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Gene Therapy Cures Blindness

Gene Therapy Prevents Blindness

Gene Therapy Cures BlindnessAn FDA panel has unanimously recommended approval of Luxturna, a new gene therapy for the treatment of two inherited retinal diseases which cause blindess.

The FDA will formally meet in January 2018 to officially decide if Luxturna (voretigene neparvovec) will be approved.  This may be the first gene therapy treatment used for eye disease.

Luxturna is manufactured by Spark Therapeutics and is intended to be used to treat patients with Leber’s Congenital Amaurosis (LCA) and retinitis pigmentosa 20.

Mutant Genes Produce Mutant Proteins

Both Leber’s Congenital Amaurosis (LCA) and retinitis pigmentosa 20 develop from a defective gene known as RPE65.

Genes produce proteins.

The defective gene can not produce a functioning protein necessary for the normal “vision cycle” to occur.

The “vision cycle” is the process whereby light is translated by the retina into electrical signals which are understood by the brain.

Both Leber’s Congenital Amaurosis and retinitis pigmentosa 20 can lead to blindness due to non-functioning vision cycles.  There is presently no cure or treatment for either disease.

Eye Injection

Luxturna, a one time treatment, will insert “normal” DNA into the retinal cells.   Luxturna will be injected into the eye to allow direct exposure to the retina.

The normal DNA will contain intact and functioning copies of RPE65 which will produce a normal protein.

Production of the normal protein should restore, or improve, the retina’s “vision cycle” and lead to improved vision.

FDA Fast Track

Spark Therapeutics has been able to achieve “Fast Track” status for Luxturna.  FDA reviews “fast track” applications as they have the potential to significantly impact the treatment of a disease.

In these cases, there is no present treatment.

Results submitted to the FDA include the mobility results of patients with the confirmed inherited retinal diseases.   The patients were subjected to a maze under varying lighting conditions.  The maze would change to prevent memorization.

In most situations, patients vision improved such that successful navigation through the mazes was achieved with only the equivalent of a nightlight.   Most patients have exhibited improvement lasting over a year.  The study includes patients maintaining improvement for 2-4 years.

Inherited retinal diseases are caused by over 220 known defective genes.  Retinitis pigmentosa 20 and LCA are two diseases caused by the same gene.

I should also point out that “retinitis pigmentosa” is a collection of diseases caused by variuos genes.  Luxturna will treat only retinitis pigmentosa 20.

All the best,

Randy

Total Eclipse of the Sun | Protect Your Eyes

Solar Eclipse | What You Need to Know

Total Eclipse of the Sun Can Cause Solar Retinopathy | Randall Wong, M.D. Retina SpecialistThe Great American Solar Eclipse 2017 is just around the corner.   Are you ready?

Here are some quick tips you will need to know to insure that your family and friends can enjoy this “once in a lifetime” event and protect their vision at the same time.

Total Eclipse of the Sun

Bonnie Tyler will sing “Total Eclipse of the Sun” while aboard a Royal Caribbean cruise ship.  The ship leaves from Miami and will be situated within the path of totality as it leaves the coast of South Carolina.

The path of totality starts in Oregon and moves eastward through South Carolina.  The path of totality is about 70 miles wide and will be the only area in the United States where a total eclipse of the sun will be experienced.

For 2 minutes and 4o seconds, those in the path of totality will essentially experience total darkness as the sun is completely blocked by the moon.

Those not within this 11 state swath will experience a partial eclipse.

Protect Your Eyes with ISO Filters

Sunglasses offer no protection from the damaging UV light of the sun.   Only ISO certified filters offer protection from direct sunlight.ISO 12312-2 Filters Protect Against Solar Retinopathy | Randall Wong, MD, Retina Specialist

ISO 12312-2 filters are used in “eclipse glasses” and solar viewers.  These filters are strong enough to allow direct visualization of the eclipse.

