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Pepose J, Brigell M, Lazar E, Heisel C, Yousif J, Rahmani K, Kolli A, Hwang M, Mitrano C, Lazar A, Charizanis K, Sooch M, McDonald M. A randomized phase 2 clinical trial of phentolamine mesylate eye drops in patients with severe night vision disturbances. BMC Ophthalmol 2022; 22:402. [PMID: 36209072 PMCID: PMC9548101 DOI: 10.1186/s12886-022-02621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Dim light vision disturbances (DLD) comprise a wide range of symptoms affecting the quality of vision at low illumination including glare, halos, and starbursts. This exploratory study investigated 1.0% phentolamine mesylate ophthalmic solution (PMOS) as a treatment to improve vision and image quality for patients with DLD. METHODS In this placebo-controlled, randomized, double-masked clinical trial, 24 adult patients with severe DLD were randomized in a 2:1 ratio to receive either one dose of PMOS or placebo. Subjects were eligible if they reported experiencing severe night vision difficulty that was not eliminated by distance spectacle correction and scored ≥0.3 log units below the normal range of contrast sensitivity assessed under mesopic conditions with glare at ≥2 spatial frequencies. Key efficacy outcomes were change from baseline in pupil diameter, contrast sensitivity, and visual acuity. Safety measures including intraocular pressure, conjunctival hyperemia, and systemic effects were also assessed. RESULTS Eight subjects were randomized to placebo (63% female; mean age 47 years) and 16 were randomized to PMOS (75% female; mean age 42 years). Mean (SD) pupil diameter of PMOS-treated subjects decreased significantly - 1.3 mm (0 to - 2.8 mm) with p < 0.0001. Mean contrast sensitivity with glare in PMOS-treated subjects improved significantly post-treatment at spatial frequencies 3, 6, 12, and 18 cycles per degree (p ≤ 0.03). PMOS also demonstrated improvements in the numbers of letters read for mesopic and photopic, high- and low-contrast visual acuity (LCVA). Importantly, a statistically greater proportion of PMOS-treated eyes registered mesopic LCVA 5 letter (69% vs. 31%, p = 0.029) and 10 letter (34% vs. 6%, p = 0.04) improvement, with a trend at 15 letters (19% vs. 0%, p = 0.16). PMOS was well tolerated with the only reported side effect being a mild increase in conjunctival hyperemia. CONCLUSION PMOS was well tolerated and effectively reduced pupil size with improvements in contrast sensitivity and visual acuity in adults with severe DLD. Future Phase 3 studies should be conducted to further evaluate its potential to treat DLD. TRIAL REGISTRATION The trial registration number is NCT04004507 (02/07/2019). Retrospectively registered.
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Affiliation(s)
- Jay Pepose
- Pepose Vision Institute, St. Louis, MO, USA.,Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Mitchell Brigell
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | | | - Curtis Heisel
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Jonah Yousif
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Kavon Rahmani
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA.
| | - Ajay Kolli
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Min Hwang
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Cara Mitrano
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Audrey Lazar
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | | | - Mina Sooch
- Ocuphire Pharma, Inc., 37000 Grand River Ave., Suite 120, Farmington Hills, MI, 48335, USA
| | - Marguerite McDonald
- Department of Ophthalmology, New York University Langone Medical Center, New York, NY, USA
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Effect of over-the-counter brimonidine tartrate 0.025% ophthalmic solution on pupil size in healthy adults. Graefes Arch Clin Exp Ophthalmol 2021; 259:3333-3338. [PMID: 34251483 PMCID: PMC8523379 DOI: 10.1007/s00417-021-05297-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose To evaluate the effect of brimonidine tartrate 0.025% ophthalmic solution on pupil size under scotopic conditions in healthy adults Methods Pupil size was measured in 56 eyes of 28 volunteer participants using a pupillometer under scotopic conditions. Age, gender, and iris color were recorded. Subjects using any ophthalmic medications other than artificial tears were excluded. The pupil size was subsequently measured again under scotopic conditions 60 min after instillation of brimonidine tartrate 0.025% ophthalmic solution. Results Statistically significant miosis was seen after instillation of brimonidine tartrate 0.025% (p = 0.04). Average pupil size prior to brimonidine 0.025% instillation was 7.28 ± 1.05 mm, and average pupil size after instillation of brimonidine 0.025% was 6.36 ± 1.68 mm, a reduction of − 23.7% in pupil area. Subjects with light irides demonstrated a greater miotic effect than subjects with dark irides (1.55 mm vs. 0.67 mm, p < 0.0001), with a pupil area reduction of − 37.6% and − 17.4%, respectively. The amount of miosis was independent of initial pupil size. Conclusions Brimonidine tartrate 0.025% causes significant miosis in scotopic settings, although the effect is not as great in darker colored eyes. Further studies are needed to determine the latency and duration of the effect and whether the amount of miosis is clinically significant.
