Monthly Archives: May 2014

Mathematical model may lead to cure for dry eye

May_Part 2_Ophthalmology

A treatment for dry eye – a burning, gritty condition that can impair vision and damage the cornea – could some day result from computer simulations that map the way tears move across the surface of the eye.

Kara Maki, assistant professor in Rochester Institute of Technology’s School of Mathematical Sciences, contributed to a recent National Science Foundation study seeking to understand the basic motion of tear film traversing the eye. “Tear Film Dynamic with Evaporation, Wetting and Time Dependent Flux boundary Condition on an Eye-shaped Domain,” published in the journal Physics of Fluid, is an extension of Maki’s doctoral research under her thesis advisor and co-author Richard Braun, professor in the University of Delaware’s Department of Mathematical Sciences.

“We’re hoping if we can understand better the basic dynamics of the tear film, then we can start to understand what goes wrong if you have dry eye and start to think about potential cures by studying simulations,” Maki said.

Dry eye is a common condition without a cure. Many causes, including the aging process, contribute to discomfort resulting from either a lack of tears or tears that evaporate too quickly. In the United States alone, nearly 5 million people age 50 and older suffer from dry eye, according to the National Eye Institute, part of the National Institutes of Health. Women are predominantly afflicted with the condition, with more than 3 million diagnosed with dry eye due to hormonal changes associated with menopause. Treatment to alleviate symptoms includes eye drops and temporary or surgical plugs to stopper tear ducts at the inner corners of the eyes and retain fluid.

To understand dry eye, Maki had to begin with the physics and chemistry of tears. Tear film consists of a layer of water sandwiched between an oily layer of lipids on the outside to prevent evaporation and an inner mucous layer to spread the water over the eye.

Kara developed a mathematical model to simulate the direction tear film travels when entering the eye from the lacrimal glands above the upper eyelid. Using the software program Overture, she recreated the flow of tears on the surface of an open eye, moving from the upper corner and draining through the ducts at the opposite corner.

“One thing we were able to find is that when your eyes are open, the tears get thin right along the edge of the eye, and that is referred to as the ‘black line,'” Maki said. “That has been seen clinically and can be reproduced in our simulations.”

The tears, Maki explains, climb up the eyelid and join a column of fluid that travels along the lids. Lower pressure sucks the fluid into the meniscus and away from the center, creating the black line and dry spots in the tear film that can compromise vision and irritate the cornea.

Maki saturated the eye with liquid to penetrate the black line. She wanted to know if the fluid would travel down the front of the eye and relieve the thinning of the tear film.

“We found that we had to really flood the eye in our simulations. The fluid would rather travel in the meniscus,” Maki said. “It splits traveling along the upper lid and the lower lid. We confirmed that blinking is necessary to stop this thinning from happening. Every time you blink, the tear film gets repainted on the front of your eye. It’s important to have smooth tear film for optical quality.”The next step for Maki and the team led by Braun is to simulate the dynamics of tear films in a blinking eye.

“The nice thing about having a model is that you can make unrealistic things happen,” Maki said. “For example, we can flood the eye and see where the tears go. Or we can look at what happens when the drainage holes are plugged. Where does the fluid go? You can start to explore these things in a safe way.”

http://www.medicalnewstoday.com/releases/277495.php

 

Picture courtesy to www.optometrystudents.com

 

 

 

GPs urged to ensure every squint is checked with a red reflex test to rule out eye cancer

May_Part 1_Ophthalmology_Pediatrics

A children’s cancer charity is calling for all squints in babies and young children to be checked with a red reflex test to rule out eye cancer.

Figures released from the Childhood Eye Cancer Trust (CHECT) show that in 2013, over a quarter (26%) of babies and young children diagnosed with retinoblastoma (Rb) presented with a squint as a symptom.1 It is the second most common symptom after leukocoria (white pupillary reflex).

Joy Felgate, Chief Executive of CHECT said: “In our experience, some babies and young children are facing serious delays in receiving life-saving treatment as a result of parents either being told incorrectly that their baby’s squint is completely normal, or being given a non-urgent squint referral.”

Katy Bishop’s son Owen was incorrectly referred to a squint clinic at five months of age. His bilateral retinoblastoma was not diagnosed until he was ten months old. “Owen was too young to tell me his vision was failing, and his diagnosis was delayed five months because his squint was not properly checked. By the time he was diagnosed, he had a detached retina and was borderline for enucleation. Since then, he has had chemotherapy, cryotherapy and blood transfusions. We will never know the impact that five months’ delay has had on Owen’s future.”

As squints are common in babies up to the age of three months, the only way to determine whether this is a sign of a much more serious condition is to carry out a simple red reflex test, which is a non-invasive procedure, simply involving looking in the eye with a hand-held ophthalmoscope.

Mrs Felgate continued: “Non-urgent squint referrals can take months to come through, which can be a devastating delay for a child with undiagnosed eye cancer. Retinoblastoma is a very aggressive form of cancer and any delays in diagnosis can have a serious impact on treatment options. Currently more than 70% of children with unilateral Rb lose an eye to the disease.

“We are asking GPs to check every squint they see with the red reflex test.”

To promote this message CHECT has developed e-cards and an email campaign that GPs can share and forward on to colleagues. Copies of these are available from info@chect.org.uk.

Retinoblastoma is a fast-growing cancer of the eye affecting mainly 0 to 5-year-old children. Early detection of this aggressive condition is crucial to offer the child the best chance of saving their vision, their eyes and their life.

CHECT urges GPs to pay particular attention to children with

  • A recently onset squint
  • A white reflex (leukocoria) or an abnormal reflex in flash photographs
  • A change in colour to the iris
  • A deterioration in vision

Occasionally a retinoblastoma may present as a red, sore or swollen eye without infection. It is important to remember, however, that a child with Rb may appear systemically well.

Following a successful campaign by CHECT, most of these symptoms are now also listed in the latest versions of the Public Child Health Record (red book).

If any of the above symptoms are detected, a simple red reflex test can rule out retinoblastoma.

If you are unable to confidently rule out retinoblastoma with a red reflex test NICE guidelines state an urgent referral must be made to the local ophthalmology department stating ‘suspected retinoblastoma’. We recommend you call to alert them to the case and to find out how quickly urgent referrals are seen (in some cases it can be longer than two weeks).

http://www.medicalnewstoday.com/releases/276723.php