ISO filters are the only way to directly visualize the eclipse without risk of solar retinopathy.  Solar retinopathy is caused by the sun’s intense UV radiation causing damage to the rods and cones of your retina.

Symptoms of Solar Retinopathy

While gazing too long at the sun, UV damage to your retina is painless.  Symptoms of solar retinopathy include:

  • Decreased color perception
  • Blind spots in central vision
  • Distortion
  • Pain, especially when looking at bright lights
  • Redness and tearing, especially when looking at bright lights
  • Loss of vision in both eyes

Solar retinopathy can be permanent.  Blindness can occur.

Indirect Viewing is Safest

If you can not find certified ISO eclipse glasses, consider constructing your own pinhole camera.

Using simple materials found around the house (aluminum foil, white paper, tape, scissors), construct an easy to build pinhole camera.

A pinhole camera avoids direct sun light and, therefore, avoids any chance of developing permanent vision loss from solar retinopathy.

All the best,

Randy

 

 

Protect Your Eyes and Vision from Solar Eclipse | Randall Wong MD Retina Specialist

How to Watch the Eclipse Safely | Avoid Blindness

Are your prepared to watch the eclipse safely?

WARNING:  It’s never safe to stare directly at the sun or at an eclipse.

Here’s how you can safely view the upcoming eclipse without causing eye damage or blindness.

The Great American Eclipse 2017

A total eclipse of the sun will occur on August 21, 2017 in North America.  This may be a “once in a lifetime” opportunity to experience the “path of totality” – when the moon completely blocks the sun for about 3 minutes.

The “path of totality” is about 70 miles wide and will sweep eastward from Oregon to South Carolina.  For those viewing within this path, they will experience a total eclipse of the sun.  The sky will become a dark twilight.

The rest of the country will experience a partial eclipse – differing amounts of sunlight loss.

Next Total Solar Eclipse

Incidentally, the last total eclipse of the sun occurred on March, 2016 and could be experienced in Indonesia.  The next total eclipse of the sun will occur in South America, 2019.

For most of us, the Great American Eclipse 2017 will be the only practical opportunity to experience this unique astronomical event.

Solar Retinopathy Can Blind

Staring directly at the sun, including an eclipse, can blind you.  The light rays of the sun are strong enough to burn your macula.  The macula is the most sensitive portion of your retina.

Sun damage can permanently destroy your central vision.  This condition is called solar retinopathy.  There is no cure for solar retinopathy.

Never look or photograph the sun without use of special lenses which have been designed specifically for the sun.

Eclipse Glasses Safely Protect Retina

There is only one safe way to view the sun or eclipse.  The American Academy of Ophthalmology and the American Astronomical Society recommend the use of special lens filters, ISO 12312-2, which have been designed for sun viewing.

If your “eclipse glasses” or solar viewers are compliant with the ISO 12312-2 safety standard, you may view the sun or eclipse safely.

These filters are strong enough to block the harmful rays of the sun and are thousands of times stronger than the darkest sunglasses.

The filters are used in “eclipse glasses” and other solar viewers.  I have included a link to known telescope and solar-filter companies that manufacture eclipse glasses and handheld solar viewers.

It may be fun to construct a pinhole camera to indirectly, and safely, view the upcoming eclipse.  A pinhole camera uses simple materials found around the house and can be a fun and inexpensive way to enjoy the total eclipse of the sun.

Fireworks Cause Significant Eye Injuries | Randall Wong MD | Retina Specialist

Happy 4th July | Avoiding Eye Injuries

Fireworks Cause Significant Eye Injuries | Randall Wong MD | Retina Specialist4th of July means BBQs and fireworks.  It can be a fun holiday, but for thousands this year, bodily injury and eye injury will occur.

Injuries occur to both bystanders and the handlers of the celebratory explosives.   Unfortunately, fireworks are marketed as toys – implying safety, but as you read, fireworks can cause serious bodily injury and eye injury.

Here are some tips to avoid eye injuries from fireworks – for both you and your children.

