Two Patients With Macular Degeneration Get Artificial Retinas

LYON, France — A 72-year-old woman with dry age-related macular degeneration (AMD) was the first patient to receive an artificial retina implant as part of the multicenter PRIMAvera clinical trial, which is looking at the safety and efficacy of the PRIMA system.

“Her vision was severely impaired by this condition. We used the ETDRS chart to assess her visual acuity, as this is the current method in ophthalmology. She was able to read only nine letters,” said Laurent Kodjikian, MD, PhD, from Hôpital de la Croix-Rousse in Lyon, who is a former president of the French Society of Ophthalmology. To put that in perspective, a person with normal vision can make out 85 letters, he explained.

“The goal is to get her reading another ten letters,” he told Medscape Medical News.

The hospital where Kodjikian works is one of six centers in France selected to take part in the ongoing AMD clinical trial; other study sites are in Germany, Italy, the Netherlands, and Spain. The 38 study participants will be followed for 12 months after implantation to assess visual acuity and adverse events, and outcomes will be monitored for 3 years. Investigators hope that the findings will lead to the device receiving authorization to enter the market.

The PRIMA artificial retina system has three elements: a tiny wireless retinal implant; a pair of glasses with a camera and digital projector; and a portable processor connected to the projector. The camera captures visual scenes from the surrounding environment. The processor uses algorithms to process and simplify the images, which are then sent back to the glasses. The digital projector uses pulses of infrared light to project the processed images onto the retinal implant’s photovoltaic receptors. These receptors then convert the optical information into electrical stimulation, which excites the nerve cells of the inner retina, allowing them take in the information and transmit it, via the optic nerve, to the brain. This then induces visual perception.

A Delicate Operation

To implant the chip, Kodjikian made a rather large incision — 3.5 mm — and then peeled off the retina, all while looking through a surgical microscope.

“It’s easy to peel off the retina in a healthy eye. However, the procedure becomes more difficult in an eye affected by dry AMD, where the retina tissue is not only very thin and firmly attached to the back wall of the eye, but is also very fragile. A lot can go wrong during this step, so we have to really take our time,” he said. “You can’t go too deep, and if you go too close to the surface, you risk perforating the retina. Like walking on a very thin tightrope, there’s danger all around, and very little room for error.”

After the chip was inserted under the retina, Kodjikian put the retina tissue back into place. “This was the first time I’d ever done this kind of procedure, and it was quite a challenge,” he told Medscape.

The operation took 2.5 hours, which is much less time than the 4 to 5 hours estimated by the manufacturer.

The patient will undergo rehabilitation for 12 months to help her adapt to the system. “Our hope is that this patient will be able to see better with the implant. She probably won’t get to the point of being able to drive a car. And while reading novels in small print may not be possible, it’s quite likely that she’ll be able to read large-print editions,” Kodjikian explained.

Upon activation of the retinal prosthetic, the patient experienced visual impressions that she couldn’t see before the surgery. And 1 month after the procedure, things seem to be on track, according to a press release. “The postoperative result is excellent. There are no complications, the chip is perfectly in place and the vision has not been degraded by the operation. She should now start to improve thanks to rehabilitation,” said Kodjikian.

“Of the various artificial retina systems out there, this one is the most sophisticated because it has the most pixels. The technology will certainly continue to advance. But for the time being, the clinical study should allow us to show that it does work,” he concluded.

In December 2021, he implanted an artificial retina in a second patient, and it took him 50 minutes less than the first one.

This article originally appeared in the French edition of Medscape.

The authors have disclosed no relevant financial relationships.

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After 40 years of blindness, injection of light-sensitive protein restores a man’s vision

The first successful clinical test of a technique called optogenetics has allowed a 58-year-old man to see for the first time in decades.

The man was able to see with the help of image-enhancing goggles after 40 years of blindness, thanks to an injection of light-sensitive proteins into his retina.

According to a study published by Nature Medicine on May 24, this is the first successful clinical application of optogenetics, a technique in which flashes of light are used to control gene expression and neuron firing.

The study revealed that the technique is widely used in laboratories to probe neural circuitry and is being investigated as a potential treatment for pain, blindness and brain disorders.

The clinical trial, run by the company GenSight Biologics, based in Paris, enrolls people with retinitis pigmentosa — a degenerative disease that kills off the eye’s photoreceptor cells, which are the first step in the visual pathway.

In a healthy retina, photoreceptors detect light and send electrical signals to retinal ganglion cells, which then transmit the signal to the brain.

GenSight’s optogenetic therapy skips the damaged photoreceptor cells entirely by using a virus to deliver light-sensitive bacterial proteins into the RGCs, allowing them to detect images directly.

GenSight is one of several companies developing optogenetics as a treatment for RP and other disorders of the retina.

In March, Nirenberg’s company Bionic Sight announced that four of the five people with RP it had treated with a similar optogenetic therapy and a virtual-reality headset had recovered some level of vision, although the full trial results have not yet been published.

Also, Swiss pharma giant Novartis is developing a therapy based on a different protein that is so light-sensitive that goggles might not be needed. That therapy has not yet entered clinical trials.

The researchers injected the virus into the eye of a man with RP, then waited four months for protein production by the RGCs to stabilise before testing his vision, the Nature Medicine reported.

José-Alain Sahel, an ophthalmologist at the University of Pittsburgh Medical Center in Pennsylvania and leader of the study, says that one of the challenges was regulating the amount and type of light entering the eye, because a healthy retina uses a variety of cells and light-sensitive proteins to see a wide range of light.

“No protein can replicate what the system can do,” he says. So the researchers engineered a set of goggles that captured the visual information around the man and optimised it for detection by the bacterial proteins.

