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January 10, 2001


Goal is to minimize collateral damage and prevent involvement of second eye.

The terms "heart attack" and "brain attack" have become commonplace, but now neuro-ophthalmologists are waging war on the all too common, underreported, and untreated condition referred to as "eye attacks." These attacks, known medically as Ischematic Optic Neuropathy ("ION"), result from a sudden lack of blood flow to the eye. Eye attacks, which are usually painless, can develop quite rapidly--sometimes overnight, often with catastrophic consequences to the vision of the individual, such as a sudden and permanent loss of peripheral or central vision in one eye. The resulting visual impairment and the degree of severity usually varies from patient to patient but can include loss of the bottom half of one's vision and difficulty with light and darkness.

University of Pennsylvania Medical Center researchers are working to help educate the public about this condition, which is the most common cause of acute optical nerve disease in adults over 50 years of age. While the frequency of the condition is estimated to occur in only a couple of people per thousand, per year, the catastrophic results are unquestioned. Studies indicate that irreversible damage can occur as quickly as within the first 90 seconds of the attack. "Prompt acknowledgement and treatment of the problem are essential if there is any chance of minimizing present and future damage", says neuro-ophthalmologist and researcher Nicholas J. Volpe MD, Associate Professor of Ophthalmology & Neurology at the University of Pennsylvania's Scheie Eye Institute. However, a new multi-center clinical trial, funded by the pharmaceutical company Allergan, is about to commence at approximately 50 research sites across the country, including the Scheie Eye Institute. The goal of the study is to determine whether neuro-protection-- i.e., delivering a proprietary and investigational topical agent to help a damaged nerve-- is viable. Specifically, Allergan is testing eye drops that will hopefully minimize collateral losses to the eye by saving some of the optic nerve fibers.

Contributing to the sense of urgency in promoting public awareness is the fact that most sufferers do not come forward and report the condition-- believing it, instead, to be a problem with their glasses or just a temporary, passing phase. This failure in reporting is critical, as researchers have been hampered by limited access to affected persons in a timely manner. Early reporting is essential as evidence now suggests that measures designed to limit further damage are most likely to succeed if intervention occurs within the first several hours. In addition, evidence exists that an attack in the other eye occurs up to 15 % of the time, over the following five years. Currently, a daily dose of aspirin is the only treatment offered, having a potential prophylactic effect on the second eye.

Eye attacks, which are not a new occurrence, have been treated over the years by using steroids and surgical intervention--neither with much success. A visual problem that typically occurs later in life as part of the aging process, "ION" is also suspected to occur with increased frequency in patients with diabetes and hypertension, in addition to occurring frequently in people with small, crowded optic nerves.

At this time, little can be done for the damaged eye, therefore successful prevention of second eye involvement is another goal of new research studies. A secondary and independent research study is also being performed by Volpe in conjunction with Carolyn Glazer, MD and Juan Grunwald MD, a retinal blood flow expert, also with Penn's Scheie Eye Institute. This study will attempt to focus on the characteristics and nature of the blood flow patterns in a patient's healthy eye, once he or she has suffered an eye attack. By examining the characteristics of the optic nerve in the healthy eye, the researchers hope to develop treatment strategies that can be used to protect the second eye.

Editor's Note: Dr. Volpe has no have financial interest in Allergan.




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