Eye Injuries … Exploding

Significant and permanent damage can occur from a ruptured globe (ruptured eye), retinal detachment, chemical and thermal burns and corneal abrasions.

The American Academy of Ophthalmology reports that nearly 1300 eye injuries caused by fireworks occurred in 2014 as reported by emergency rooms.  There were barely 600 cases reported in 2012.

Spectators and Children Injured

Nearly half the injuries are sustained by spectators.  Of that, 35% are children under the age of 15.

Most eye injuries are caused by bottle rockets, firecrackers and sparklers.  The heat generated by sparklers can exceed 3000 F depending upon the fuel and oxidizer used which can cause significant burns and even ignite clothing.

The American Academy of Ophthalmology (AAO) and the American Optometric Association (AOA) recommend:

  • Discuss firework safety with your children and teens
  • Children should not be unsupervised around fireworks
  • Wear protective eyewear when handling any fireworks
  • Fireworks, matches and lighters should be stored securely away from children
  • Sparklers are dangerous – refrain from purchasing
  • View fireworks from at least 500 feet away, respect barriers
  • Report unexploded fireworks to professionals, do not touch

What to Do for a Fireworks Eye Injury

  • Call 911 or go to Emergency Room
  • Do not rub eyes or apply pressure
  • Do not rinse eyes
  • Do not remove any objects stuck in the eye

Happy fourth of July!  Celebrate responsibly and enjoy the holiday.  I wish you and your family a very safe holiday.

All the best,

Randy

Echo Voice Assistant

“Alexa, Read This” | Personal Voice Assistants Aid Low Vision Patients

amazon alexa | voice assistantThis article has been contributed by Paul Burden.  Paul’s mother suffers from wet macular degeneration.  Paul founded Our Voice after he discovered the advantages of personal voice assistants and how they can help blind or low vision patients such as his mom.  I am impressed with the variety of information and tasks a personal voice assistant, such as Amazon’s Echo, can perform.  Enjoy.  – Randy.

Personal Voice Assistants have fundamentally changed the way we use technology. A voice assistant can be especially beneficial for the blind and low vision community. It’s difficult to use and keep up with ever changing technology.

Voice Instead of Keyboard

With a voice assistant, there’s no more complicated software to learn and update; no keyboard, users simply speak. Using voice only, users can:

  • have their music played
  • get the latest headlines and weather
  • listen to their favorite radio stations and podcasts
  • have books read to them
  • do their shopping
  • manage their calendars
  • contact family and friends in case of an emergency
  • query the Internet for information
  • make and receive phone calls
  • and much more

Meet Amazon’s “Alexa”

There are several voice assistants on the market, but the Amazon Echo family of products is far and away the most widely used voice assistant with more than 70% market share.

The Echo’s voice is named Alexa.

Once the Echo is connected to your Wi-Fi, you have immediate access to a wide variety of information.  For example,

Just say, “Alexa, what are today’s headlines?”  Headlines are immediately read to you.

“Alexa, what’s the weather look like for tomorrow?” You’ll get tomorrow’s forecast, or the 10 day forecast if you like.

In addition to all the information immediately available, there are lots of Apps available as well. What you think of as an App on your smartphone or computer, is called a “skill” on the Echo. They’re the same thing.   A large number of skills are particularly useful for blind and low vision users. A few examples:

My Buddy Skill

“My Buddy” allows the user to call, text or email any number of designated “buddies” or family members.

If you find yourself in distress and need help, say: “Alexa, my buddy.” Alexa will ask: “Who do you want me to contact?” You reply, “My family.”

Your family can include as many members as you’d like.  Do you have 20 members of your family you’d like contacted?  All at once?  No problem.  The call/email/text goes out to all 20 simultaneously.

Shopping by Voice

You can shop from the comfort of your home, using your voice only. Amazon has nearly 500 million products in stock!

Down to your last roll of paper towels? Say, “Alexa, order paper towels.” Alexa will offer a few options, asking for your permission to place the order.

