EyeWorld Asia-Pacific March 2011 Issue

34 March 2011 EW NEWS & OPINION IOLs, vitreoendoscopes, and glaucoma drainage devices—they have also led to an improved understanding of the mechanics of conditions such as glaucoma and retinal vascular diseases. Such sciences that might generally be thought of as peripheral to ophthalmology are thus becoming increasingly important in virtually all aspects of ophthalmic medicine. Nanotechnology, for one, provides new ways to detect and diagnose ophthalmic diseases, and, in combination with bioengineering, suggests new ways to deliver drug therapy more efficiently (see also sidebar). However, there is, perhaps, no more spectacular manifestation of ACS building Pan-Asian corneal infection database T he Asia Cornea Society Infectious Keratitis Study (ACSIKS) will look at all corneal infections seen at these sites for a year, collecting information on antibiotic use and resistance patterns. According to Donald Tan, MD, Medical Director, Singapore National Eye Centre, Chairman of the Singapore Eye Research Institute (SERI), Singapore, and president, ACS, because most published research focuses on infection patterns in the West, commercially available anti-infectious agents which are developed based on this evidence do not adequately address infections in Asia. This may in fact be responsible for increasing patterns of resistance. The Pan-Asian study will be sharing data with the pharmaceutical industry, with the goal of developing anti-infectious agents that are more appropriate to infection patterns in Asia. In addition, where possible, study sites will be collecting and storing pathogenic samples from cases to be archived at a central ACSIKS repository located at the ACSIKS Secretariat and Laboratories in Singapore. These samples can be used for industry testing to ensure "real-world" efficacy of commercially produced anti-infectious agents. This prospective, observational study is only the beginning of long- term collaboration between participant and non-participant countries and institutions alike, looking towards closer continuous monitoring of infection patterns in Asia, allowing both clinicians and the pharmaceutical industry to better adapt to any changes that are sure to take place as both available treatments and pathogenic organisms evolve. This study will be the world's first multinational study on infectious keratitis, and will be the largest study tackling the problem of corneal blindness from infections. the interaction between ophthalmic researchers and engineers than the concept of the bionic eye. The bionic eye We have been replacing parts of the eye with artificial prostheses for decades: the first translimbal glaucoma drainage device was implanted in 1912; the first IOL in 1949. Using less stringent criteria, we can go back even further: non- functional ocular prostheses may have been used as far back as 2900 BC. The complexity of the retina’s structure and function had until recently made it virtually impossible to develop a working replacement; vision lost to retinal disease was considered lost forever. Now advancements in engineering and materials technology over the last decade or so put a working retinal implant well within reach; in fact, some researchers have already completed preclinical studies and are in the early stages of clinical investigation. The concept is fairly simple: an electrode array is implanted somewhere on the retina to stimulate surviving retinal ganglia. The specifics of the various strategies vary: Caroline Chee, MD, and her colleagues in Singapore, for instance, are working on a subretinal implant for photoreceptor disease; Robyn Guymer, MD, and Michael Ibbotson, MD, of Bionic Vision Australia are working on a suprachoroidal and an epiretinal implant. They say they have the advantage of working with the engineers who developed wireless transmission for both data and power for cochlear implants. Many researchers work with photoconductive electrodes; Mark Blumenkranz, MD, and his colleagues in the US are developing a photovoltaic implant that allows them to use the same infrared signal to transmit visual information and electrical power. Of course, replacement is only one of the possible approaches researchers are looking at to create a “bionic” eye, i.e., to restore vision in retinal disease. Techniques including the use of 9-cis beta carotene and stem cell treatments are being explored by researchers that include Michael Belkin, MD (Israel), Pete Coffey, MD (UK), and Elizabeth Rakoczy, MD (Australia). At the moment, researchers think the patients most likely to benefit from either retinal replacement or regeneration are those with retinitis pigmentosa— the worse the retinal condition, in fact, as some studies have shown, the more likely these procedures will be successful. However, researchers are also hoping the treatments can be applied in other conditions such as age-related macular degeneration. The Singapore Eye Research Institute (SERI) and Asia-ARVO put together a symposium that brought together these and other researchers from around the world who are currently working on making the bionic eye—restoring retinal function by replacement or by regeneration—a reality. Basic science, epidemiology One thing that the existence of Asia-ARVO as a distinct offshoot of ARVO highlights is the relative lack of data on ophthalmic conditions specific to the Asia-Pacific region. The 2011 meeting demonstrated how quickly that is changing. “The stature of this meeting reflects Asia’s increasingly important contributions to global eye and vision research,” said Jonathan Mark Petrash, PhD, President, ARVO. Prof. Petrash called the region “home to some of the world’s fastest growing eye and vision research enterprises”. “This region is key to the future of eye and vision research and to ARVO as an organization,” he said. In a media conference held during the Asia-ARVO meeting, Dr. Tan announced the collaboration between the Asia Cornea Society (ACS), the Asian Cornea Foundation (ACF) and 11 sites in eight countries to build a database on corneal infections in Asia (see sidebar). It will be, he said, the world’s first multinational study on infectious keratitis, and will be the largest study tackling the problem of corneal blindness from infections. Each symposium also included at least one epidemiological study, and of course many of the non- epidemiological research presented at the meeting were greatly dependent on epidemiological data. Epidemiological data, for instance, combined with a closer look at the condition, led Ian Morgan, MD (Australia), to conclude that the risk factors for myopia—an important condition in the Asia- Asia-ARVO continued from page 33 continued on page 36