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THE NATIONAL ALLIANCE FOR EYE AND VISION RESEARCHE-ZINE Volume 3, Number 3 (June 2007) Welcome to the third edition of the National Alliance for Eye and Vision Research's (NAEVR) E-Zine, a quarterly electronic publication that highlights breakthrough eye and vision research funded by the National Eye Institute (NEI) within the National Institutes of Health (NIH). The nation's investment in the NEI results in new treatments and therapies to not only stabilize vision loss but to restore it, or ultimately prevent the onset of eye disease. Vision impairment and eye disease currently cost the United States $68 billion annually in healthcare expenditures, reduced productivity and diminished quality of life. In this edition:
ALLIANCE FOR EYE AND VISION RESEARCH (AEVR) Children’s Vision Research Thursday, June 28, 2007 Featured Speakers: Dr. Michael Repka Please join us.
NEI DIRECTOR DR. SIEVING TESTIFIES BEFORE SENATE ON PUBLIC HEALTH CHALLENGE FROM AGING EYE DISEASE On June 22, NEI Director Dr. Paul Sieving testified before the Senate Labor, Health and Human Services, and Education (LHHS) Appropriations Subcommittee. This hearing, appropriately entitled A New Vision for Medical Research, was the last of a series of hearings featuring NIH Institute/Center Directors. In opening comments, Subcommittee Chair Sen. Tom Harkin (D-IA) and Ranking Member Sen. Arlen Specter (R-PA) briefly acknowledged the June 19 Subcommittee markup and June 21 full Senate Appropriations Committee meeting at which a Fiscal Year (FY) 2008 LHHS appropriations bill was approved which would increase NIH and NEI funding by $1 billion and $14.8 million, respectively, over FY2007. "NEI-funded research has resulted in remarkable advances to save and restore sight," stated Dr. Sieving, who in written and verbal testimony focused his comments on the vision public health challenge resulting from the aging of the baby boom generation. Citing age-related macular degeneration (AMD), the leading cause of vision loss, as an example of NEI research that meets NIH goals of research that is preemptive/preventive, predictive, personalized, and participatory, he described NEI’s identification of genes associated with an increased risk of developing AMD; NEI’s demonstration that antioxidant vitamins and minerals can reduce the progression of the moderate stage of AMD to the severe stage by 25 percent; and new Food and Drug Administration (FDA)-approved ophthalmic drugs that are stabilizing and restoring vision loss. In response to a follow-up question, Dr. Sieving announced that within the next two months, NEI-funded investigators would begin human clinical trials in the United States of a gene therapy to treat neurodegenerative eye diseases, including Leber’s Congenital Amaurosis (LCA). Previous research has restored vision in dogs with LCA. Dr. Sieving was joined by Directors of Institutes/Centers for: Complementary and Alternative Medicine; Dental and Craniofacial Research; Environmental Health and Sciences; and Child Health and Human Development. In commenting on Dr. Sieving’s testimony, NAEVR’s James Jorkasky stated that, "NEI estimates that, by 2020, more than 50 million Americans over age 40 will experience blindness, low vision, or an aging eye disease, exponentially increasing the current $68 billion annual cost of vision impairment. Adequately funding the NEI can delay, save, and prevent expenditures and ensure productivity, independence and quality of life." Dr. Sieving’s written testimony is at: http://www.eyeresearch.org/pdf/sieving_062207.pdf NEI ANNOUNCES PROTECTIVE EFFECT OF OMEGA-3 FATTY ACIDS ON RETINAL DISEASE On June 24, the NEI announced that a study it has funded demonstrates the protective effect of omega-3 polyunsaturated fatty acids against retinopathy (deterioration of the retina) in mice. The study, published in the July 2007 edition of the journal Nature Medicine, is important for several reasons. Retinopathy in the mouse shares many characteristics with Retinopathy of Prematurity (ROP) in humans, a disease of premature infants in which blood vessels proliferate in the retina, leading to bleeding, scarring, and potential blindness. Following up on this finding, NEI will fund a clinical trial to test the effects of omega-3 supplements in premature infants. The study also found that this disease process may apply to both diabetic retinopathy and age-related macular degeneration (AMD), the latter of which is the leading cause of vision loss in Americans. The NEI is currently conducting the second phase of its Age-Related Eye Disease Study (AREDS2), which will assess the effect of omega-3 fatty acids on the progression of AMD. The first phase of AREDS demonstrated that antioxidant vitamins and minerals reduced the progression of the