TREATMENT FOUND TO REDUCE VISION LOSS

NEW TREATMENT FOUND TO REDUCE VISION LOSS FROM CENTRAL RETINAL VEIN OCCLUSION
Eye injections of corticosteroid medication may improve patients’ vision

Scientists have identified the first long-term, effective treatment to improve vision and reduce vision loss associated with blockage of large veins in the eye. This research was part of a multi-center, phase III clinical trial supported by the National Eye Institute (NEI) at the National Institutes of Health.

The Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE) Study, conducted at 84 clinical sites, found that eye injections of a corticosteroid medication could reduce vision loss related to the blockage of major blood vessels within the eye, a condition known as central retinal vein occlusion (CRVO). Treated patients were also five times more likely to gain vision after one year than patients who were under observation.

“These are extremely compelling results because a large, longer-term clinical trial has never before shown that patients with central retinal vein occlusion could experience a visual improvement with treatment,” said Michael S. Ip, M.D., associate professor at the University of Wisconsin, Madison, and chair of the SCORE Study.

In the United States, vein occlusion is estimated to be the second most common condition affecting blood vessels in the retina. Currently, no treatment exists for CRVO, in which a blood clot slows or stops circulation in a large vein within the eye’s light-sensitive retinal tissue. Reduced retinal circulation may lead to new blood vessel growth and blood vessel leakage, resulting in retinal tissue swelling — a common cause of vision loss from CRVO.

Until now, there has been no proven, effective way to treat CRVO. However, some ophthalmologists have treated patients with eye injections of an anti-inflammatory corticosteroid called triamcinolone, though its effectiveness had not been tested in a clinical trial. The SCORE Study was the first to compare the safety and effectiveness of standard care observation with two different dosages of triamcinolone: 1 mg and 4 mg. The results appear in the September 2009 issue of Archives of Ophthalmology, published alongside findings from a separate trial within the SCORE Study, which looked at blockages in smaller retinal veins (http://www.nei.nih.gov/news/pressreleases/091409b.asp).

Study participants included 271 people with CRVO who were an average of 68 years old. Patients in the treatment group could receive a maximum of three corticosteroid injections every year for up to three years, based on the state of their disease.

At one year, patients who received either dose of the corticosteroid medication were five times more likely than those who did not receive treatment to experience a substantial visual gain of three or more lines on a vision chart-equivalent to identifying letters that were half as small as they could read before treatment. However, patients in the 1 mg group had fewer side effects related to increased eye pressure and cataract formation than those in the 4 mg group.

“These are very welcome results because up to now there has been no effective way to treat patients who have a central retinal vein occlusion,” said Frederick L. Ferris III, M.D., clinical director of the NEI. “Now, clinicians could offer CRVO patients a low-dose corticosteroid injection that may increase their chance of visual improvement.”

The SCORE study was co-chaired by Michael S. Ip, M.D., associate professor at the University of Wisconsin, Madison, and Ingrid U. Scott, M.D., M.P.H., professor at Penn State College of Medicine. Find more information about this clinical trial (NCT00105027) at .

The National Eye Institute (NEI), part of the National Institutes of Health, leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit .

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit .

U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH NIH News
National Eye Institute
Embargoed for Release: Monday, September 14, 2009,
4 p.m. EDT

CONTACT: National Eye Institute, 301- 496-5248, neinews@nei.nih.gov>

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LASER TREATMENT FOR VISION LOSS

LASER TREATMENT FOR VISION LOSS FROM BRANCH RETINAL VEIN OCCLUSION IS SAFER THAN CORTICOSTEROID INJECTIONS AND EQUALLY EFFECTIVE

Scientists have found that laser therapy is equivalent to two different dosages of corticosteroid medications for treating vision loss from the blockage of small veins in the back of the eye, a condition known as branch retinal vein occlusion (BRVO). Furthermore, laser treatment was shown to have fewer complications for patients.

This research was part of the Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE) Study, a phase III clinical trial conducted at 84 sites and supported by the National Eye Institute (NEI) at the National Institutes of Health.

“The SCORE study is the first to demonstrate that laser treatment and injections of corticosteroid into the eye have a similar impact on vision loss for patients who have retinal swelling due to branch retinal vein occlusion,” said Ingrid U. Scott, M.D., M.P.H., professor at Penn State College of Medicine and co-chair of the SCORE study. “However, the lower rate of complications with laser treatment may indicate that it is the best proven treatment option for patients at this time, and that laser represents the benchmark against which other treatments should be compared in future clinical trials.”

In the United States, vein occlusion is estimated to be the second most common condition affecting blood vessels in the retina. In BRVO, a blood clot slows or stops circulation in a small vein within the eye’s light-sensitive retinal tissue. This may lead to new blood vessel growth and blood vessel leakage, which results in retinal tissue swelling — a common cause of vision loss from BRVO.

Eye doctors typically treat BRVO with laser therapy applied to the affected retina in a grid pattern. However, some ophthalmologists have treated people who have BRVO using eye injections of an anti-inflammatory corticosteroid called triamcinolone. Because clinical observations suggested a visual benefit, the SCORE study was initiated to compare the safety and effectiveness of standard care laser treatment with two different doses of triamcinolone — 1 milligram and 4 milligrams. The results appear in the September 2009 issue of Archives of Ophthalmology, published alongside findings from a separate trial within the SCORE study, which looked at blockages in larger retinal veins (http://www.nei.nih.gov/news/pressreleases/091409a.asp).

Participants in the study included 411 people with BRVO who were an average of 67 years old. Patients could receive treatment every four months for up to three years. One year after patients began the trial, equal numbers of patients experienced visual improvement in each treatment group. Twenty to 30 percent of patients in each group experienced substantial visual gains of three or more lines on a vision chart-equivalent to identifying letters that were half as small as they could read before treatment.

However, patients who received either dosage of corticosteroid medication were more likely to develop a cataract or have an increase in eye pressure requiring medication than patients who received laser treatment. Between one and two years after treatment was begun, patients who received the 4 milligram dosage were also more likely to undergo cataract surgery.

“These results may have a significant public health impact by providing guidance for clinicians and patients in their selection of a branch retinal vein occlusion treatment,” said Frederick L. Ferris III, M.D., clinical director of the NEI. “Still, better treatments for this condition are needed. This information could guide future clinical trials of new and more effective treatments for BRVO patients.”

The SCORE study was co-chaired by Michael S. Ip, M.D., associate professor at the University of Wisconsin, Madison, and Ingrid U. Scott, M.D., M.P.H., professor at Penn State College of Medicine. Find more information about this clinical trial (NCT00105027) at .

The National Eye Institute (NEI), part of the National Institutes of Health, leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit .

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit .

U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH NIH News
National Eye Institute
Embargoed for Release: Monday, September 14, 2009,
4 p.m. EDT

CONTACT: National Eye Institute, 301- 496-5248, neinews@nei.nih.gov>

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