Using a camera, the goggles analyse changes in contrast and brightness and convert them in real-time into what Sahel describes as a ‘starry sky’ of amber-coloured dots. When the light from these dots enters a person’s eye, it activates the proteins and causes the RGCs to send a signal to the brain, which then resolves these patterns into an image.

The trial participant had to train with the goggles for several months before his brain adjusted to interpret the dots correctly. “He was like an experimentalist, a scientist trying to understand what he was seeing and make sense of it,” Sahel says.

Eventually, he was able to make out high-contrast images, including objects on a table and the white stripes in a crosswalk. When the researchers recorded his brain activity, they found that his visual cortex reacted to the image in the same way as it would have if he had normal sight.

The man still can’t see without the goggles, but Sahel says that he wears them for several hours per day and that his vision has continued to improve in the two years since his injection.

Sahel says six other people were injected with the same light-sensitive proteins last year, but the COVID-19 pandemic delayed their training with the goggles.

A neurobiologist at the University of California, John Flannery says the study “is a big step for the field.

“The most important thing is that it seems to be safe and permanent, which is really encouraging.”

Flannery said while the image may never be as good as natural vision, it is exciting that the brain can interpret images accurately.

Other researchers are, however, calling for more studies.

Sheila Nirenberg, a neuroscientist at Weill Cornell Medical College in New York City says she looks forward to seeing whether the other people in the trial, including some who were injected with higher doses of the protein, have similar results.

“It’s interesting, but it’s an N of 1,” she says.

Karl Deisseroth, a neuroscientist at Stanford University in California who co-developed optogenetics as a lab technique, says the study is important because it is the first time that the technique’s effects have been shown in people.

“It will be interesting to try this with more light-sensitive opsins” that might not require goggles, he says. But he expects optogenetics to be most useful as a research tool that leads to therapies, rather than a therapy itself.

“What we hope to see even more of is optogenetics-guided human and clinical studies,” he says.

How to maintain health eyes

Good vision helps you perform well—at home, at work, or behind the wheel. That’s why it’s important to take a few simple steps to make sure you help keep your eyesight at its best. A regular eye exam is the best way to protect your eyesight – and an easy precaution to take. Here are some tips to help maintain eye health as you age.

Eat a Balanced Diet

fruit vegetablesAs part of your healthy diet, choose foods rich in antioxidants, like Vitamins A and C; foods like leafy, green vegetables and fish.  Many foods – especially fatty fish, such as salmon – contain essential omega-3 fatty acids that are important to the health of the macula, the part of the eye responsible for central vision.

An inadequate intake of antioxidants, consumption of alcohol or saturated fats may create free-radical reactions that can harm the macula – the central part of the retina. High-fat diets can also cause deposits that constrict blood flow in the arteries. The eyes are especially sensitive to this, given the small size of the blood vessels that feed them.

Your eyes are unique, and have their own set of nutritional needs. Ocuvite eye vitamins are specially designed to provide a balanced combination of nutrients dedicated to the health of your eyes.* Visit Ocuvite.com to learn more.

Exercise

Exercise improves blood circulation, which improves oxygen levels to the eyes and the removal of toxins.

Get a good night’s sleep

You’ll feel the difference when you get the sleep you need. You’ll look great, you’ll perform at home or work—and good rest will support the health of your eyes.

Wash your hands

Keeping your hands clean is so important when it comes to your eyes, especially if you’re a contact lens wearer. Before you touch your eye—and before you put in or remove a contact lens—wash your hands with a mild soap and dry with a lint-free towel. Some germs and bacteria that come from your hands can cause eye infections, like bacterial conjunctivitis (pink eye). When you touch your eye, whatever is on your fingers goes right onto your eye’s surface. This is one way that people catch colds—rubbing their eyes while they have cold virus germs on their hands.

Don’t Smoke

Smoking exposes your eyes to high levels of oxidative stress. While the connection has not been clearly identified, it is known that smoking increases your risk for a variety of health conditions affecting the eye. To help you quit, visit the American Lung Association’s free online smoking cessation program – Freedom From Smoking Online – at www.ffsonline.org.

Wear Sunglasses

To protect your eyes from harmful ultraviolet (UV) light, choose sunglasses with both UVA and UVB protection. Also, wearing a hat with a brim will greatly reduce the amount of UV radiation slipping around the side of your sunglasses.

Devices and Blue Light

You’re probably using digital devices for hours each day at work and at home. These devices are exposing your eyes to high energy blue light. It’s called blue light because the wavelengths emitted are near the bluer part of the spectrum. Lutein & Zeaxanthin are eye nutrients that are concentrated in the macula and help eyes filter blue light.* Lutein and Zeaxanthin cannot be produced by our bodies on their own, so they must be obtained through diet and/or supplements. If you don’t think you’re getting enough in your diet, visit Ocuvite.com to learn more. 

Here are some other tips to help when you’re on your computer:

  • Keep your computer screen within 20″-24″ of your eye.
  • Keep the top of your computer screen slightly below eye level.
  • Adjust lighting to minimize glare on the screen.
  • Blink frequently.
  • Take a break every 20 minutes to focus on an object 20 feet away for 20 seconds.
  • Use lubricating eye drops to soothe irritated, dry eyes.

