A patient with retinitis pigmentosa was able to recover part of the vision after undergoing optogenetic therapy and light stimulation. For the first time, this technique has achieved partial recovery of visual function, according to clinical trial researchers. The study was published in Nature Medicine journal .
Before treatment, the man could only perceive the presence of light. Now, he already finds, counts, and touches objects. Learn about the clinical trial and how optogenetic therapy works.
The research
Researchers from the Sorbonne University, Quinze-Vingts Hospital and the company GenSight Biologics, from France, in partnership with the University of Pittsburgh, from the United States, and the Institute of Molecular and Clinical Ophthalmology of Basel, from Switzerland, conducted clinical trials with optogenetic therapy in patients with retinitis pigmentosa.
That degenerative genetic disease damages the retinal photoreceptor cells, causing progressive loss of vision. The condition evolves until the patient is completely blind. The problem affects one in 3.5 thousand people, according to Orphanet database. Currently, an estimated two million cases exist worldwide.
A 58-year-old man, blind for 20 years, received an injection into one of his eyes with a gene called ChrimsonR, that encodes opsin proteins and identifies amber light. These proteins are responsible for sending visual information to the brain.
He then underwent treatment with flashes of light directly on the retina. In optogenetic therapy, light pulses control gene expression and activation of neurons. Currently, they are widely used in laboratories to unravel neural circuits and can be a potential treatment for pain, blindness and brain problems.
Results
After producing enough opsins, which occurred five months after beginning therapy, the patient was given camera glasses that project amber-colored images onto the retina.
In the first exercise, the man needed to notice, find and touch a large book and a small box of staples. In total, he managed to touch the book in 92% of evaluations, and the boxes in 36% of the time.
In the second test, the patient achieved 63% efficiency when counting glasses on a table. In the third exercise, he wore an electrode helmet that monitored if he recognized a glass on the table or not. In this one, he was successful 78% of the time.
Seven months after receiving the injection, the patient already showed signs of improvement in vision.
After two years of treatment, the man still uses the glasses to see better. In fact, images will never be the same as natural ones, but for those who have been blind for 20 years, it is life-changing.
It is the first time that optogenetic therapy has managed to partly reverse vision loss by a genetic degenerative eye disease. The trial will now advance to phase 3 to confirm the effectiveness of this therapeutic approach. However, it will still take some time to offer the technique, as it needs more studies, more patients and more longevity.
Reviewed by Paulo Schor, ophthalmologist, free professor and director of innovation of the Federal University of São Paulo (Unifesp) and collaborator of the Faculty of Medicine of the Albert Einstein Hospital.
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Since last year, scientists raised the hypothesis that glasses help to bar the contamination by the new coronavirus (SARS-CoV-2) through the eyes. This is because this region is also an open door for the virus, as well as a source of contagion.
Now, a recent study found out that the risk of infection by covid-19 in people who wear glasses may be twice to three times lower.The research, conducted in India, was published in the website medRxiv.
Learn more about the preliminary work, how it was done, th results and next steps. It is worth noting the new investigations are necessary, but, as the disease is new, it is important to follow studies in the area.
Glasses and coronavirus: the research
The research evaluated 304 people, 223 men and 81 women, aging from 10 to 80, residents in Northern India, during two weeks.Everyone presented symptoms of covid-19.
58 patients (19%) reported they frequently wore eyeglasses or sunglasses when exposed to sunlight.Through a questionnaire, volunteers stated they touched the face 23 times and the eyes 3 times per hour, in average.
Glasses and coronavirus: results
According to the scientists, the results related to extended use of sunglasses were significant.The current contamination rate of 1,35 of the population, in general, dropped to 0,48 among those who regularly wore glasses.The calculated risk ratio, according to the study, was 0,36%.
That is, the chance of covid-19 infection dropped three times.
Researches believe that the low transmission ratio is due to two factors: glasses protect against contaminated droplets in the air and less frequent touches in the eye while wearing them.