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Xu R, Gil D, Dibas M, Rickert M, Meyer D, Perron L, Kollbaum P, Bradley A. Time-course of the visual Impact on presbyopes of a low dose miotic. Ophthalmic Physiol Opt 2020; 41:73-83. [PMID: 33150654 DOI: 10.1111/opo.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the pupil and visual impact of a single early morning drop of a low concentration miotic. METHODS Pupil size, refraction, visual acuity (VA), near reading performance and intraocular pressure were monitored for 8 h at a wide range of light levels following bilateral instillation of single drops of 0.1% brimonidine tartate in 19 early presbyopes (40-50 years) and 11 mature presbyopes (>50 years). RESULTS Pupil miosis did not alter distance VA or refraction. Significant pupil miosis peaked at 1-2 h after dosing, which expanded the depth of focus of mature presbyopes with the mean improvement in near logMAR VA of -0.15, -0.07 and -0.03, at 20, 200 and 2000 lux, respectively. One hour after instillation, near reading speed improved by 21, 24 and 5 words per min for text size commonly seen in US newspaper and cellphone text messages, 18, 21 and 19 words per min for text size of grocery labels and 12, 13 and 30 words per min for text size of over-the-counter medications at light levels of 20, 200 and 2000 lux, respectively. No such improvements in near VA and near reading speed were observed in the young presbyopes having some residual accommodation. Most of the pupil miosis remained 8 h after instillation, whereas near VA improvements disappeared after 4 h. CONCLUSION Low dose miotics can enhance near vision in presbyopic subjects while retaining high quality distance vision over a wide range of light levels. Significant improvements in near vision were observed only during the 1-2 h period after dosing when miosis peaked.
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Affiliation(s)
- Renfeng Xu
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, USA
| | | | | | - Martin Rickert
- School of Optometry, Indiana University, Bloomington, USA
| | - Dawn Meyer
- School of Optometry, Indiana University, Bloomington, USA
| | - Laura Perron
- School of Optometry, Indiana University, Bloomington, USA
| | - Pete Kollbaum
- School of Optometry, Indiana University, Bloomington, USA
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, USA
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Adhikari P, Zele AJ, Thomas R, Feigl B. Quadrant Field Pupillometry Detects Melanopsin Dysfunction in Glaucoma Suspects and Early Glaucoma. Sci Rep 2016; 6:33373. [PMID: 27622679 PMCID: PMC5020729 DOI: 10.1038/srep33373] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022] Open
Abstract
It is difficult to detect visual function deficits in patients at risk for glaucoma (glaucoma suspects) and at early disease stages with conventional ophthalmic tests such as perimetry. To this end, we introduce a novel quadrant field measure of the melanopsin retinal ganglion cell mediated pupil light response corresponding with typical glaucomatous arcuate visual field defects. The melanopsin-mediated post-illumination pupil response (PIPR) was measured in 46 patients with different stages of glaucoma including glaucoma suspects and compared to a healthy group of 21 participants with no disease. We demonstrate that the superonasal quadrant PIPR differentiated glaucoma suspects and early glaucoma patients from controls with fair (AUC = 0.74) and excellent (AUC = 0.94) diagnostic accuracy, respectively. The superonasal PIPR provides a linear functional correlate of structural retinal nerve fibre thinning in glaucoma suspects and early glaucoma patients. This first report that quadrant PIPR stimulation detects melanopsin dysfunction in patients with early glaucoma and at pre-perimetric stages may have future implications in treatment decisions of glaucoma suspects.
