Health Research: Multiplying teeth, literally ♦ Could peroxisomes be key to stopping West Nile and Dengue viruses? ♦ New generation of synthetic bone grafts created

Multiplying teeth, literally Researchers have found a way to--literally--multiply teeth. In mice, they were able to extract teeth germs--groups of cells formed early in life that later develop into teeth, split them into two, and then implant the teeth into the mice's jaws, where they developed into two fully functional teeth.

Mental health status prior to bladder cancer surgery can indicate risk of complications A patient's mental health prior to surgery can influence postoperative outcomes. Removal of the bladder, or radical cystectomy  is an effective treatment for locally advanced bladder cancer, but complications occur in as many as 66% of patients Researchers found that patients whose self-assessment of mental health was low suffered more high grade complications in the 30 days following surgery than patients with higher self-assessments

Could peroxisomes be key to stopping West Nile and Dengue viruses? A new discovery could open the door to one day treat or prevent diseases caused by West Nile virus and Dengue virus infections. Together the viruses are the cause of tens of millions of infections each year. Currently there are no treatments or vaccines available.

New generation of synthetic bone grafts created A new type of synthetic bone graft has been developed, which boosts the body's own ability to regenerate bone tissue and could produce better outcomes for patients. The research found that the new type of graft called Inductigraft was able to guide bone tissue regeneration in as little as four weeks.

Health Research:In US, poverty dampens genetic influence on IQ ♦ Patients can safely self-administer long-term IV antibiotics, reducing hospital stays

Surgery is more effective than drug in hyperparathyroidism post-kidney transplantation A new study compared the results of surgery with drug therapy in patients with tertiary hyperparathyroidism, i.e., after a kidney transplant.

In US, poverty dampens genetic influence on IQ The influence of genes on intelligence varies according to people's social class in the US, but not in Western Europe or Australia.

Patients can safely self-administer long-term IV antibiotics, reducing hospital stays Uninsured patients can be trained to safely and efficiently self-administer long-term intravenous antibiotics, physicians have found, a result that may have profound implications for patient treatment at public hospitals across the country.

Herpes zoster is linked to increased rates of both stroke and myocardial infarction Herpes zoster (also called 'shingles') is linked to a transient increased risk of stroke and myocardial infarction in the months following initial zoster diagnosis.

Heart Research: Genetic link between heart and neurodevelopmental disease ♦ Genes linked to stress-triggered heart disease identified ♦ arterial thrombus formation

First outcomes report from novel heart surgery registry shows excellent results for TAVR Four years after its approval in the United States, transcatheter aortic valve replacement (TAVR) continues to evolve and demonstrate positive outcomes for patients with aortic stenosis, a common heart problem.

Biophysicists develop a model for arterial thrombus formation Biophysicists have developed a mathematical model of arterial thrombus formation, which is the main cause of heart attacks and strokes. The scientists described the process of platelet aggregation as being similar to the popular video game Tetris and derived equations that allowed them to reproduce the wave process of platelet aggregate formation in a blood vessel.

Genes linked to stress-triggered heart disease identified For the first time, genetic risk factors have been identified that are linked to stress-induced cardiomyopathy (SIC), a rare type of heart disease. Patients with SIC generally show no symptoms until they suffer some form of intense emotional or physiological distress. For this reason the disorder is sometimes referred to as 'broken heart syndrome.'

Genetic link between heart and neurodevelopmental disease Children with significant congenital heart disease have a far better chance of surviving today than in decades past, thanks to major advances in surgery. But some infants who recover from repairs to their hearts later show the effects of delays in brain development. Researchers reported exome sequence analyses of more than 1,200 children and their parents and showed that children with both congenital heart disease and neurodevelopmental delays share certain genetic mutations that thwart the normal development of both the heart and the brain

Weight Loss Research: How weight-loss surgery reduces sugar cravings ♦ Stored fat fights against the body's attempts to lose weigh ♦ Scientists unravel brain circuits involved in cravings

Scientists unravel brain circuits involved in cravings Researchers studying rats have discovered that activation of designer neural receptors can suppress cravings in a brain region involved in triggering those cravings. The study is the first to systematically show how designer brain receptors and designer drugs work together to change how cues for food stimulate motivation.