Scientists evaluated 276 positive covid-19 patients.Factors are the same: less touches in the eyes and protection against airborne droplets.
Conclusion
In fact, scientists remark that the relation between wearing eyeglasses and the new coronavirus is still inconclusive.This is because the study has not been revised by peers yet. Sampling was small and there was also difficulty to measure how long people wore glasses during the pandemic.
New investigations are necessary to evaluate the effects of glasses, such as protection against covid-19. However, as the disease is new, it is important to follow studies in the area.
Follow Phelcom’s blog and stay on top of main news in the area of eye care.
Currently, it is estimated that 1.5 million people worldwide lose their vision each year due to corneal injuries and diseases. Thus, problems in this membrane are the third largest global cause of visual impairment, behind only cataracts and glaucoma.
But this scenario may change. Recently, Israeli doctors performed the world’s first successful artificial corneal transplant. The patient, a 78-year-old man, was able to regain his sight after 10 years of blindness.
In fact, synthetic corneal implants already exist, but because they required more complex surgeries, they were used only as a last resort, such as rejection in corneal transplants. The new technology, on the other hand, can be implanted in a relatively simple way, with minimal cutting and suturing.
In the following, understand how the artificial cornea transplant occurred, how it acts inside the organism, the next steps, and how the result can change the reality of millions of people waiting for a cornea transplant to see again.
The artificial cornea transplant
Israeli startup CorNeat Vision has developed the KPro artificial implant to replace a patient’s deformed cornea. The procedure was performed at the Rabin Medical Center hospital in Israel.
The device has a non-degradable synthetic nano-tissue, which is placed under a membrane that lines the surface of the eyelid and the sclera (white part of the eyeball). When implanted, it unifies with the living tissue and encourages cell proliferation within the eye.
The synthetic cornea is only indicated in cases where the tissue is deformed, opaque, or scarred.
In an interview with the Israel Hayom website, the doctor and creator of the technology, Gilad Litvin, said that the surgery was relatively simple and lasted less than an hour.
Elderly Man Recognizes Relatives After Surgery
Patient Jamal Furani was able to regain his sight already the day after the artificial cornea transplant. The elderly man says that light was the first thing he could see. Afterwards, he was able to recognize relatives and even read texts.
“The result exceeded all our expectations,” says physician Irit Bahar, head of the Department of Ophthalmology at Rabin Medical Center.
Next Steps
The expectation is that the procedure will become viable and end the waiting line for donors around the world. “This technology was key to turning the tide against global blindness. It is very exciting to be at the forefront of this project that will undoubtedly impact millions of lives,” Bahar believes.
“We hope this will enable millions of blind patients around the world, in areas where there is no corneal practice or organ donation culture, to regain their sight,” says Gilad Litvin, medical director of CorNeat Vision. However, the company has not yet announced a market launch date.
Now the clinical trials continue. A further 10 approved Israeli patients are awaiting artificial corneal transplantation at Rabin Medical Center hospital. In addition, countries like Canada, France, the United States, and the Netherlands also have patients eligible for clinical trials.
A research carried out in two referral centers for covid-19 in Rio de Janeiro (RJ) identified alteration in the retina of patients hospitalized in serious condition. The study occurred in May 2020, in the clinical hospitals Mario Lioni and from Jacarepaguá, and was published in the journalPlos One in December, the same year.
The work was also one of the first to discover retinal damage in critical cases of the disease.It is noteworthy that other Brazilian studies, from the ABC School of Medicine (FAMBC) and the Federal University of São Paulo (Unifesp) , published shortly before, also detected retinal alterations.
Researchers used the smart device Phelcom Eyer to carry out the retinography in 47 eyes of 25 patients. Coupled to a smartphone, the device carries out high-quality fundus exams, in few minutes and without need of pupil dilation.It connects to an online platform, the Eyer Cloud, which allows remote diagnosis and assures safety to data stored in the cloud.