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Affiliation(s)
- Prakash Adhikari
- Medical Retina and Visual Science Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew J. Zele
- Medical Retina and Visual Science Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ravi Thomas
- Queensland Eye Institute, South Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Beatrix Feigl
- Medical Retina and Visual Science Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia
- Queensland Eye Institute, South Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, Harding S, Johnston RL, Kelly SP, Kelly S, Lotery A, Mahmood S, Menon G, Sivaprasad S, Talks J, Tufail A, Yang Y. Defining response to anti-VEGF therapies in neovascular AMD. Eye (Lond) 2015; 29:721-31. [PMID: 25882328 DOI: 10.1038/eye.2015.48] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/01/2015] [Indexed: 11/09/2022] Open
Abstract
The introduction of anti-vascular endothelial growth factor (anti-VEGF) has made significant impact on the reduction of the visual loss due to neovascular age-related macular degeneration (n-AMD). There are significant inter-individual differences in response to an anti-VEGF agent, made more complex by the availability of multiple anti-VEGF agents with different molecular configurations. The response to anti-VEGF therapy have been found to be dependent on a variety of factors including patient's age, lesion characteristics, lesion duration, baseline visual acuity (VA) and the presence of particular genotype risk alleles. Furthermore, a proportion of eyes with n-AMD show a decline in acuity or morphology, despite therapy or require very frequent re-treatment. There is currently no consensus as to how to classify optimal response, or lack of it, with these therapies. There is, in particular, confusion over terms such as 'responder status' after treatment for n-AMD, 'tachyphylaxis' and 'recalcitrant' n-AMD. This document aims to provide a consensus on definition/categorisation of the response of n-AMD to anti-VEGF therapies and on the time points at which response to treatment should be determined. Primary response is best determined at 1 month following the last initiation dose, while maintained treatment (secondary) response is determined any time after the 4th visit. In a particular eye, secondary responses do not mirror and cannot be predicted from that in the primary phase. Morphological and functional responses to anti-VEGF treatments, do not necessarily correlate, and may be dissociated in an individual eye. Furthermore, there is a ceiling effect that can negate the currently used functional metrics such as >5 letters improvement when the baseline VA is good (ETDRS>70 letters). It is therefore important to use a combination of both the parameters in determining the response.The following are proposed definitions: optimal (good) response is defined as when there is resolution of fluid (intraretinal fluid; IRF, subretinal fluid; SRF and retinal thickening), and/or improvement of >5 letters, subject to the ceiling effect of good starting VA. Poor response is defined as <25% reduction from the baseline in the central retinal thickness (CRT), with persistent or new IRF, SRF or minimal or change in VA (that is, change in VA of 0+4 letters). Non-response is defined as an increase in fluid (IRF, SRF and CRT), or increasing haemorrhage compared with the baseline and/or loss of >5 letters compared with the baseline or best corrected vision subsequently. Poor or non-response to anti-VEGF may be due to clinical factors including suboptimal dosing than that required by a particular patient, increased dosing intervals, treatment initiation when disease is already at an advanced or chronic stage), cellular mechanisms, lesion type, genetic variation and potential tachyphylaxis); non-clinical factors including poor access to clinics or delayed appointments may also result in poor treatment outcomes. In eyes classified as good responders, treatment should be continued with the same agent when disease activity is present or reactivation occurs following temporary dose holding. In eyes that show partial response, treatment may be continued, although re-evaluation with further imaging may be required to exclude confounding factors. Where there is persistent, unchanging accumulated fluid following three consecutive injections at monthly intervals, treatment may be withheld temporarily, but recommenced with the same or alternative anti-VEGF if the fluid subsequently increases (lesion considered active). Poor or non-response to anti-VEGF treatments requires re-evaluation of diagnosis and if necessary switch to alternative therapies including other anti-VEGF agents and/or with photodynamic therapy (PDT). Idiopathic polypoidal choroidopathy may require treatment with PDT monotherapy or combination with anti-VEGF. A committee comprised of retinal specialists with experience of managing patients with n-AMD similar to that which developed the Royal College of Ophthalmologists Guidelines to Ranibizumab was assembled. Individual aspects of the guidelines were proposed by the committee lead (WMA) based on relevant reference to published evidence base following a search of Medline and circulated to all committee members for discussion before approval or modification. Each draft was modified according to feedback from committee members until unanimous approval was obtained in the final draft. A system for categorising the range of responsiveness of n-AMD lesions to anti-VEGF therapy is proposed. The proposal is based primarily on morphological criteria but functional criteria have been included. Recommendations have been made on when to consider discontinuation of therapy either because of success or futility. These guidelines should help clinical decision-making and may prevent over and/or undertreatment with anti-VEGF therapy.
