Vision Gains for Retinal Vein Occlusion Patients

Retinal vein occlusion is one of the most common blinding conditions in the United States; without treatment, central retinal vein occlusion (CRVO), the most severe type of retinal vein occlusion often leads to significant and permanent vision loss. New research shows that a treatment for retinal vein occlusion yields long-lasting vision gains, with visual acuity remaining significantly above baseline at five years. However, many patients require ongoing treatment.  A report on five-year outcomes of the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2), was published April 21 in American Journal of Ophthalmology. SCORE2 was funded in part by the National Eye Institute (NEI), a part of the National Institutes of Health.

Retinal Vein OcclusionRetinal vein occlusion is caused by a blockage of the veins carrying blood away from the retina, the light-sensitive tissue at the back of the eye. This blockage can lead to macular edema where fluid becomes trapped within and under the retina, leading to rapid and severe loss of visual acuity. Without treatment, this condition typically leads to permanent loss of vision. The most effective treatment, injections of anti- vascular endothelial growth factor (VEGF) drugs, helps control blood vessel leakage and swelling in the retina.

“While anti-VEGF therapy is associated with significant improvement in both retinal swelling and visual acuity in patients with central or hemi-retinal vein occlusion, our findings show that most of the patients followed still required treatment to control the macular edema for at least five years,” said Ingrid U. Scott, M.D., M.P.H., Penn State College of Medicine, Hershey, chair of the study. “This demonstrates the importance of continued monitoring of these patients.”

In 2017, SCORE2 clinical trial investigators reported that two types of anti-VEGF treatment were equally effective at improving visual acuity in people with macular edema due to CRVO or hemi-retinal vein occlusion (HRVO). CRVO affects the entire retina, while HRVO generally affects about half of the retina. Half of the study participants had been given Avastin (bevacizumab) while the other half received Eylea (aflibercept). At the six-month mark, the vision of participants in both groups had, on average, improved over three lines on an eye chart.

At five years, many participants in both groups had lost some visual acuity when compared to their acuity at the 6 and 12-month marks; however, they retained on average three lines of improvement, compared to their acuity at the beginning of the study.

“It was surprising to us that despite many participants still needing treatment after five years, their visual acuity outcome remained very good,” said Michael Ip, M.D., co-chair of the study from Doheny Eye Institute, University of California Los Angeles. “In comparison to this treatment for wet age-related macular degeneration, where initial vision improvements fade over time, these results are quite favorable.”

“This five-year study tells us a lot about what’s happening with retinal vein occlusion patients in the real world,” said Scott. “Prior to this study, retinal vein occlusion was widely considered an acute illness. This study shows that RVO is a chronic disease. It also underscores the importance of disease monitoring and individualized treatment to achieve the best possible vision.”

“The SCORE2 study provides invaluable data to guide clinicians and their patients toward informed decisions regarding treatment for retinal vein occlusion,” said NEI Director Michael F. Chiang, M.D.

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I thought you looked familiar…

In a recent study led by Cedars-Sinai, researchers have found new information about how the part of the brain responsible for memory is activated when the eyes come to rest on a face versus another object or image. Their findings, which were published in the peer-reviewed journal Science Advances, add to already established scientific understanding of how memory works, and to evidence supporting a future treatment targeted for memory disorders.

While vision feels continuous, people move their eyes from one distinct spot to another three to four times per second. In this study, researchers found that when the eyes land on a face, certain cells in the amygdala, a part of the brain that processes social information, react and trigger memory-making activity.

“You could easily argue that faces are one of the most important objects we look at,” said Ueli Rutishauser, PhD, director of the Center for Neural Science and Medicine at Cedars-Sinai and senior author of the study. “We make a lot of highly significant decisions based on looking at faces, including whether we trust somebody, whether the other person is happy or angry, or whether we have seen this person before.”

The study was conducted using 13 epileptic patients who had electrodes implanted in their brains and were then shown images varying from human faces to geometric figures to cars to flowers while having a camera trained on their eyes to determine what they were looking at.  In addition the researchers also recorded the patient’s theta wave activity.  Theta waves are a distinct electrical brain wave that is created in the hippocampus and they are key in processing information and forming memories.

Researchers showed the patients the images in two sessions and found that each time the participants’ eyes landed on a human face, certain cells in the amygdala fired. Every time these “Face Cells” fired the pattern of theta waves in the hippocampus reset or restarted.

Vision and Faces“We think that this is a reflection of the amygdala preparing the hippocampus to receive new socially relevant information that will be important to remember,” said Rutishauser, the Board of Governors Chair in Neurosciences and a professor of Neurosurgery and Biomedical Sciences.

Interestingly, the researchers showed that the more quickly a subject’s face cells fired when their eyes fixed on a face, the more apt the subject was to remember that face. When a subject’s face cells fired more slowly, they were more likely to forget the face they had seen.

Subjects’ face cells also fired more slowly when they were shown faces they had seen before, suggesting those faces were already stored in memory and the hippocampus didn’t need to be activated.

Rutishauser said these results suggest that people who struggle to remember faces could have a dysfunction in their amygdala, noting that this type of dysfunction has been implicated in disorders related to social cognition, such as autism.

The results also indicate the importance of both eye movements and theta waves in the memory process, Rutishauser said.

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