Road safety and your eyesight

Uncorrected vision continues to endanger the lives of drivers, passengers, and pedestrians around the world. Compounded by external factors such as nighttime driving, inclement weather, and adverse road conditions, uncorrected vision contributes to more than 1.25 million road accident deaths each year.[1] Until recently, the intersection of vision and road safety has not received adequate attention. Consequently, there is a lack of awareness around the need to address the impact of vision problems on driver and road safety. While governments and policymakers can play a significant role in raising  greater awareness of this public health threat, eye care professionals are also part of the solution as they are a competent authority in promoting effective assessment of vision and correcting drivers’ visual functions.CONTENTKEY TAKEAWAYSREFERENCES

The problematic relationship between uncorrected vision and road safety is a deadly, global phenomenon, and is growing more dangerous. The World Health Organization (WHO) has reported that road traffic crashes are a leading cause of road deaths globally and the main cause of deaths among those aged 15 to 29 years-old.[2] What is perhaps most disturbing is how traffic accidents disproportionately affect low- or middle-income countries, which are home to more than 80 percent of the world’s population. Though these countries account for only 54 percent of the world’s vehicles, they see 90 percent of all road traffic deaths. These road accidents also come with an adverse economic impact, estimated at US$500 billion a year –another burden on low- or middle-income countries. [2]

“These road accidents also come with and adverse economic impact, estimated at US$ 500 Billion a year – another burden on low- or middle-income countries.”

There are hopeful signs, yet much work remains. Globally, the number of traffic deaths plateaued between 2007 and 2015 despite a four percent increase in the world’s population – and an increase in motorization even four times higher than that – suggesting that intervention efforts can and do save lives. [2] However, disparity remains. Among the 68 countries that saw a rise in the number of road traffic deaths between 2010 and 2013, 84 percent were low- or middle-income.[2]

Recognizing the severity and disparity of both the human toll and economic burden that traffic accidents place on national economies and individual households alike, the United Nations, in its Sustainability Goals, included an ambitious goal of halving traffic-related deaths and injuries by the year 2020.

This new imperative to address road safety brings with it a greater urgency to understand the underlying causes of traffic accidents. Much attention has been given to the effects of drunk driving and, more recently, the use of wireless devices while driving. But in addition to the important issues of inebriated and inattentive driving, vision impairment also warrants attention.

The assumption of good vision, necessary to safely operate a vehicle, has long caused uncorrected vision to be overlooked as a factor in road safety. Drs. Cynthia Owsley and Gerald McGwin note in their analysis, “Vision and Driving,” that “the visual demands of driving are intricate.” [3] By cataloging the many and varied visual tasks involved in driving, including the simultaneous use of central and peripheral vision to monitor primary and secondary tasks, they reinforce how visually intensive driving under normal conditions is. These findings have led researchers to conclude that many visual tests for drivers are inadequate, often failing to simulate the distractions and wide ranging contrast and luminance levels experienced in real-world road conditions.[3] This is compounded by the fact that many drivers avoid seeking evaluation and treatment for vision issues; in Europe, 19 percent of drivers reported delaying visits to an optician until they notice problems with their vision.[5]

Driving and vision infographics Vision Impact Institute - Points De Vue

The contributions of Owsley, McGwin, Chakrabarty and others to the growing dialogue around driving and vision are indicative of the increased attention and analysis that this issue requires. However, though the link between vision and road safety should be a global concern, the disparity between high-income and low- or medium-income countries illustrates that it remains very much a local issue, which demands a greater understanding of local factors.

Road Safety Around the World

As the correlation between vision and road safety has come to the forefront, more data is becoming available from both high-income and low- or medium-income countries.

In India, for example, the dual forces of population growth and economic development have resulted in a higher number of vehicles on the road and, consequently, a greater number of traffic accidents. One study of vision and drivers in India calculated the road crash involvement rate of drivers with unacceptable vision test results at 81 percent, which was 30 percent higher than that of drivers with good vision.[6] While many factors, including poor vehicle and road conditions and traffic violations, have been found to affect driver safety, researchers have pointed to vision problems,  worsened by night driving, as significant causes of driver safety challenges.

As the correlation between vision and road safety has come to the forefront, more data is becoming available from both high-income and low- or medium-income countries.

In India, for example, the dual forces of population growth and economic development have resulted in a higher number of vehicles on the road and, consequently, a greater number of traffic accidents. One study of vision and drivers in India calculated the road crash involvement rate of drivers with unacceptable vision test results at 81 percent, which was 30 percent higher than that of drivers with good vision.6 While many factors, including poor vehicle and road conditions and traffic violations, have been found to affect driver safety, researchers have pointed to vision problems,  worsened by night driving, as significant causes of driver safety challenges.

Driving and vision infographics Vision Impact Institute - Points De Vue

Despite the disproportionate impact of uncorrected vision on road safety in low- or medium-income countries, high-income countries are not immune to this threat. A 2003 European analysis of health-related risk factors in traffic accidents found that the risk of car crash increased by nine percent when there was a visual impairment.[7] Research also reveals how even a relatively small percentage of drivers with uncorrected vision can cause a significant economic impact. In the U.K., for example, only seven percent of the population suffers from uncorrected vision, yet the economic impact of road accidents in relation to vision amounted to US$55 million in 2012.[9,13]

Driving and vision infographics Vision Impact Institute - Points De Vue

Vision Solution Efforts

Though uncorrected vision remains a danger to road safety, recent research is helping to make the case for policies and resources that can put the brakes on this global public health threat. With more stakeholders undertaking efforts to understand the intersection of vision and road safety, researchers, governments, organizations and eye care professionals around the world are beginning to identify promising solutions. In Italy, researchers evidenced that the use of an appropriate ophthalmic compensation with corrective lenses is able to improve drivers’ visual abilities.[10] In India, for instance, as the result of early efforts to prevent traffic accidents, drivers are now required to undergo vision screenings and be granted access to driving aids such as anti-glare glasses.[4]

Based on their research, Drs. Owsley and McGwin recommend additional screening measures to augment current visual acuity tests, which would examine drivers’ contrast sensitivity, visual field, processing speed, and divided attention. But most importantly, they call for more research methodology on vision and driving to expand upon the current database of knowledge.[3]

However, more research, more testing and even more rigorous testing will not reduce the threat of uncorrected vision on road safety if drivers do not seek evaluation and treatment from eye care professionals. The WHO released a report, “Universal Eye Health: A Global Action Problem 2014-2019,” which focuses on finding solutions to visual impairments. According to the report, if vision care – such as refractive services and surgeries – were provided, more than two-thirds of people affected by uncorrected vision could improve their eyesight.[11]