moderate stage of AMD to the severe stage of the disease by 25 percent. Study co-lead author and NEI scientist Dr. John Paul SanGiovanni commented that, "the study provides a reasonable biological explanation for findings from a number of human studies on diet and retinal disease, and it identifies low-cost and widely available nutrient-based treatment approaches that may show merit in future research on diseases that damage retinal blood vessels and nerve cells." The June 22 testimony of NEI Director Dr. Paul Sieving (see previous story), coupled with this most recent NEI finding, demonstrates NEI’s commitment to eye disease preemption and prevention, hallmarks of NIH’s research paradigm for the 21st century. Commenting on NEI’s findings, NAEVR Executive Director James Jorkasky stated that, "With research ranging from ROP in infants to AMD in seniors, the NEI affects and benefits Americans at all stages of life," and added that this is a major justification for NIH/NEI funding increases currently being considered in Congress. The study was a collaborative effort by researchers at Children’s Hospital Boston, the primary pediatric teaching affiliate of Harvard Medical School, Brigham and Women’s Hospital, Massachusetts General Hospital, the University of Goteborg in Sweden, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and NEI. NEI’s press release on the omega-3 study is at: http://www.nei.nih.gov/news/pressreleases/062407.asp NEI’s press release about the AREDS2 study is at: http://www.nei.nih.gov/news/pressreleases/101206.asp VISUAL IMAGING CHANGES DIAGNOSIS AND TREATMENT OF EYE DISEASE, STATES NAEVR PRESIDENT DR. STEPHEN RYAN At an April 17 Congressional Briefing entitled Vision for the Future: Eye Imaging to Save and Restore Sight, NAEVR Board President Dr. Stephen Ryan (Doheny Eye Institute/University of Southern California) described a new digital imaging technology that is changing the way vision disorders are diagnosed and treated. This technology is optical coherence tomography, or OCT. This noninvasive technique allows one to observe the layers of the retina-the neural tissue which converts light into images we see. The latest OCT technology, which reveals the retina three-dimensionally and in color though sophisticated computer software, can be used to identify early changes related to potentially blinding diseases, such as age-related macular degeneration (AMD, the leading cause of blindness), diabetic retinopathy, and glaucoma, and to subsequently monitor the effectiveness of treatments emerging from research. As OCT technology enters common practice in clinical research and in practitioners’ offices, it will revolutionize the "old 20th century approach" to retinal disease. Past practice has relied primarily on photographic images limited in their ability to sense subtle changes in retinal pathology. "This new OCT technology," said Ryan, "will transform and improve the way we diagnose AMD, diabetic retinopathy, and glaucoma. The major asset is that it creates a quantitative measurement of retinal changes which, when coupled with a functional measurement of vision, can maximize the use of evidence-based medicine in eye care." Since retinal changes often precede improvements or losses in vision detected functionally by the eye chart, Ryan emphasized that treatments for individual patients can begin earlier, before permanent retinal damage sets in. He added that the quantitative basis of OCT will impact clinical trials of new treatments, since this research will require fewer patients, take less time, and be far less costly. "This OCT technology facilitates in eye care the goal described by NIH Director Dr. Zerhouni for research and clinical practice in the 21st century-that which is preemptive/preventive, predictive, personalized and participatory." Ryan concluded by stating that it is hard to overemphasize the value of this new technology—stating that it is similar to the difference between snail mail and email, or between the biplane of old and a new jetliner-in that we get so much more information about the retina. "As of June 2006 and for the first time in history, we have a Food and Drug Administration (FDA)-approved ophthalmic drug that improves vision in people with AMD. OCT can track changes that will help us make the best diagnoses for our patients and tell us when to initiate or follow-up with injections of the drug," said Ryan, who predicted that the same will apply to glaucoma and diabetic retinopathy within the next five years. "The level of federal investment in medical research to deal with the growing and costly public health problem of eye disease and vision impairment will play a large part in determining the progress in implementing treatments for blinding eye diseases."
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