Precursors to Corneal Transplant Failure; Patients Who Skip Glaucoma Treatment; Antibiotic-Resistant Bugs and LASIK

SAN FRANCISCO, CA, Jun 01 (MARKET WIRE) --
The June issue of Ophthalmology, the journal of the American Academy of
Ophthalmology, includes new insights on why some corneal transplants
fail, why some patients skip their glaucoma medications, and why
preventing infections after LASIK is a growing concern.

Patients at Higher Risk for Corneal Transplant Failure

Researchers analyzed data for 1,090 participants in the Cornea Donor Study
(CDS), a multicenter, controlled clinical trial, to find factors linked
with corneal transplant failure. The failure rate was about four times
higher in patients diagnosed with corneal edema (swelling) associated with
either intraocular lens (IOL) implants or no natural lens following
cataract removal, than in patients diagnosed with Fuchs' dystrophy, a
disorder of the corneal endothelial layer. Also, failure rates were
substantially higher for glaucoma patients treated surgically, with
medications, or both. These results, reported by Alan Sugar, M.D., for the
CDS Investigator Group, were part of a five-year study funded by the
National Eye Institute and coordinated by the Jaeb Center for Health
Research, Tampa, Florida.

The 27 percent of patients diagnosed with IOL-associated corneal edema
whose transplants failed may have shared an underlying problem: an
abnormal reaction to cataract surgery and/or IOLs that negatively
impacted the cornea in some way. (The vast majority of patients who have
cataract-IOL surgery have no such reaction.) When these patients received
new corneas, their underlying problem remained and compromised the
transplant, the researchers suggest. In contrast, Fuchs' dystrophy
patients had only a seven percent failure rate, including those who had
IOLs. The failure rate for participants who did not have glaucoma was 11
percent versus failure rates of 20 percent, 29 percent and 58 percent for
glaucoma patients treated with medications alone, surgery alone, or both,
respectively.

Why do Some Glaucoma Patients Skip Their Medications?

Motivating patients with chronic illness to follow treatment plans is a
challenge for physicians, as ophthalmologists who treat people with
glaucoma can attest. Studies covering a range of chronic diseases
consistently show that only about 70 percent of prescribed medications
are taken. With glaucoma, patients may not take their eyedrops because
they often have no pain and few symptoms and because treatment benefits
are apparent over years rather than immediately. To learn more about
adherence, a team of researchers from Johns Hopkins and University of
Pennsylvania Schools of Medicine gave glaucoma patients a prostaglandin
eyedrop medication at no cost and monitored use with an electronic device.

"Eighty-six of our 196 study patients (44 percent) took their medication
less than 75 percent of the time. A combined analysis found the most
important factors were age (younger and older patients were less
adherent), African-American ethnicity, and poorer overall health," said
lead researcher David S. Friedman, MD, of Johns Hopkins Wilmer Eye
Institute. Other factors included whether the patient was knowledgeable
about glaucoma, understood how treatment worked, and expressed concern
that it would help preserve his or her vision. These findings add to and
are consistent with previous reports. Some research has suggested that the
ethnicity of the health professional may affect quality of care for
African-Americans, but that effect was not detected here. Dr. Friedman
recommended further research to explore lower adherence among
African-Americans.

Beating Bacteria to Prevent Post-LASIK Infections

Since bacteria mutate frequently and become resistant to new antibiotics,
ophthalmic researchers are on a continuous quest to identify the worst
offenders and best treatments. Infections occur rarely in LASIK patients,
but data show rates are slowly rising. A recent study at Yonsei
University College of Medicine, South Korea, evaluated infection risk in
105 patients using eye surface (conjunctiva) swabs taken immediately
before LASIK or similar refractive surgery to measure preexisting
bacteria.

Coagulase-negative staphylococci (CNS) was found in 84.9 percent of the
cultures grown from the swab samples, and 31.4 percent was antibiotic
(methicillin)-resistant. In other studies over the past decade the
incidence of resistant CNS was less than two percent. This significant
increase suggests that resistant strains are spreading through community
contact and not only through surgical units, the researchers said. The
community-based spread of infections like CNS and methicillin-resistant
staphylococcus aureus (MRSA) is raising concern world-wide, including in
the United States. Lead researcher Kyoung Yul Seo, M.D., and colleagues
used five fluroquinolone antibiotics (three newer generation and two
older) to treat the bacteria in the culture samples. The most effective
was the newest fluroquinolone approved by the U.S. Food and Drug
administration. Dr. Seo thinks using the newer fluroquinolones as initial
treatment may limit bacterias' ability to generate resistant mutations.

"Since resistant CNS is now widespread, it makes sense to develop
ophthalmic agents using the newest fluroquinolones and to consider their
use after refractive surgery to attempt to reduce infections, " Dr. Seo
said.

Eds: Full texts of the studies are available from the Academy's media
relations department.

About the American Academy of Ophthalmology

AAO is the world's largest association of eye physicians and surgeons --
Eye M.D.s -- with more than 27,000 members worldwide. Eye health care is
provided by the three "O's" -- opticians, optometrists and
ophthalmologists. It is the ophthalmologist, or Eye M.D., who can treat it
all: eye diseases and injuries, and perform eye surgery. To find an Eye
M.D. in your area, visit the Academy's Web site at www.aao.org

Contact:
Media Relations
(415) 561-8534
media@aao.org

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