For this reason, organizations like Essilor and the Fédération Internationale de I’Automobile (FIA) have pledged to address the correlation between poor vision and driver and road safety. Essilor’s role in the partnership is to advocate for road safety and reinforce FIA’s messages about the vital role of adequate vision along with corresponding efforts to lobby against road accidents and deaths. The collaboration between these two organizations rests on the “New Golden Rule, ‘Check your vision,’” which aims to raise awareness on vision as a public health challenge by updating FIA’s ten “Golden Rules” on road safety. This partnership received the distinct endorsement of the World Council of Optometry and the Vision Impact Institute at the 2nd World Congress of Optometry in Sept. 2017.[12]

Conclusion

It is imperative that we address vision problems and their impact on the safety of drivers, passengers, and pedestrians. Vision standards for driving must be a priority, and the development and implementation of these standards should not fall solely on local, state and national governments, but also on eye care professionals around the world. As we work towards our goal of expanding access to proper vision care around the world, our success will hinge on the collaboration between stakeholders to identify solutions that will improve driver vision, equip medical professionals with the information and resources they need and, ultimately, ensure road safety for drivers everywhere.

“It is imperative that we address vision problems and their impact on the safety of drivers, passengers, and pedestrians.”

Glaucoma

Glaucoma

Glaucoma is a condition that damages your eye‘s optic nerve. It gets worse over time. It’s often linked to a buildup of pressure inside your eyeGlaucoma tends to run in families. You usually don’t get it until later in life. 

The increased pressure in your eye, called intraocular pressure, can damage your optic nerve, which sends images to your brain. If the damage worsens, glaucoma can cause permanent vision loss or even total blindness within a few years.

Most people with glaucoma have no early symptoms or pain. Visit your eye doctor regularly so they can diagnose and treat glaucoma before you have long-term vision loss.

If you lose vision, it can’t be brought back. But lowering eye pressure can help you keep the sight you have. Most people with glaucoma who follow their treatment plan and have regular eye exams are able to keep their vision.

Glaucoma Causes

The fluid inside your eye, called aqueous humor, usually flows out of your eye through a mesh-like channel. If this channel gets blocked, the liquid builds up. Sometimes, experts don’t know what causes this blockage. But it can be inherited, meaning it’s passed from parents to children.

Less-common causes of glaucoma include a blunt or chemical injury to your eye, severe eye infection, blocked blood vessels inside your eye, and inflammatory conditions. It’s rare, but eye surgery to correct another condition can sometimes bring it on. It usually affects both eyes, but it may be worse in one than the other.

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Glaucoma Risk Factors

It mostly affects adults over 40, but young adults, children, and even infants can have it. African Americans tend to get it more often, when they’re younger, and with more vision loss.

You’re more likely to get it if you:

  • Are of African American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
  • Are over 40
  • Have a family history of glaucoma
  • Have poor vision
  • Have diabetes
  • Take certain steroid medications such as prednisone
  • Have had an injury to your eye or eyes
  • Have corneas that are thinner than usual
  • Have high blood pressure, heart disease, diabetes, or sickle cell anemia
  • Have high eye pressure
  • Are nearsighted or farsighted

Types of Glaucoma

There are two main kinds:

Open-angle glaucoma. This is the most common type. Your doctor may also call it wide-angle glaucoma. The drain structure in your eye (called the trabecular meshwork) looks fine, but fluid doesn’t flow out like it should.

Angle-closure glaucoma. This is more common in Asia. You may also hear it called acute or chronic angle-closure or narrow-angle glaucoma. Your eye doesn’t drain like it should because the drain space between your iris and cornea becomes too narrow. This can cause a sudden buildup of pressure in your eye. It’s also linked to farsightedness and cataracts, a clouding of the lens inside your eye.

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Less common types of glaucoma include:

Secondary glaucoma. This is when another condition, like cataracts or diabetes, causes added pressure in your eye.

Normal-tension glaucoma. This is when you have blind spots in your vision or your optic nerve is damaged even though your eye pressure is within the average range. Some experts say it’s a form of open-angle glaucoma.

Pigmentary glaucoma. With this form, tiny bits of pigment from your iris, the colored part of your eye, get into the fluid inside your eye and clog the drainage canals.

Glaucoma Symptoms

Most people with open-angle glaucoma don’t have symptoms. If symptoms do develop, it’s usually late in the disease. That’s why glaucoma is often called the “sneak thief of vision.” The main sign is usually a loss of side, or peripheral, vision.

Symptoms of angle-closure glaucoma usually come on faster and are more obvious. Damage can happen quickly. If you have any of these symptoms, get medical care right away:

  • Seeing halos around lights
  • Vision loss
  • Redness in your eye
  • Eye that looks hazy (particularly in infants)
  • Upset stomach or vomiting
  • Eye pain

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Glaucoma Diagnosis

Glaucoma tests are painless and don’t take long. Your eye doctor will test your vision. They’ll use drops to widen (dilate) your pupils and examine your eyes.

They’ll check your optic nerve for signs of glaucoma. They may take photographs so they can spot changes at your next visit. They’ll do a test called tonometry to check your eye pressure. They may also do a visual field test to see if you’ve lost peripheral vision.

Glaucoma Treatment

Your doctor may use prescription eye drops, oral medications, laser surgery, or microsurgery to lower pressure in your eye.

Eye drops. These either lower the creation of fluid in your eye or increase its flow out, lowering eye pressure. Side effects include allergies, redness, stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect your heart and lungs. Be sure to tell your doctor about any other medications you’re taking or are allergic to.