“Our study showed that, from the patients hospitalized in serious conditions for covid-19 clinical stabilization, 12% presented some finding”, says one of the doctors responsible for the work, Rafael Lani Lozada, ophthalmology resident in Gamboa Hospital (RJ).
A 35-year-old man from the mentioned sample, who had diverse clinical complications during hospitalization, manifested bilateral nerve fiber layer infarctions and micro-hemorrhages in the papillomacular bundle; another man, 56 years old, who needed to undergo full anticoagulation, had a unilateral “flame-shaped” hemorrhage; and a third man, 49 years old and hypertensive, presented discrete and bilateral retinal micro-hemorrhages.
To Lozada, the study shows retinal alterations may occur in severe covid-19 cases.“They were probably secondary to clinical intercurrences or comorbities rather than a direct damage by SARS-CoV-2, since it was not possible to correlate the problem directly to the virus.Thus, the retinal finding may be important and easily accessible markers of therapeutic interventions, as well as sentinels of neurological and systemic diseases during the pandemic”,
The doctor highlights that new studies with more patients are necessaryto establish statistic correlations between covid-19 and retinal lesions.
Phelcom Eyer
Louzada states that Phelcom Eyer was essential to the project, since the study, as a base, evaluated hospitalized patients in isolation, with a highly contagious and little studied virus.“Using a clean easy-to-handle portable device made it possible for us to step further in the search for a better comprehension of this disease, that afflicts humanity”, he observes.
The researcher also highlights other advantages on the equipment: short learning curve, quick image backup and a possible thorough analysis from any computer with internet access.“Not to mention that the fundus exams are very beautiful, with a great resolution and the color photos are automatically duplicated with red-free images”, he analyzes.
Beyond the pandemic
Lozada also highlights that the technical ease of retina evaluation with Eyer opens new horizons to triage exams, not only in the present pandemic context, but also for other ophthalmological diseases. “The possibility to obtain retinographies in a portable, easy and practical way, through an accessible image backup, allowing their remote careful study, is fundamental for advances in ophthalmological researches and better diagnostics”, he finishes.
During the XIX Caipira Congress, in June 2029, in Bauru (SP), the ophthalmologist Flávio Augusto Schiave Germano met the newly released smart device Phelcom Eyer.
Coupled to a smartphone, the device carries out high-quality fundus exams, in few minutes and without need of pupil dilation.It connects to an online platform, enables remote diagnosis and assures safety to data stored in the cloud.
Some months later, the doctor looked for similar devices in the annual congress of the American Academy of Ophthalmology.“But the national equipment, from São Carlos, proved to be superior both in image quality and design.It is lightweight and portable – handling is quick and intuitive, which makes it easy to use in any situation”, states Germano.
In September, 2020, the ophthalmologist acquired the smart device. He currently uses it every day in his office and in the medical residence service in the Center of Excellence in Ophthalmology (CEO), in Bauru (SP).
In the last six months, he carried out more than 1,1 thousand exams, totaling around 5,5 thousand images.As the service of medical residence works with the glaucoma ambulatory, images are mostly from the optic disc and the surrounding fibers and of the visual field.
Phelcom Eyer
Germano highlights two features of the Phelcom Eyer.“it is not necessary to carry out the exam under mydriasis, which gives more safety to patients with narrow-angle glaucoma*, and it is possible to correct the degree of myopia and hyperopia up to 20 D” he highlights.
Other positive aspects evaluated by the doctor are the fast patient registration, fast imaging and the photo resolution. “It is great and, even when exams are sent to report, the image quality remains high”, he states.
The ophthalmologist sees a great cost-effectiveness in the device. “It is an investment that brings various benefits: it helps the academic department of medical residence, patients feel safer with the regular follow-up through the retinographies and the description in medical records turns more consistent and reliable”, he points out.
Eyer Cloud
Phelcom Eyer integrates to Eyer Cloud, an online platform that enables storing and managing the patient exams. All data the equipment captures synchronize with the system automatically, so that they upload to the cloud with complete safety.
