What is Ocriplasmin?

Ociplasmin (marketed by Alcon under the name "Jetrea") is a new drug, which was approved by the FDA in the US in October 2012.  It is an enzyme (a "recombinant protease with activity against fibronectin and laminase") which helps separate the back of the vitreous gel from the retina.  In certain conditions...when there is a strong attachment of the vitreous gel to the retina...and when the vitreous collapses forward in the eye...the retina can be lifted up like a "tent" (as seen in the OCT picture above),  Such an elevation results in visual loss.  Until the availability of this drug...the only solution was vitrectomy surgery...in which the vitreous gel is removed surgically...relieving the traction on the retina...resulting in visual improvement.
The availability of this drug allows some patients to be cured without surgery.  The drug needs to be injected directly into the vitreous cavity of the eye.  The success rate is much lower than with surgery (approximately 30% vs 100%).
A small percentage of macular holes can also be treated with this drug...and also avoid the need for vitrectomy surgery (ONLY in those cases of macular holes where there is traction from the vitreous in an "anteroposterior" or front-to-back direction)
Ocriplasmin is anticipated to receive Health Canada approval later in 2013

Is it true that an "artificial retina" has been developed?

On February 14, 2013...the FDA approved the "Argus II Retinal Prosthesis System".  This ingenious device was developed by "Second Sight" in California.  It consists of an intraocular portion and an extraocular portion.
The intraocular portion consists of a pattern of electrodes which are implanted onto the surface of the retina...as well as a receiving and transmitting coil...implanted onto the surface of the eye...these transmitters are connected by a wire to the electrodes inside of the eye.
The extraocular portion consists of a pair of glasses, onto which is mounted a camera.
The camera then sends images wirelessly...to the receiving coils...which then sends the images to the transmitting coils...and then to the electrodes on the retinal surface.  Impulses are then transmitted to the retinal nerve finer layer...then to the optic nerve...and then to the brain.
As of this writing...30 patients have had this device surgically implanted, as part of an FDA study.  The results have been quite remarkable.  Only patients with no light perception vision or bare light perception vision were eligible...and only patients who had a previous history of "form vision" in the past.  Patients have shown variable abilities to see large objects, navigate obstacles, reach for items on a table and even read large letters!
It is important to note that this device is now FDA approved ONLY for patients with an inherited retinal disease called RETINITIS PIGMENTOSA.
We anticipate commencing studies with the Argus II system in Toronto in late 2013.

Watch an actual intravitreal Lucentis injection (patient consent obtained)

How frequently does Lucentis need to be injected for wet ARMD?

There is no absolute answer. Lucentis...blocks a chemical called "VEGF" (vascular endothelial growth factor) which is secreted in excess by the body in wet macular degeneration. VEGF causes abnormal blood vessels to grow and bleed...while Lucentis is in the eye...it blocks VEGF...and stops bleeding...once Lucentis is absorbed...the blood vessels tend to grow and bleed.

Different people however absorb Lucentis at different rates...so Lucentis stays inside the eye for different periods of time in different people. On average...Lucentis stays for approximately 28 days...so when Lucentis was first evaluated...it was re-injected every 28 days...we now however know...not surprisingly...that different people differ in how quickly or slowly they absorb Lucentis...and therefore...people differ in how frequently they need to be retreated with Lucentis.

The best approach if for the retinal specialist to follow each patient as an individual...by clinical examination and, as required...OCT and angiography...to individualize the treatment program best suited for each patient.

The iPad as a "low vision" tool.

Apple's new iPad might prove to be the most brilliant, portable and cost-effective low vision tool ever!

The iPad is extremely easy to use, portable (1.5 lbs) and relatively inexpensive (starting at $499)...when compared to very large, cumbersome and much more expensive CCD devices currently available to low vision patients.

As opposed to conventional low vision aids...which require the user to place the reading material underneath the device in order for the printed material to be magnified...the iPad not only allows the fast and easy downloading of all printed material (books, magazines, etc)...but also allows access to everything on the internet! The user can then, with simple hand gestures on the touchscreen...enlarge the image to as large as is required! A new use for an already very brilliant device.

I seem to be resistant to Lucentis...am I unusual?

Lucentis is not a cure...it must be considered a maintenance therapy. A person with "wet" macular degeneration really needs the Lucentis to be present in their eye "24 hours per day...FOREVER". While Lucentis is present in the eye...blood vessel growth and leakage is retarded...but as the Lucentis gets absorbed (by 4 weeks)...blood vessel growth and leakage resumes...in most people...usually quickly.

One should therefore not feel that they are resistant to the Lucentis...it is unfortunately the nature of the drug. Lucentis is a terrific drug...but the nature of the disease and the duration of the drug in the eye requires injections approximately every four weeks...in most people. Every patient is however different in their response...your retinal specialist needs to monitor you very frequently...both via examination...and with imaging such as OCT and sometimes angiography...to determine whether additional treatment is required.

Do i have to pay for my own Lucentis if I go South for the winter?

If a resident of Ontario goes South for the winter...we can arrange with the Pharmacy supplying Lucentis to supply the drug while you are away...arrangements must be made with a retinal specialist at your destination to receive the drug and to administer the drug. Great care must be taken in the transportation process to ensure that the drug is maintained at the temperatures recommended by the manufacturer. As an Ontario resident...you are just as entitled to have an ODB covered drug such as Lucentis while you are away as you are entitled to have a drug that is taken orally.