Oral medication. Your doctor might also prescribe medication for you to take by mouth, such as a beta-blocker or a carbonic anhydrase inhibitor. These drugs can improve drainage or slow the creation of fluid in your eye.

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Laser surgery. This procedure can slightly raise the flow of fluid from your eye if you have open-angle glaucoma. It can stop fluid blockage if you have angle-closure glaucoma. Procedures include:

  • Trabeculoplasty. This opens the drainage area.
  • Iridotomy. This makes a tiny hole in your iris to let fluid flow more freely.
  • Cyclophotocoagulation. This treats areas of the middle layer of your eye to lower fluid production.

Microsurgery. In a procedure called a trabeculectomy, your doctor creates a new channel to drain the fluid and ease eye pressure. This form of surgery may need to be done more than once. Your doctor might implant a tube to help drain fluid. This surgery can cause temporary or permanent vision loss, as well as bleeding or infection.

Open-angle glaucoma is most often treated with combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors tend to start with medications, but early laser surgery or microsurgery could work better for some people.

Infant or congenital glaucoma — meaning you are born with it — is usually treated with surgery because the cause is a problem with your drainage system.

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Glaucoma Prevention

You can’t prevent glaucoma. But if you find it early, you can lower your risk of eye damage. These steps may help protect your vision:

  • Have regular eye exams. The sooner your doctor spots the signs of glaucoma, the sooner you can start treatment. If you’re over age 40 and have a family history of the disease, get a complete eye exam from an eye doctor every 1 to 2 years. If you have health problems like diabetes or are at risk of other eye diseases, you may need to go more often.
  • Learn your family history. Ask your relatives whether any of them have been diagnosed with glaucoma.
  • Follow your doctor’s instructions. If they find that you have high eye pressure, they might give you eye drops to prevent glaucoma.
  • Exercise. Moderate activity like walking or jogging at least three times a week might help lower eye pressure.
  • Protect your eyes. Use protective eyewear when playing sports or working on home improvement projects

About Us

 

Our Mission

To Be the Region’s Leading Eye Care Provider, Delivering the Most Advanced, Specialized Eye Care Services in a Compassionate, Patient-Centered Approach.

Our Commitment

Above all other principles, we affirm patients are the basis for our existence as an organization. We continuously strive to exceed the expectations and needs of each patient at every visit, or encounter. Our commitment to our patients is reflected in our employee’s attitude and respect towards others. We are committed to providing the highest quality of service and meeting our patients’ needs with the utmost care and courtesy. This commitment must be reflected in our behavior.

The Team

Eyes are among our most precious tools. Much of our quality of life depends on these windows to the world. Eyupdate Eye clinic lives by our mission by providing the newest technologies, treatments and surgical techniques as a team.

Eyeupdate Clinic is the region’s leading eye care center with experienced Eye-Doctors improving the quality of life for people like you. Our Board certified Eye-Doctors are among the most highly educated and trained specialists practicing in the World today. Our Ophthalmologists and Optometrists at Eyeupdate Eye Clinic are committed to delivering expert eye care to patients including general vision and specialty eye care, disease diagnosis, treatment, and surgical options.

At Eyeupdate Eye Clinic, we focus on quality, patient-centered eye care and are able to triage and treat many urgent and emergency situations right in the clinic.

Our Pediatric Ophthalmologists/Optometrists have the tremendous privilege of caring for kids to help them achieve their best vision. We understand, as parents, nothing is more important to you than your children, and like you, we want them to have a lifetime of excellent vision. Working with you, in a patient-centered approach, we treat your child’s eyes all the way from infancy through high school.

Outpatient surgical procedures, corrective lenses, and diagnostic and surgical treatment of eye diseases are available onsite. In addition, we offer a full-service Optical shop and Contact Lens department at each location.

To schedule an appointment, call: 07030000001

 

LOCATIONS

Eyeupdate Clinic & Optical Supplies, 01, Ajuwon junction, Ajuwon bus stop, Akute/Ajuwon Road, beside BPNL Filling Station, Ajuwon, Ifo, Ogun State. Tel: 07030000001.

 

Eyeupdate Clinic & Optical Supplies 222 Iju road, Balogun bus stop, Iju-Ishaga, Lagos, Nigeria. Tel: 08107531046

Eyeupdate Clinic & Optical Supplies, 20 Akute/Ajuwon Road, Akute, Ifo, Ogun State.Tel: 08034971582

Buy freshlook contact lenses at N2000/pair with 120ml solution, storage case and picker within in Ajuwon Giwa Okearo Alagbole Akute

Buy Freshlook coloured contact lenses @ N2000/pair with 120ml solution and storage case and picker.
– Available quantity: 10, 000 pairs
– available colours: All freshlook colours…including all new unique colours
– Expiry Date: January 2024
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– Supply ability: 50, 000 pairs/ month
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– To order between 1 pair and 2000 pairs, call +2347030000001
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Corneal layers and corneal transplant -Eye care perspective

What are the different layers of the cornea?

The cornea is the clear front wall of the eye, similar to a watch crystal. Functionally, the cornea has 3 main layers. All layers are clear and must be so to focus light properly.

The outer 10% of the cornea, the epithelium, is the protective skin layer that has sensation. It tells you to blink when your eyes are dry or if you get something in it. The epithelium protects the stroma from infection, scarring, drying out, and other potential harm. Just like the outer layer of your skin, the corneal epithelium sheds and regenerates itself every week. The new cells are grown by corneal epithelial stem cells. Therefore, an eye with an area of bad or opaque epithelium that blocks vision likely does not need a transplant to remove to opacity. Instead of the opacity typically only needs to be removed so that new healthy and clear epithelium can grow in (superficial keratectomy or SK). All other corneal layers do not regenerate and would need to be replaced or transplanted if removed.

The middle layer, the stroma, is the tough structural portion that makes up about 85% of the cornea thickness. The stroma is covered on the outside by the epithelium and on the inside by Descemet’s membrane.