“Eyer Cloud is simple, modern and intuitive,” says Germano. Main features include the possibility of gathering information of a single patient from more than one clinic and visualize them in the platform; searching patients by name or exam date; and creating report templates from pre-ready models that the system provides.
In case of no internet access during the exam, images remain stored in the device and are sent to the cloud as soon as a connection is available.
The tool may be accessed in the device itself or via cellphone, tablet or computer.
Slit lamp
Phelcom slit lamp support. Note: This photo was taken before covid-19 pandemic.
About Phelcom slit lamp support, which enables attaching Eyer to a tabletop, Germano says it eases the documentation by providing agility and optimal alignment between the patient face and the fundus camera.
“The device also offers the advantage of not needing to directly touch the eyelids and eyelashes of patients, which guarantees more safety during the pandemic”, he notes.
Phelcom Technologies
Eyer is the first equipment of Phelcom Technologies, startup that unites technology and health, headquartered in São Carlos (SP). It produces portable devices, connected and wearable, aiming to democratize access to healthcare, offering more from less and to more people.
“Phelcom can synthesize what is best in startups: agility in the communication, highly effective in technical support and innovation in favor of patients. Undoubtedly, Eyer is a great investment in a diagnostic toolbox increasingly important to the ophthalmologic practice”, evaluates Germano.
Eyes are an open door.Contaminated tears as a possible source of contagion.Conjuntctivitis.Retina alterations.Glaucoma.
From symptoms as conjunctivitis to possible sequelae as retinopathy and glaucoma, diverse studies and reports point to the relation of the new coronavirus and the eyes.
As it is a new disease, we sill do not know for sure how itreaches this organ.Therefore, nowadays, researches serve mainly as an alert.
Now, a new study identified small nodules in the eyes of patients with severe covid-19. The work of the French Radiology Society (SFR) was published in the scientific journal Radiology.
Know more about the research, results and how data is important to better understand and encourage investigation of the possible sequelae of the new coronavirus to the eyes.
Study
From March to May 2020, researchers submitted 129 severe covid-19 patients, 43 women and 86 men, to brain MRI exams.They aimed to detect possible anomalies in the eyes.
Results
Nine patients presented one or more small nodules in the posterior macular area:
From them, eight had anomalies in both eyes;
Eight were hospitalized in the ICU;
Seven remained prone for an extended time;
Six were obese;
Two had diabetes;
Two suffered from hypertension.
The team could not identify the reason for the nodules to appear.However, they raised some hypotheses:
Virus-caused inflamation;
Poor blood circulation in the ocular veins in patients intubated in the ICU, such as damage and blockage;
Small eye hemorrhages;
Disruption of nerve fibers.
According to scientists, it is the first time there is documentation of this kind of sequelae through MRI.
Next steps
The volunteers remain under monitoring to observe possible changes of the ocular nodules or vision impairment. In addition, new severe patients from the second and third waves are under evaluation.
In fact, the study needs to deepen, in order to prove the formation of nodules in the eyes due to the new coronavirus. However, the study highlights it is important to capture images of the eyes in severe covid-19 cases and follow the patient post-treatment evolution.
Brain MRI, fundoscopy and optical coherence tomography figure as useful exams.
“Our study advocates triage for all patients hospitalized in ICU with severe covid-19. We believe they must receive specific eye protection treatments”, said ina note the main author of the study, Augustin Lecles, associated professor at the University of Paris, and neuroradiologist* of the Department of Neuroradiology of the Adolphe de Rothschild Foundation Hospital in Paris.
Conclusion
In fact, there is still a long way to prove the correlation between coronavirus and the eyes.However, studies are essential to encourage more attention to the eyes of infected patients, by means of exams and monitoring after the cure.
More than that, this research highlights that patients with pre-existing diseases, such as diabetes and hipertension, have a higher risk factor. Therefore, they also must undergo eye investigations.
Learn first-hand information on the main researches about the coronavirus and the eyes. Follow Phelcom’s blog.
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