Eyes to the future
Clinical trials benefit area patients; new lens technology
BY LIBBY MCMILLAN Special to Florida Weekly

COURTESY PHOTO Dr. Richard Glasser performs a slit lamp examination on a patient. The slit lamp uses a high-intensity light and microscope to look at the interior of the eye in detail.

The leading cause of legal blindness for Southwest Floridians over 50 is age-related macular degeneration (AMD). Now that baby boomer birthdays are putting them into the danger zone for AMD, the disease is getting more press. Thankfully, new treatments are being developed all the time, and while AMD patients across the globe benefit from those drugs and therapies, which eventually prove successful, patients in southwest Florida actually have the chance to participate in the proving grounds.

"We're involved in a number of clinical studies," says Dr. Alexander Eaton, board-certified ophthalmologist and founder of the Macular Degeneration Research Center at Retina Health Center in Fort Myers. "We have a research department with two fulltime research assistants," he says, and reveals that 10-20 studies are currently underway regarding macular degeneration.

FRANTZ

Success stories

Eaton describes two patients who participated in clinical trials: one could no longer see his fishing line or read emails, while the other was no longer enjoying his favorite hobby, which required good vision. Today, the hobby is in full swing again, the patient's sight restored. His counterpart in a separate study had a "dramatic improvement and has required very little in the way of treatment," according to Dr. Eaton. "There have been many, many success stories," he says, of his patients' participation in clinical trials for promising drugs and therapies.

Eaton's practice also treats macular hole, diabetic retinopathy and retina problems; he has twice conferred with the Secretary of the Department of Health and is currently on the faculty at Duke University. His keen interest in research began in Medical School; his partner at the research center, Dr. Hussein Wafapoor, shares his enthusiasm for discovery of treatments, which improve one's quality of life.

Drug companies wanting to do trials contact the Macular Degeneration Research Center regularly. Eaton founded the center as an adjunct to his practice to "bring the best we can to our patients in Fort Myers." When a brand new treatment or therapy improves a patient's sight, "it brightens your day, and it brightens their day," says Eaton.

GLASSER

Wet and dry

What exactly is age-related macular degeneration? In a nutshell: the center of the eye's inner lining, known as the macula area of the retina, suffers atrophy, thinning, or bleeding. This can result in a brutal loss of central vision, meaning a person can no longer read, see road signs, or even distinguish one face from another.

AMD has two forms: the treatable "wet" form, and the "dry" version. "Dry" means the tissue that supports the retina becomes damaged from life and time, and, as a result, the tissue does not function as well and vision is lost. "The majority of people with the dry version have good vision and do okay," says Eaton, but a small percentage see progression and have vision loss. For dry, there are medicines and treatments under development that can prevent the progression or perhaps improve vision, but not a lot can be done now if vision loss occurs.

Medical technology and procedures are advancing so fast that it's difficult for consumers to keep up. This is part two of Florida Weekly's eight-part series examining what's new in medicine in Southwest Florida. NEXT WEEK: Orthopedics. .

Nearly 85 percent of AMD patients have dry macular degeneration, but anywhere from 15-85 percent of those with the innocuous dry version convert over time to having the "wet" version, which is treatable, but which "is more severe and progresses more rapidly," explains Eaton.

"If dry converts to the wet form, one Monday you might be reading, and the next Monday you might not."

Good, better, best?

Typically, wet AMD patients aiming to improve their vision opt for intraocular injections of one of two drugs: Lucentis or Avastin. Both drugs target the molecule largely responsible for damage to one's vision. Injections are typically given every 4-6 weeks, and patients must continue treatment to maintain any improvement in vision they attain. With a current drug under trial at Eaton's research facility, however, that story is changing.

The patient who last year couldn't see his fishing line because of wet AMD participated in a local study of a new drug called VEGF-Trap, and now has 20/25 vision. Better yet, hasn't had an injection since August.

"The drug is by a company called Regeneron," says Eaton, of the trial, which is giving new hope at his research facility. "That drug really looks exciting."

Post-cataract improvements

Florida Eye Health's Dr. Jonathan Frantz, also a board-certified ophthalmologist, has many patients enjoying exciting improvements in the arena of cataract surgery. Traditionally, patients undergoing cataract surgery could expect to eventually need bifocals, trifocals or progressives. "With new technology lenses and modern surgical techniques," says Frantz, "we now have the ability to make it so that people are able to function without glasses after surgery." He's referring to the latest lens implants: Rezoom,

ReSTOR and Crystalens. Patients who receive these lenses can see both up close and at a distance. "That's something that's been very desirable," says Frantz.

While patients find the option of these implantable lenses exciting, "they have their benefits and drawbacks," counsels the doctor. Glare at night is a potential, if unlikely, drawback. Frantz's practice offers yet another option for patients having cataract surgery: they can choose new-technology lens implants specifically designed to give better, sharper night vision.

Night vision vs. no glasses

This means cataract patients are now faced with a critical decision before their surgery: would they rather go without glasses or see better at night? Frantz quizzes his patients to help them choose the lens that best fits their lifestyle. "What kind of computer needs do they have?" he says, as an example of the type of question he would ask. "We spend a lot of time making sure that we select the best possible lens implant for the best possible outcome for each patient. It's not like it was in years past. It's very customized at this point."

Frantz gives hope to cataract patients with an additional issue. "Up until several years ago," he says, "we did not have great ways of treating astigmatism." A common condition, astigmatism is a curvature of one or more refractive surfaces of the eye, resulting in blurred vision. "Now we have the toric lens implant," says Frantz, "that we place inside the eye, that allows us to correct the astigmatism before the surgery. We've had great results."

Dr. Richard M. Glasser, M.D. also board-certified, of Southwest Florida Eye Care, also sees a lot of patients who opt for ReSTOR and Rezoom lenses. The combination "works really well, and we do a lot of it," he says.

Life-changing successes

Glasser's associate at the practice, Dr. Rick Palmon, is now using artificial corneas for transplants. For patients who have already had one or two unsuccessful corneal transplants, the artificial cornea can be a miracle. Southwest Florida Eye Care uses the Boston KPro, developed at Harvard University. It's made of an acrylic material. Patients receiving the artificial cornea have all had a previous problem, which was very serious, such as a burn to the eye or a chemical injury.

"They're not very commonly needed," says Glasser of the artificial corneas, "but those are for people who are desperate." The surgery "takes about an hour to an hour and a half," he says, "and most people get enough vision to care for themselves, feed themselves, and dress themselves. Some can even drive," he says.