The inner layer of the cornea, Descemet’s membrane, makes up 3 to 5% of its thickness. It is a thin Saran wrap-like membrane that has a single layer of extremely important endothelial cells living on its inner surface. The cornea needs oxygen and nutrients delivered to it, but it does not have blood flow like other parts of the body since blood vessels would make it opaque. The cornea is nourished by a clear fluid called aqueous humor. Aqueous inside the eye is made by arteries and is drained by veins. Descemet’s membrane limits the rate that aqueous humor can flow into the cornea. The endothelial cells pump out “used” aqueous humor so that it does not build up in the cornea which would otherwise make it opaque.

Corneal Layer Diagram

Is it possible to remove and/or transplant just one layer of the cornea?

Yes. We can explain the different types of cornea transplantation using the analogy of a wall. Think of the stroma as the drywall and bricks, Descemet’s membrane and endothelium as the wallpaper, and the epithelium as the temporary protective layers of clear coat that the owner must paint on the bricks from time to time.

Not that long ago, the only available surgery was a full thickness cornea transplant or penetrating keratoplasty (PK). With PK, all of the corneal layers are transplanted, and new epithelial cells grow over the new cornea in time. The entire wall is knocked out with a hammer, and a new wall and all its layers are brought in. The owner provides a new layer of clear coat over time. A prosthetic corneal transplant (keratoprosthesis (KPro) is an artificial full-thickness corneal transplant.

Selective keratoplasty surgeries are a huge advance over PK in that they allow us to replace just the portion of the cornea that is diseased.

Selective Keratoplasty Diagram

    • Superficial keratectomy (SK) and phototherapeutic keratectomy (PTK) remove the epithelium (and possibly some superficial stroma with PTK) so that new healthier epithelium can grow in. The corneal epithelium is the only layer of the cornea that regenerates. So, SK and PTK aren’t true transplants. They are like removing some imperfections in the layer of clear coat on the outside of the house so that the owner can lay down new clear coat. Conversely, an epithelial stem cell transplant is necessary when the owner’s can of clear coat runs out or goes bad. It becomes necessary to give the owner a new supply of clear coat, which involves transplanting in a special area of a donor cornea.
    • Deep anterior lamellar keratoplasty (DALK) transplants all stroma but leaves the host’s healthy Descemet’s membrane and endothelium behind to allow less risk of rejection or less risk from blunt trauma. The entire wall is changed out, but the host’s own delicate wallpaper is left behind.
  • Descemet’s membrane endothelial keratoplasty (DMEK) and Descemet’s stripping automated endothelial keratoplasty (DSAEK) replace Descemet’s membrane and endothelium without removing the host’s stroma. DMEK is more selective than DSAEK. Both DMEK and DSAEK remove old Descemet’s membrane and endothelium. DMEK adds a new Descemet’s membrane and endothelium only. DSAEK also adds a new Descemet’s membrane and endothelium but with an additional layer of donor stroma. Using the wallpaper analogy, in both DMEK and DSAEK the old wallpaper is removed. With DMEK, only new wallpaper is inserted. With DSAEK, a new piece of drywall that has new wallpaper on it is inserted on top of the old drywall.

Why do we need different types of transplants? Why not just do PK for everyone

PK has many limitations regarding vision, astigmatism, recovery time, rejection rate, and other risks. All types of selective transplants improve the outcomes when compared to PK. DMEK especially has many other benefits compared to DSAEK and PK. For example, performing PK for purely endothelial disease is outdated. It would be like knocking down the wall and bringing in a whole new wall when the only thing needed is new wallpaper!

Cornea Transplant Procedures Diagram

Do I need to go on systemic immunosuppressive medications for a corneal transplant?

Not for most types of corneal transplants. Epithelial stem cell transplants are an exception. When someone gets a kidney or a heart transplant, they need to go on strong medications that make the immune system less aggressive and less likely to attack the transplant. These medications have some potentially significant side effects.

Because there are no blood vessels in the cornea, it is generally invisible to the immune system. Thus for corneal transplants, with the exception of epithelial stem cell transplants, we only need anti-inflammatory eye drops to prevent an immune system attack or rejection. Most patients get down to one drop a day after several few months.

Rarely, patients with aggressive immune systems require stronger systemic medications to prevent rejection. Even with aggressive immune systems, rejection is still very rare with DMEK and is more commonly seen with DSAEK, DALK, or PK. PK has the highest risk of rejection.

After a corneal transplant, do I have to take any precautions if I ever receive a vaccination?

There is some data to suggest that the increase in the immune system activity after vaccination, including the flu and shingles vaccines, may put the graft at a slightly increased risk for a rejection episode. To combat this, we typically recommend that if you were down to just one steroid drop a day, immediately following a vaccine you should increase the steroid drops to four times a day for one week, then two times a day for one week, and then go back to just one daily. If you have previously been told that you cannot take steroid drops due to pressure problems or other issues, ask your cornea surgeon for advice before getting a vaccine. transplant.

How long will my transplant last?

Traditional full thickness corneal transplants (PK) last about 20 years. Cell count studies show that, with the passage of time, transplants still lose endothelial cells gradually just like any other cornea, but usually at a faster rate. When the endothelial cell counts fall low enough, the transplant becomes opaque and fails. Since DMEK and DSAEK are relatively new, it is not possible to say how long they will last; however, preliminary data is encouraging, especially for DMEK. There is variation between transplants, but early data suggest some transplants can even last one’s lifetime. Either way, the replacement of a transplant is possible.

Dr. Tenkman is studying variables that may reveal which donors have cells that are more resistant to death and also surgical techniques that are minimally harmful to endothelial cells. Many surgeons suggest it is normal to lose 30 to 50% of the donor’s endothelial cells during surgery. We have some early data suggesting less than 10% cell loss from surgery when selecting a specific subset of donors.