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Affiliation(s)
- W M Amoaku
- Division of Clinical Neurosciences, Department of Ophthalmology, Academic Ophthalmology, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - U Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, and the Royal Victoria Hospitals Trust, Belfast, UK
| | - R Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - M Gavin
- Department of Ophthalmology, Gartnavel Hospital, NHSGG, Glasgow, UK
| | - F Ghanchi
- Department of Ophthalmology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - J Gibson
- Department of Ophthalmology, School of Life and Health Sciences, Aston University and Heart of England NHS Foundation Trust, and Birmingham and Midland Eye Centre Birmingham, Birmingham, UK
| | - S Harding
- Department of Ophthalmology, University of Liverpool and Royal Liverpool University Hospital, Liverpool, UK
| | - R L Johnston
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - S Kelly
- Department of Ophthalmology, Royal Bolton Hospital, Bolton, UK
| | - A Lotery
- Department of Ophthalmology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S Mahmood
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Hospitals Foundation Trust, Manchester, UK
| | - G Menon
- Department of Ophthalmology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - S Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - J Talks
- Department of Ophthalmology, Newcastle University Hospirtals NHS Trust, Newcastle, UK
| | - A Tufail
- Department of Ophthalmology, Moorfields Hospital NHS Trust, London, UK
| | - Y Yang
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab. Am J Ophthalmol 2013; 156:15-22.e1. [PMID: 23706500 DOI: 10.1016/j.ajo.2013.02.017] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/24/2013] [Accepted: 02/24/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the outcome of intravitreal injection of aflibercept in cases with exudative age-related macular degeneration, (AMD) resistant to injections of bevacizumab or ranibizumab. DESIGN Retrospective observational case series. METHODS A retrospective chart review at a single institution was conducted to identify patients with exudative AMD and choroidal neovascularization (CNV) in 1 or both eyes resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with at least 3 monthly injections of aflibercept. In total, 36 eyes from 31 patients were included. The demographic data, visual acuities, central macular thickness on optical coherence tomography (OCT), complications, and number of injections were reviewed. RESULTS The mean patient age was 79 years (range 60-88). There were 13 male and 18 female patients. The number of prior injections with either bevacizumab or ranibizumab ranged from 6-74. After 3 monthly injections of aflibercept, there was a reduction of either subretinal or intraretinal fluid in 18 of 36 (50.0%) of the treated eyes; the amount of fluid remained stable in 15 eyes (41.7%) and worsened in 3 eyes (8.3%). A significant average decrease was observed for the central macular thickness after 3 injections of 65 μm (P = 2.9 × 10(-6)), with no significant change in visual acuity. CONCLUSIONS Aflibercept therapy appears to be beneficial in a subset of patients with neovascular age-related macular degeneration who exhibit recurrent or resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab.
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Chen Y, Kardon RH. Studying the effect of iris mechanics on the pupillary light reflex using brimonidine-induced anisocoria. Invest Ophthalmol Vis Sci 2013; 54:2951-8. [PMID: 23513058 DOI: 10.1167/iovs.12-10916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study and correct for the limiting effect of iris mechanics on the amplitude of light-evoked pupil contractions in order to derive a more clinically accurate assessment of afferent input to the visual system. METHODS Transient pupil responses were recorded to a series of 1-second red Ganzfeld light stimuli with a stepwise increase in stimulus intensity using a binocular infrared computerized pupillometer. One eye of eight healthy subjects was treated with 0.2% brimonidine tartrate ophthalmic solution to induce pupil size reduction. The amount of pupil contraction as a function of stimulus intensity was compared between the brimonidine-treated, miotic eye and the untreated eye. RESULTS BRIMONIDINE TREATMENT PRODUCED SIGNIFICANT REDUCTION IN PUPIL SIZE IN HEALTHY SUBJECTS (MEAN REDUCTION IN PUPIL SIZE: 1.78 ± 0.35 mm, P < 0.05). For increasing light intensity, the treated pupil started to show reduced pupil contractions compared with the contralateral untreated pupil when the peak of pupil contraction reached an average pupil size of 3.25 ± 0.61 mm (range, 2.38-4.44 mm). When measured by percent pupil contraction (contraction amplitude/baseline pupil diameter), the pupil response as a function of stimulus intensity in the treated, miotic eye did not differ from that in the untreated eye. CONCLUSIONS Iris mechanics limits the amount of pupil contraction and can act to reduce the assessed neuronal integration of the pupil light reflex. Pupil response assessed by using percent contraction amplitude is least affected by mechanical effects and provides a more accurate approximation of afferent input.