When you hear what you like and confirm, your order is placed. Your order will arrive in a day or two, frequently your order is delivered on the same day.

Would you like to know when your order will be delivered? Just say, “Alexa, where’s my stuff?”.  Alexa responds with the day and approximate time your order will be delivered.

“Alexa – Read This!”

Alexa will read books on your Kindle.  The books are read to the listener in Alexa’s own computer generated voice.

Amazon owns another electronic book service called Audible.  Audible works very well with the Echo family of products.  The listener can bookmark particular chapters, fast forward/rewind, pause, adjust volume and summon a different book.

Audible books are read by professional voices.  While most Echo skills are free, Audible is not.  Audible requires a monthly subscription of $14.99, allowing 2 books a month.  More books can be added.

What’s the Next Step?

While the Echo is very easy to use, it can be difficult to set up and configure. That’s where Our Voice comes in, we’re Amazon Echo experts. Our Voice is a company dedicated to making voice assistants available to everyone. Our Voice installs and configures the Echo for the specific needs of the customer. We then train the customer to use device so they get the most out of their voice assistant experience. To learn more about Our Voice, visit www.ourvoice.net or call toll free: 844-voice 13 – 844-864-2313.

Our Voice | Personal Voice Assistant ExpertsPaul Burden is the Founder of Our Voice; a company dedicated to bringing voice technology to the blind and low vision community.  Prior to Our Voice, Burden held executive positions at Microsoft, Cyveillance and XAPPmedia.  You may contact Paul at www.ourvoice.net

Asteroid Hyalosis | Common Floaters of the Vitreous

Asteroid hyalosis is a common finding of the vitreous.   As you can see in beginning of the video, the “asteroid bodies” are creamy white flecks suspended in the vitreous.

Asteroid Hyalosis is Benign

The exact cause of asteroid hyalosis is not known and does not appear to be associated with any particular systemic disease though there may be an association with aging.

 

My experience has been that asteroid hyalosis is a benign finding and not associated with either systemic or eye disease.  As you are able to see in this video, the flecks really move around as they are suspended in the vitreous.

Curiously, in most cases, patients with asteroid hyalosis are completely unaware of the condition, that is, the flecks, or asteroid bodies, do not cause any problems with vision.  Patients usually do NOT complain of floaters.

Asteroid and Floaters

I included this video really to demonstrate the appearance of asteroid hyalosis.  If you listen and watch the video, this patient has been complaining of floaters for many years.  There is no real way to determine if what he is seeing is the asteroid hyalosis or “normal” floaters.

Regardless of what the cause, the floaters had been bothering him for quite a while.  Anything which moves back and forth with eye movement has to be related to the vitreous, hence, a vitrectomy should remove the opacities, aka “floaters.”

Induce PVD

Toward the end of the video, I “induce” or cause a posterior vitreous detachment (PVD).  I inject Kenalog to help me see remaining vitreous.  Unfortunately, the Kenalog is a suspension and is the same color as the asteroid hyalosis.

Though a bit difficult to see, the posterior portion of the vitreous lifts up toward the front of the eye when the PVD is successfully created.

In conclusion, I operated on this patient who had been complaining of longstanding floaters and, as an incidental finding, had floaters (not necessarily from the asteroid).

 

Raindrop for the Treatment of Presbyopia

Raindrop Mark Whitten MD Treatment for PresbyopiaThis article is contributed by Mark Whitten, M.D.  Dr. Whitten and I have known each other for over 25 years when I was a resident assisting him in surgery.  He is a world-renowned laser vision correction specialist.

There is a new treatment for a condition called presbyopia.  Presbyopia, or near vision loss, is a natural event requiring the need for reading glasses as approach our 40s.

If you have problems reading a book, seeing a menu or need glasses to read you phone, and over the age of 40, you probably have presbyopia.