Does a rejection episode mean that I will lose my cornea transplant?

No. If untreated, a rejection episode can cause significant damage. But usually, the episode stops with an increase in anti-inflammatory eye drops. Patients are instructed to RSVP: come see us if they develop Redness, Sensitivity to light, Vision reduction, or Pain. It’s key to see us right away for prompt diagnosis and treatment.

Will I need glasses after my transplant? Could laser vision correction be done to reduce any postoperative need for glasses?

Whether or not you need glasses after your transplant depends on many factors. DMEK transplants reduce glasses dependence the most often. DSAEK is less predictable. DALK and PK can both frequently cause high astigmatism that needs glasses or even hard contacts to attain good vision.

Some patients are candidates for ASA (advanced surface ablation) to minimize their dependence on glasses or contacts after corneal transplant surgery. ASA is a laser vision correction procedure similar to LASIK. Whether or not ASA could be done to reduce dependence on glasses or contacts after surgery depends on several factors and is taken on a case by case basis.

What are the costs and risks of a cornea transplant?

Corneal transplant tissue is donated, but still typically costs $3,700 or more. The fees go to the eye banks that must harvest the corneas, screen for possible diseases that could be transferred to the patient, transport, and process the corneas, and deliver them to the surgery center… all within just a few days. The cost of receiving a transplant includes not just the tissue, but the surgery center, surgeon, and anesthesia fees. Fortunately, these costs are less at an outpatient surgery center and are typically covered by Medicare and private insurance, although patients may be responsible for deductibles and co-payments. Generally, DMEK and DSAEK can be performed in an outpatient surgery center whereas DALK and PK more often have to be done at a hospital. Having surgery at a hospital can increase costs several-fold.

The risk of infection from a corneal transplantation procedure is about the same as following a routine blood transfusion. The risk of receiving a disease from a transplant is very low.

Other risks include primary graft failure, rejection, graft dislocation, cataract formation, glaucomainfection, irregular astigmatism, double vision, bleeding, iris damage, vitreous prolapse, and cystoid macular edema. Most of these complications are quite rare but are theoretically possible with all types of eye surgery. Patients using steroid drops, which all corneal transplants require, have to be followed for the development of increased pressure. High eye pressure usually gives no symptoms, so follow up is crucial to allow the doctor to treat as necessary with medication or procedures. Patients are usually seen every 3 to 6 months for life depending on the strength of steroid used.

In our hands, the overall success rate for a DMEK or DSAEK graft attaching and working well is about 99%. Should the transplant fail due to rejection or otherwise, it would need to be repeated.

Because the time to heal is longer for DALK and PK, and because they involve more risk, the odds of a DALK or PK failing to restore vision is more significant than for DMEK or DSAEK. DALK and PK have several additional risks.

  • DALK, and more so PK, have a higher risk of bleeding during surgery while the patient’s own cornea is removed and the eye is depressurized. Although not common, such bleeding can do significant damage to the eye.
  • DALK, and more so PK, also have a significant risk of rejection. Higher doses of steroid drops may be necessary in here to prevent or treat rejection, which can increase the risk of increased eye pressure (glaucoma).
  • DALK and PK involve a 360-degree corneal incision. Such large corneal wounds don’t heal with full strength and are at risk to split open with moderate blunt trauma (ie if a patient fell and hit their face in the shower). If the wound were to split open, it could lead to loss of the eye.
  • DALK and PK require about 16 sutures. These sutures are not removed for many months or even over a year. The sutures are buried in a manner so they cause no pain to the patient. However, they commonly become loose and can cause a foreign body or sandy sensation. More significantly, a loose suture is a risk for infection (corneal ulcer). Corneal ulcers can be more serious in the setting of a corneal transplant because the immune system in the area is suppressed by steroid eye drops.
  • DALK and PK commonly heal with large amounts of astigmatism. The normally spherical corneal surface becomes like an irregularly shaped egg. Since the smooth corneal shape largely determines focus, an irregular cornea causes blurred vision. Corneal astigmatism is measured in diopters. In routine patients who have not had had a corneal transplant, we consider 1 diopter mild astigmatism, 2 diopters moderate astigmatism, and 3 diopters high astigmatism. DALK and PK average about 4 to 5 diopters of astigmatism. A common range is 2 to 10 diopters of astigmatism. Regarding astigmatism risk, there are controllable and uncontrollable causes. The surgeon can try to sew the graft as evenly as possible to reduce risk of severe astigmatism; however, the surgeon cannot control the natural tension lines in the cornea or how symmetrically the tension lines will balance as the wound heals. Severe or irregular astigmatism cannot be corrected with glasses. Special hard contact lenses are often necessary. On average, one-third of all DALK and PK patients need hard contact to see their best due to astigmatism. Therefore, at Bennett & Bloom, we never perform DALK or PK for keratoconus patients to try to get out of contact lenses. The patient could go through all the added cost and risk of surgery only to end up where they started… or worse. DALK and PK are reserved for severe disease that cannot be fixed by contact lens wear

 

For corneal transplant at Bennet & Bloom Eye center in the USA or for medical tourism in the USA, contact Eyeupdate Clinic & Optical Supplies, 01 Ajuwon junction, Off Elliot bus stop, Iju Ishagah, Lagos.Tel: +2347030000001, +19093663551

Muscles, Nerves, and Blood Vessels in the Human Eye

By David Terfera, Shereen Jegtvig

Muscles enable you to move your eyes. Ocular nerves allow you to interpret what you see and blood vessels keep your eyes oxygenated. Six muscles, collectively called the extraocular muscles, move the eyeball. A seventh muscle moves the eyelid and is also found in the orbit.

The muscles of the human eye

The following muscles help your eyes move around.