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Affiliation(s)
- Yanjun Chen
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA.
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Brown SM, Bradley JC. Comparison of 2 monocular pupillometers and an autorefractor for measurement of the dark-adapted pupil diameter. J Cataract Refract Surg 2011; 37:660-4. [DOI: 10.1016/j.jcrs.2010.10.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 09/22/2010] [Accepted: 10/26/2010] [Indexed: 11/25/2022]
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Effect of brimonidine tartrate 0.10% ophthalmic solution on pupil diameter. J Cataract Refract Surg 2011; 37:486-9. [DOI: 10.1016/j.jcrs.2010.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 09/15/2010] [Accepted: 09/16/2010] [Indexed: 11/24/2022]
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Cho SW, Kim JM, Park KH, Choi CY. Effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy for glaucoma. Jpn J Ophthalmol 2010; 54:407-13. [PMID: 21052902 DOI: 10.1007/s10384-010-0855-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 04/13/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effects of brimonidine 0.2%-timolol 0.5% fixed-combination therapy in the treatment of patients with glaucoma. METHODS To measure the main treatment effects of a fixed combination of brimonidine 0.2%-timolol 0.5%, we conducted three small studies: (1) a comparison of diurnal intraocular pressure (IOP) at baseline and at 6 months after brimonidine/timolol fixed-combination therapy (n = 81); (2) an assessment of the effects of one drop of the brimonidine/timolol fixed combination on diurnal IOP (n = 25); and (3) the effects of brimonidine/timolol fixed-combination therapy on the anterior ocular segment over time (n = 64). RESULTS (1) After 6 months of treatment with the brimonidine/timolol fixed combination, the mean diurnal IOP in primary open-angle glaucoma (POAG) decreased from 21.4 ± 2.0 to 14.5 ± 3.1 mmHg (32.2%, P < 0.001), and the mean diurnal IOP in normal-tension glaucoma (NTG) decreased from 13.5 ± 2.8 to 10.9 ± 2.0 mmHg (19.3%, P < 0.001). (2) After instillation with one drop of the brimonidine/timolol fixed combination, the IOP in the instilled eye was lowest at 9:00 p.m. and had decreased by 1.7 mmHg compared with the baseline IOP in the instilled eye. The difference in IOP between the instilled eye and untreated fellow eye was largest at 3:00 p.m., measuring 1.7 mmHg (P = 0.011). (3) Brimonidine/timolol fixed-combination therapy caused significant miosis over time (P = 0.003). CONCLUSIONS The results of this study suggest that brimonidine/timolol fixed-combination therapy has beneficial IOP-lowering effects and significant effects on pupil size.
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Affiliation(s)
- Sung Woo Cho
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Stüve O, Kieseier BC, Hemmer B, Hartung HP, Awad A, Frohman EM, Greenberg BM, Racke MK, Zamvil SS, Phillips JT, Gold R, Chan A, Zettl U, Milo R, Marder E, Khan O, Eagar TN. Translational research in neurology and neuroscience 2010: multiple sclerosis. ACTA ACUST UNITED AC 2010; 67:1307-15. [PMID: 20625066 DOI: 10.1001/archneurol.2010.158] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Over the past 2 decades, enormous progress has been made with regard to pharmacotherapies for patients with multiple sclerosis. There is perhaps no other subspecialty in neurology in which more agents have been approved that substantially alter the clinical course of a disabling disorder. Many of the pharmaceuticals that are currently approved, in clinical trials, or in preclinical development were initially evaluated in an animal model of multiple sclerosis, experimental autoimmune encephalomyelitis. Two Food and Drug Administration-approved agents (glatiramer acetate and natalizumab) were developed using the experimental autoimmune encephalomyelitis model. This model has served clinician-scientists for many decades to enable understanding the inflammatory cascade that underlies clinical disease activity and disease surrogate markers detected in patients.