There is a new procedure to correct near vision loss!  The Raindrop Near Vision Inlay is FDA approved for the treatment of presbyopia (near vision loss).

Effective Treatment for Near Vision Loss

Many of you have likely heard of a vision correction procedure called LASIK.  I treated Tiger Woods back in 1999.

LASIK is still in vogue today and is highly effective for the correction of distance vision.

In my opinion and based upon my own experience, the Raindrop corneal inlay will have the same effect on patients with presbyopia.

Ophthalmologists and optometrists have been waiting for a correction for near vision loss.  My own patients have shown me how well this surgery can treat near vision loss.

15 Minute Procedure

A complete eye exam and medical history is necessary before the procedure to ensure that you are a good candidate and that you have realistic expectations.

We also need to confirm the diagnosis and make sure there are no signs of ocular disease which could complicate your situation.

The Raindrop inlay will be placed in your non-dominant eye (FDA mandated).  The procedure takes about 15 minutes, you are awake and there is no pain.

I have my own surgical suites within my offices in Washington, D.C., Richmond, VA and Charlotte Hall, MD.  For me, it allows me to operate very efficiently and with my own “team.”

Most of my patients start reading as soon as they get off the table!

Mark Whitten, M.D.
Washington DC
Charlotte Hall MD
Richmond VA
www.WhittenLaserEye.com

Botox Injection | Retina Specialist Fairfax Virginia

Botox Injections for Wrinkles and Lines

Botox Injection | Retina Specialist Fairfax VirginiaBotox is an injectable medicine which has both medical and cosmetic applications.  It is FDA approved for a variety of conditions, but it is most often used cosmetically for the treatment of facial wrinkles and lines.

How Does Botox Work?

Botox is called a neurotoxin.  For a muscle to contract, it must be activated or stimulated by a nerve.  Neurotoxins block this normal pathway resulting in a limp or paralyzed muscle…the muscle simply can NOT contract.

Botox is a very effective neurotoxin and is used for medical conditions such as;

  • Blepharospasm – involuntary spasm of the eyelids
  • Hemifacial Spasm – spasm of facial muscles
  • Chronic Migraine
  • Dystonia – severe neck spasms
  • Shoulder Spasms
  • Overactive Bladder
  • Others

Wrinkles and Lines

As we age, our skin becomes less elastic.  Many wrinkles and lines are caused by small muscles located underneath the skin.  When the muscles contract, wrinkles can develop in areas which move and contort, such as the face.

Paralyzing the involved muscles by injecting the toxin can smooth out these wrinkles and lines.  Botox is FDA approved for the treatment of glabellar lines, but there are other areas treated as well;

  • Glabellar Lines or Frown Lines are the creases between the eyebrows
  • Frontal Lines are horizontal lines across the forehead
  • Crow’s Feet are wrinkles at the corner of  your eyes
  • Marionette Lines are at the edges of your mouth
  • Smoker Lines are around the lips

Botox Treatment

The drug is injected into the involved muscle(s).  The treatment usually take about 10-15 minutes and are performed in the office setting.

There is usually no recovery needed.

Botox does not work immediately and will take a couple of days for initial results.  The full effects  can take up to 1-2 weeks to develop.

The effects of Botox are temporary lasting 3-6 months.  Injections need to be repeated, but no more sooner than every 3 months.  Results will vary depending upon the condition treated, severity of the condition, and in the case of wrinkles, the health of your skin.

 

 

 

What is Uveitis?

Uveitis Can Cause Redness, Blurry Vision and Sensitivity to Light | Randall Wong MD | Retina Specialist VirginiaUveitis is an internal inflammation of the eye.  Arthritis is an inflammation of our joints.  Think of uveitis (or iritis) as arthritis of the eye.

Intraocular inflammation is not a common condition, but is a condition that every eye doctor sees several times a year.  Many times, a retina specialist is referred patients with uveitis.  There are subspecialists who treat ocular inflammation, but they number far fewer compared to the number of retina specialists.

