AOA Disputes New Screening Recommendations for Kids
In an updated version of its 2004 document, the U.S. Preventive Services Task Force (USPSTF) calls for vision screening of all children between the ages of three and five, stating that vision screens for children under three years of age have not been proven advantageous. This statement has won the seal of approval from

Prevent Blindness America, but not everyone is as enthusiastic. The AOA fears that, if adopted, these new standards will further devastate the efforts to raise awareness of preventable vision loss among children.

“With nearly one in four school-aged children now suffering from preventable vision loss—which directly impacts their ability to learn, grow and function normally—ensuring that our children receive early and periodic comprehensive vision and eye health examinations will prove both cost-effective for our country and will be the key to fully confronting and potentially solving this continuing crisis,” says AOA President Joe E. Ellis, O.D.

The USPSTF blames false-positive results in preschool vision screens for needless corrective therapy. “Potential harms of preschool vision screening include psychosocial effects such as labeling and anxiety, unnecessary referrals because of false-positive screening results and unnecessary use of corrective lenses or treatments to prevent amblyopia, which can have potential effects on long-term vision or function,” reads the recommendation statement published in the January issue of Pediatrics.¹

“These ill-advised USPSTF recommendations seem to ignore mountains of scientific data showing that the vast majority of vision screenings for children demonstrate an unacceptably high rate of error,” says AOA President-elect Dori Carlson, O.D. “To make matters worse, for those children lucky enough to have been told they have failed a screening, numerous studies have also clearly shown that the overwhelming majority of those kids do not receive proper diagnosis and follow-up care. High error rates found in most children’s vision screening programs coupled with little or no assurances of proper diagnosis or follow-up care are the very reasons we find ourselves facing this crisis today.”

The AOA calls for immediate withdrawal of the USPSTF recommendations, hoping to come to a consensus that will help continue to promote early vision screenings in children of all ages.
 
1. Chou R, Dana T, Bougatsos C. Screening for Visual Impairment in Children Ages 1-5 Years: Update for the USPSTF.Pediatrics. 2011 Feb;127(2):e442-79.

Soothe XP Recalled
Bausch + Lomb announced a voluntary recall of its Soothe Xtra Protection (XP) eye drops. Soothe XP is only available in the United States; the recall affects all products with an expiration date between February 2011 and August 2012.

The recall stemmed from testing that showed specific lots of the Soothe XP Protection product were out of specification for preservative efficacy prior to their listed date of shelf-life expiration. B+L is recalling all lots, although there have been no adverse events reported for this product attributed to preservation efficacy. In the meantime, Soothe Preservation Free drops and Soothe Night Time Ointment continue to be available.

For more information, call the Soothe XP Protection hotline at 866-761-9526 or the Bausch + Lomb customer service center at 800-553-5340.

Retinopathy Without Diabetes?
Individuals who have a 10-year history of elevated blood glucose levels or poor blood glucose control are more likely to develop eye-related problems, according to a study in the February issue of Archives of Ophthalmology.

In this study, the researchers examined the retinas of 700 men and women who had their fasting plasma glucose and HbA1c levels monitored for the previous nine years. During the study period, 235 patients were diagnosed with diabetes, 227 had impaired fasting plasma glucose levels and 238 had normal glucose levels.

At the end of the study, the researchers determined that 38 patients with diabetes or impaired fasting plasma glucose levels developed retinopathy, compared to just six patients with normal glucose levels.

“It is now well established that the non-diabetic population also has retinopathy, albeit at a lower frequency than patients with diabetes and in a milder form, indicating that there may be factors other than fasting plasma glucose levels that increase the risk of retinopathy,” wrote the authors.

Massin P, Lange C, Tichet J, et al. Hemoglobin A1c and Fasting Plasma Glucose Levels as Predictors of Retinopathy at 10 Years: The French DESIR Study. Arch Ophthalmol. 2011 Feb;129(2):188-195.

Lipitor, Green Tea Could Treat DR
Oral statin therapy could be used to help treat patients with diabetic retinopathy (DR), according to a study in the March issue of Diabetologia.¹ Currently, there are no FDA-approved oral treatments for DR.

Uncontrolled diabetes leads to the production of free radicals in the retina. This oxidative process causes the eye to release a protein (pro-nerve growth factor) that normally matures into nerve growth factor, which protects the retina from damage. However, the researchers suggested that the free radicals generated by excessive glucose levels disrupt protein maturation and ultimately cause impaired neuronal function and resultant vision loss.

In this study, the researchers administrated oral atorvastatin––commonly known as Lipitor (Pfizer)––to rats with diabetes. The researchers found that atorvastatin blocked the formation of free radicals in the retina, which restored proper levels of nerve growth factor and preserved neuronal function.

“[Oral statins] removed the break on the pro-form nerve growth factor to develop into its mature form,” says lead author Azza El-Remessy, Ph.D., assistant professor at the University of Georgia College of Pharmacy. “The exciting part is that there are now treatment options that are proven to be safe that can be immediately translated to patients.”

In a related study published in the March issue of Diabetologia, Dr. El-Remessy and associates found that epicathecin––a component of green tea––also prevented adverse actions of pro-nerve growth factor in diabetic rats.²

Unlike atorvastatin, epicathecin does not retard the maturation process of pro-nerve growth factor into nerve growth factor, but rather prevents pro-nerve growth factor from signaling a receptor that triggers neuronal cell death.

“We are still getting the same result––that we are preventing neuronal death and restoring neuronal function—but just in a different way,” says Dr. El-Remessy. 

1. Ali TK, Al-Gayyar MM, Matragoon S, et al. Diabetes-induced peroxynitrite impairs the balance of pro-nerve growth factor and nerve growth factor, and causes neurovascular injury. Diabetologia. 2011 Mar;54(3):657-68.
2. Al-Gayyar MM, Matragoon S, Pillai BA, et al. Epicatechin blocks pro-nerve growth factor (proNGF)-mediated retinal neurodegeneration via inhibition of p75 neurotrophin receptor proNGF expression in a rat model of diabetes. Diabetologia. 2011 Mar;54(3):669-80.

ABO Open Exam Registration
Registration for the June 1-18, 2011 Board Certification Examination has begun. Active eligible candidates can register through the MyABO portal on the American

Board of Optometry (ABO) website. Once registered, candidates can reserve a seat at one of the 400 Prometric test centers. Optometrists may apply to become an active candidate by visiting www.abopt.org.