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Affiliation(s)
- Olaf Stüve
- Neurology Section, VA North Texas Health Care System, Medical Service, 4500 S Lancaster Rd, Dallas, TX 75216, USA.
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Effectiveness of daily use of brimonidine as antimydriatic agent. J Cataract Refract Surg 2009; 35:1845-6; author reply 1846. [DOI: 10.1016/j.jcrs.2009.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 06/08/2009] [Indexed: 11/19/2022]
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Direct and consensual murine pupillary reflex metrics: establishing normative values. Auton Neurosci 2009; 151:164-7. [PMID: 19683968 DOI: 10.1016/j.autneu.2009.07.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/25/2009] [Accepted: 07/20/2009] [Indexed: 11/20/2022]
Abstract
Pupillometry is a non-invasive technique, based on well-established neurophysiologic principles, that can be utilized to objectively characterize pathophysiologic demyelinating and neurodegenerative changes involving the pupillary reflex pathway. In animal models of human disorders, pupillometry derived reflex metrics could potentially be used to longitudinally monitor disease activity and responses to pharmacotherapies. These investigations would have important implications for translational initiatives focused on the identification and application of novel neuroprotective and restorative treatments for human diseases such as multiple sclerosis. Here, we have established normal reference values for various pupillary reflex metrics across different mouse strains. Ultimately, we anticipate that this new data will help to catalyze unique lines of inquiry using pupillometry methods.
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Schaal S, Kaplan HJ, Tezel TH. Is there tachyphylaxis to intravitreal anti-vascular endothelial growth factor pharmacotherapy in age-related macular degeneration? Ophthalmology 2008; 115:2199-205. [PMID: 18930553 DOI: 10.1016/j.ophtha.2008.07.007] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 06/05/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To determine whether repetitive injections of intravitreal bevacizumab and/or triamcinolone acetate in patients with exudative age-related macular degeneration (AMD) results in a decrease in biological response. DESIGN Retrospective comparative case series. PARTICIPANTS Forty-three eyes of 43 patients with exudative AMD. METHODS Pre- and postinjection optical coherence tomography (OCT) sections of 43 patients with AMD were analyzed to determine the change in the biologic response after each subsequent injection of intravitreal bevacizumab (2.5 mg/100 microL), preservative-free triamcinolone acetonide (pfTA) (4.0 mg/100 microL), or a combination of bevacizumab (1.25 mg/50 microL) and pfTA (2.0 mg/50 microL). The retinal thickness of each OCT sector was determined and expressed as volume. Standardized volumetric change index (SVCI) was determined to identify a statistically significant change. Pre- and postinjection (6 weeks) SVCI differences were plotted as a function of time to determine the biological response after each intravitreal treatment. MAIN OUTCOME MEASURES Change in SVCI after intravitreal injections and the number of injections required to decrease the biological response by 50% (INJ(50)). RESULTS There was no difference in the age, gender, and preinjection thickness of the retina in each of the 3 groups. The SVCI after intravitreal bevacizumab injections decreased, indicating a possible tachyphylactic response to bevacizumab. This decrease in biological response was partially alleviated with the addition of pfTA. Combination of pfTA and bevacizumab increased the INJ(50) from 2.9 with bevacizumab alone to 5.1 injections. A biphasic biologic response was observed with pfTA characterized by a rapid increase in efficacy with the second injection, peaking at the third injection and gradually decreasing afterward. CONCLUSIONS Repeated intravitreal injections of bevacizumab in exudative AMD seemed to be associated with decreased bioefficacy. However, combined pharmacotherapy with triamcinolone acetate lessened this effect. Thus, multitargeted pharmacotherapy in exudative AMD may have a therapeutic benefit. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Shlomit Schaal
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
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Edwards JD, Burka JM, Bower KS, Stutzman RD, Sediq DA, Rabin JC. Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery. J Cataract Refract Surg 2008; 34:1538-41. [DOI: 10.1016/j.jcrs.2008.05.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 05/09/2008] [Indexed: 11/30/2022]