The uvea is a part of the eye consisting of 3 parts;

  • Iris – the colored portion of our eye, it forms the pupil
  • Ciliary Body – the tissue which makes the aqueous humor
  • Choroid – a deep layer of the retina

Each part may become inflamed.  More specific names are based upon the location of the inflammation or part of uvea involved, for instance;

  • Anterior Uveitis – also known as iritis, is usually referred to as inflammation of only the iris
  • Intermediate Uveitis implies inflammation of the ciliary body, with or without inflammation of the iris
  • Posterior Uveitis involves inflammation limited to the choroid, the deep layer of the retina

Symptoms of Uveitis

Symptoms can include redness, blurry vision, sensitivity to light and pain.  Symptoms vary depending upon the location of the inflammation.  For example, anterior uveitis (or iritis) usually is associated with more pain as the iris and ciliary body are quite sensitive.

There are very few nerve endings underneath the retina, hence, inflammation of the choroid is often without pain.

Complications

The cornea can become swollen leading to loss of vision and additional sensitivity to light.  Cataracts are known to occur, increased eye pressure,  hypotony (very low eye pressure) in chronic cases, retinal swelling and retinal detachment (not due to a retinal tear) are also possible.

Most cases are not too complicated and localized to the front of the eye, but complete examination is necessary to assess the extent of the inflammation and amount of damage.

Causes

Trauma is probably the most common cause of inflammation, in the form of iritis (anterior inflammation).  There are technically dozens of systemic diseases associated with uveitis, but most cases of uveitis have no known association with a disease.

Viral, fungal and bacterial infections are occasionally to blame.  Uveitis is often recurrent.

Treatment

Steroids are the preferred treatment for any inflammation and the same is true for the treatment of ocular inflammation.

Topical drops, pills and injections of steroids are all possible.   Drops are usually preferred, but in more severe cases pills and injections are necessary.

More serious conditions may require immunosuppressive medications and the efforts of several docs including a retina specialist.

Cataract Surgery Can Lengthen Your Life

Cataract Surgery

As reported by the National Bureau of Economic Research, Americans over the age of 65 are living longer and with fewer disabilities.

Cataract surgery may help you live longer.

These findings are identified in an economic research study which identified certain medical conditions which improved healthy life expectancy.  The study found that treatments for heart disease and vision (cataract surgery) improve life expectancy and quality of life.

Cataract Surgery Improves Vision and Life

It’s no surprise that cataract surgery can improve our vision thus allowing us to work longer and drive more safely.

The study cited other examples perhaps not as obvious.  Patients who had cataract surgery were compared to those who had cataracts but declined to have surgery.  The group who did have cataract surgery had fewer falls leading to a broken hip compared to the comparison group.

As was reported by the American Academy of Ophthalmology, cataract surgery was associated with a 16% decrease in hip fractures.  Moreover, those patients who had severe cataracts and had surgery were noted to have a 23% decrease in hip fractures.

Fewer Car Crashes

Other studies have noted similar findings with car crashes.  Those who have undergone cataract surgery have fewer car crashes compared to those not having cataract surgery.

In the same AAO report cited above, an Australian research group found that patients having the “first eye” surgery had 13 percent fewer car accidents.  The cost savings to the society are not insignificant.

A U.S. study found a 50% reduction in car crashes.  This study also found that as this cohort (study group) aged there was a 27% increase in accidents.  Those who never had cataract surgery experienced a 75% increase.

What Does This Mean?

The improvements in vision allow us to live safer and lengthen our ability to work.  This translates into tremendous cost savings.

There are tremendous cost savings to our society by making us healthier e.g. fewer hip fractures from falls, fewer crashes from improved vision and increasing our productive work years.

The point of the study; however, is to point out that cataracts slowly decrease your vision and most patients are unaware they have compromised sight.

Get your eyes examined regularly.

 

Randall V. Wong, M.D.

offices

Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different practices.....it's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
F:703.992.8158
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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