception, but this can improve with experience.
Macular Degeneration Research supports some of the top scientists in the world to better understand what causes AMD and find new ways to treat it.
It takes time to get used to seeing magnified objects in the IMT-implanted eye, which now has tunnel vision, and using the other eye for peripheral vision. This is comparable to using monovision contact lenses, one to see distance, the other to see near. Patients will obtain the best results from centers where surgeons are experienced with the specialized implantation procedure, and where low-vision optometrists and occupational therapists experienced with IMT training are available to help pre- and post-operatively.
Spring Cleaning
Making your home safer for people with low vision
Spring cleaning is the perfect time to make the home safer for people with low vision. There are three main ways to help prevent falls and other household injuries: lighting, contrast, and organization.
Lighting—People with low vision typically need three to four times more light than those without vision loss. One simple solution is to use an adjustable floor or desk lamp to focus light where it’s needed. Nearly all light fixtures get dusty over time, so clean them regularly. Also consider the bulb’s color temperature. “Soft white” bulbs cast an attractive warm light, but bulbs labeled “daylight” give better illumination for detail tasks like reading, chopping vegetables, putting on make-up, or doing crafts.
Contrast—Those with low vision often have trouble distinguishing between similar colors. Generally, bright colors are easier to see than pastels, and solid colors are easier to see than patterns. So keep the solid-color dishes handy and store away the patterned ones.
Organization—Nobody likes searching for items, but vision loss makes it even harder. Use color and contrast to organize items. For example, arrange your closet by color. Store hard-to-distinguish colors like black and brown at opposite ends of the closet. In the kitchen, always keep things in the same place. Put your coffee-making supplies on a brightly colored tray on the counter. To keep cupboards organized, make simple labels for canned goods by writing the name of the item on an index card and wrapping it around the can with a rubber band. In the bathroom, use “daylight” bulbs since shiny, slippery surfaces can lead to glare and falls. Keep your soap where you can find it by using soap-on-a-rope. If you can’t buy one at the store, make one by putting the soap into a sock that’s missing its mate. People with low vision can find it hard to measure and pour laundry detergent. Consider replacing liquid or loose powder detergent with detergent capsules that can be dropped into the washing home through the garage, so make sure the pathway is clear.
Create a Meaningful Legacy
Planned giving can help fight AMD
Wouldn’t it be wonderful to accelerate the search for a cure for AMD while also ensuring your family’s needs are met? You can—by naming Macular Degeneration Research in your will or estate plans. When you include us in your estate plans, your gifts will put you front and center in the fight to discover treatments that will benefit millions. You may also be able to reduce your estate taxes and leave a larger inheritance for your loved ones. It’s a simple way to create a meaningful legacy while also benefiting your family. For additional information or to discuss the many giving options available, please contact Charles Thomas at 855-345-6637 or cthomas@brightfocus.org.
Thank you for advancing the work of Macular Degeneration Research!
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Macular Degeneration Research News is published by Macular Degeneration Research, a program of BrightFocus Foundation. This information should not in any way substitute for the advice of a qualified health care professional. BrightFocus Foundation does not endorse any medical product or therapy.© BrightFocus Foundation, 2017