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Khanani AM, Brown SM. Effect of Brimonidine Tartrate 0.15% on Scotopic Pupil: Controlled Trial. V.M. Gerente, A.C. Biondi, C.P. Barbosa, C.L. Lottenberg and A. Paranhos, Jr. J. Ocul. Pharmacol. Ther 2007;23:476–480. J Ocul Pharmacol Ther 2008; 24:364-5; author reply 366. [DOI: 10.1089/jop.2007.ed.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arshad M. Khanani
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430
- Cabarrus Eye Center, Concord, N.C
| | - Sandra M. Brown
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430
- Cabarrus Eye Center, Concord, N.C
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Rho SS, Yang HS, Lew HM, Ahn JH. The Antimydriatic Effect of Brimonidine 0.15% on the Dark-adapted Pupil in Dark Brown Irides. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.10.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung Soo Rho
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Hong Seok Yang
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Ho Min Lew
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hong Ahn
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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Gerente VM, Biondi AC, Barbosa CP, Lottenberg CL, Paranhos A. Effect of Brimonidine Tartrate 0.15% on Scotopic Pupil: Controlled Trial. J Ocul Pharmacol Ther 2007; 23:476-80. [PMID: 17900228 DOI: 10.1089/jop.2007.0017.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the duration of the effect of one single dose of brimonidine tartrate 0.15% on pupil diameter, under scotopic conditions, when applied topically in 1 eye of normal subjects. METHODS The eyes of 19 normal volunteers were randomized so that 1 eye had 1 drop of brimonidine tartrate 0.15% and the other received no medication. Pupil diameter was measured using an infrared pupillometer. The first measure was obtained before the instillation of brimonidine. After that, four measures, with 2-h intervals, were performed. RESULTS From 19 participants, 14 were women and 5 were men, with a mean age of 25.05 years (standard deviation, +/- 6.98). Before brimonidine instillation, mean pupil diameter in the control eyes was 5.11 mm, and in the brimonidine eyes it was 5.15 mm. After 8 h, the mean pupil size was 4.01 mm in the treated eyes, and 4.56 mm in the untreated eyes. There was a tendency of miotic effect to be more important on the treated eye, as compared to the control eye in all intervals, but this did not reach statistical significance (P = 0.375). When comparing both eyes, independently of the periods, the treated eye had a smaller diameter than the untreated eye (P = 0.038). The miotic effect was observed for at least 8 h after instillation. CONCLUSIONS Miotic response of brimonidine tartrate 0.15% lasted for at least 8 h and has a significant effect on the nontreated eye.
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Affiliation(s)
- Vanessa M Gerente
- Department of Ophthalmology, Albert Einstein Israelite Hospital, São Paulo, Brazil
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Hachol A, Szczepanowska-Nowak W, Kasprzak H, Zawojska I, Dudzinski A, Kinasz R, Wygledowska-Promienska D. Measurement of pupil reactivity using fast pupillometry. Physiol Meas 2006; 28:61-72. [PMID: 17151420 DOI: 10.1088/0967-3334/28/1/006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Analysis of human eye pupil reactivity is a very valuable diagnostic method used mainly for evaluation of the condition of the autonomic nervous system and the visual system. The paper presents an experimental pupillometer built in the Institute of Physics of the Wroclaw University of Technology. The apparatus makes it possible to record and analyze pupillary light reflex and spontaneous changes in the pupil diameter during a session in the dark. The detector system used in the pupillometer allows us to record the pupil diameter at a rate of 90 Hz with a linear accuracy of 0.008 mm. In this paper, the proposed detection method, the principle of operation and calibration of the apparatus and the possibilities of the measurement system are presented.
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Affiliation(s)
- A Hachol
- Department of Biomedical Engineering and Instrumentation, Wroclaw University of Technology, B. Prusa 53/55, 50-317 Wroclaw, Poland.
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