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Muscles, Nerves, and Blood Vessels in the Human Eye

By David Terfera, Shereen Jegtvig

Muscles enable you to move your eyes. Ocular nerves allow you to interpret what you see and blood vessels keep your eyes oxygenated. Six muscles, collectively called the extraocular muscles, move the eyeball. A seventh muscle moves the eyelid and is also found in the orbit.

The muscles of the human eye

The following muscles help your eyes move around.

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  • Levator palpebrae superioris: Originates on the sphenoid bone above the optic canal. It inserts into the superior tarsis and skin of the eyelid. It’s innervated by the oculomotor nerve and elevates the superior eyelid.

  • Superior oblique: Originates on the sphenoid bone and inserts into the sclera deep to the superior rectus muscle. It’s innervated by the trochlear nerve and abducts, depresses, and medially rotates the eyeball.

  • Inferior oblique: Originates on the anterior part of the orbital floor and inserts onto the sclera deep to the lateral rectus muscle. It’s innervated by the oculomotor nerve and abducts, elevates, and laterally rotates the eyeball.

  • Superior rectus: Originates on the common tendinous ring and inserts into the sclera behind the corneoscleral junction. It’s innervated by the oculomotor nerve, and it elevates, adducts, and medially rotates the eyeball.

  • Inferior rectus: Originates on the common tendinous ring and inserts into the sclera behind the corneoscleral junction. It’s innervated by the oculomotor nerve and depresses, adducts, and laterally rotates the eyeball.

  • Medial rectus: Originates on the common tendinous ring and inserts into the sclera behind the corneoscleral junction, this muscle is innervated by the oculomotor nerve and adducts the eyeball.

  • Lateral rectus: Originates on the common tendinous ring and inserts into the sclera behind the corneoscleral junction. It’s innervated by the abducent nerve and abducts the eyeball.

The nerves of the eye

The eyes are served by the following cranial nerves and their branches:

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  • Optic nerve (CN II): Sensory nerve that transmits impulses from the retina to the brain

    • Oculomotor nerve (CN III), trochlear nerve (CN IV), and abducent nerve (CN VI): Enter the orbital space through the superior orbital fissure to innervate the extraocular muscles.

    • Ophthalmic nerve (part of the trigeminal nerve, CN V): This nerve has three branches:

      • The lacrimal nerve runs to the lacrimal gland and gives off branches to the conjunctiva and skin of the superior eyelid.

      • The frontal nerve enters through the superior orbital fissure and provides sensory innervation to the superior eyelid, scalp, and forehead.

      • The nasociliary nerve is the sensory nerve to the eyeball. It also has branches that serve the orbit and other parts of the face. One of its branches, the infratrochlear nerve, supplies the eyelids, conjunctiva, and lacrimal sac.

    • Ciliary ganglion: This group of postsynaptic parasympathetic nerve cell bodies is associated with the oculomotor nerve and ophthalmic nerve (CN V1). Presynaptic parasympathetic fibers from the oculomotor nerve synapse on the cell bodies of postsynaptic parasympathetic neurons in the ciliary ganglion.

      Short ciliary nerves emerge from the ciliary ganglion and enter the eye. The short ciliary nerves contain postsynaptic parasympathetic fibers from the ciliary ganglion, afferent fibers of the nasociliary nerve, and postsynaptic sympathetic fibers from the internal carotid plexus. Postsynaptic parasympathetic fibers innervate the ciliary muscle and sphincter pupillae muscle. Afferent fibers convey sensory impulses from the iris and cornea. Postsynaptic sympathetic fibers innervate the dilator pupillae muscle.

      The long ciliary nerves contain afferent and postsynaptic sympathetic fibers from the nasociliary nerve. Long ciliary nerves bypass the ciliary ganglion and run to the iris, cornea, and dilator pupillae muscle.

    The blood vessels

    Blood flow to the orbit (and beyond) comes from branches of the internal carotid artery, chiefly via the ophthalmic artery and its branches:

    • Ophthalmic artery: Branches from the internal carotid artery and passes through the optic canal into the orbital cavity

    • Central artery of the retina: Runs from the ophthalmic artery to the eyeball alongside the optic nerve; it branches at the optic disc and supplies the retina

    • Supraorbital artery: Starts at the ophthalmic artery and exits the orbit at the supraorbital notch to supply the forehead and scalp

    • Supratrochlear artery: Runs from the ophthalmic artery to the forehead and scalp

    • Lacrimal artery: Runs from the ophthalmic artery along the lateral rectus muscle to supply the lacrimal gland, conjunctiva, and the eyelids

    • Dorsal nasal artery: Branches from the ophthalmic artery and runs along the nose to supply it with blood

    • Short posterior ciliary arteries: Branch from the ophthalmic artery and pierce the sclera at the edge of the optic nerve; they supply the choroid and the rods and cones of the retina

    • Long posterior ciliary arteries: Branch from the ophthalmic artery and pierce the sclera to supply the ciliary body and iris

    • Posterior ethmoidal artery: Leaves the ophthalmic artery to supply blood to ethmoidal cells

    • Anterior ethmoidal artery: Runs from the ophthalmic artery to supply ethmoidal cells, frontal sinus, nasal cavity, and skin over the nose

    • Anterior ciliary artery: Runs from the muscular branches of the ophthalmic artery through the sclera near the rectus muscles and forms an arterial network in the iris and ciliary body

    • Infraorbital artery: Runs from the maxillary artery along the infraorbital groove and out to the face

    Blood is returned from the orbits via the superior and inferior ophthalmic veins, which pass through the superior orbital fissure into the cavernous sinus. The central vein of the retina may join an ophthalmic vein or enter the cavernous sinus directly. Vorticose veins drain the vascular layer of the eyeball, and the scleral venous sinus encircles the anterior chamber of the eyeball.