How weight-loss surgery reduces sugar cravings Weight loss surgery curbs the sweet tooth by acting on the brain's reward system, according to a new study. The researchers found that gastrointestinal bypass surgery, which is used to treat morbid obesity and diabetes, reduced sugar-seeking behavior in mice by reducing the release of a reward chemical called dopamine in the brain. The findings suggest that positive outcomes are more likely if sugary foods seem less rewarding after surgery

Stored fat fights against the body's attempts to lose weight The fatter we are, the more our body appears to produce a protein that inhibits our ability to burn fat, suggests new research. The findings may have implications for the treatment of obesity and other metabolic diseases

Low sugar diet makes foods taste sweeter but does not change preferred level of sweetness New research reveals that while foods such as vanilla pudding taste sweeter following three months on a low-sugar diet, the level of sweetness most preferred in foods and beverages does not change. People on the low-sugar diet quickly returned to their previous levels of sugar intake when allowed a diet of their choice. Together, the findings may inform public health efforts to reduce the amount of added sugars that people consume in their diets.

Health News:Functional human liver cells grown in the lab ♦ Cataract surgery lessens patients' dizziness ♦ Scientists 'see' detailed makeup of deadly toxin for the first time

Functional human liver cells grown in the lab A new technique for growing human hepatocytes in the laboratory has now been described by a team of researchers. This groundbreaking development could help advance a variety of liver-related research and applications, from studying drug toxicity to creating bio-artificial liver support for patients awaiting transplantations.

Immune-disorder treatment in mice holds potential for multiple sclerosis patients A simple, rapid way to treat an immune-related disorder in mice has been identified by researchers, an approach that could eventually help multiple sclerosis patients after further research.

Cataract surgery lessens patients' dizziness Older people with visual impairment can report feeling dizzy and falling. A new study found that after routine cataract surgery, the improved vision led to patients experiencing significantly less dizziness, although they did not experience fewer falls.

Scientists 'see' detailed makeup of deadly toxin for the first time An exciting advance provides hope for developing novel potential method of treating pneumococcal diseases such as bacterial pneumonia, meningitis and septicaemia. A team of researchers uses a technique called X-ray crystallography to see the individual atoms of the toxin. World Health Organization (WHO) estimated that more than 1.6 million people every year die from pneumococcal infections, including more than 800,000 children under 5 years old.

Cancer Research: Investigational immunotherapeutic increased bladder cancer survival ♦ Weekday of surgery affects esophageal cancer surgery prognosis

Weekday of surgery affects esophageal cancer surgery prognosis Patients who undergo surgery for esophageal cancer early in the week – on a Monday or Tuesday – have a higher chance of long-term survival than those who have surgery at the end of the working week,

Global task force tackles problem of untreatable cancers and disease relapse: Non-toxic chemicals in plants and foods may be key Many cancer therapies are highly toxic, and even when they appear to work, a significant percentage of patients will experience a relapse after only a few months.  Typically these relapses result from small subpopulations of mutated cells which are resistant to therapy, and doctors who try to address this problem with combinations of therapies find that therapeutic toxicity typically limits their ability to stop most cancers

Investigational immunotherapeutic increased bladder cancer survival Among patients with metastatic bladder cancer that had progressed after platinum-based chemotherapy, those who received an investigational, personalized peptide cancer vaccine and best-supportive care had extended overall survival compared with those who received best-supportive care alone.

Higher nicotine, carcinogen levels among smokeless tobacco users compared with cigarette users U.S. adults who used only smokeless tobacco products had higher levels of biomarkers of exposure to nicotine and a cancer-causing toxicant -- the tobacco-specific nitrosamine NNK -- compared with those who used only cigarettes

Health News: People transmit the virus to mosquitoes ♦ Why we look at pretty faces ♦ Using copper to prevent the spread of respiratory viruses

Dengue: Asymptomatic people transmit the virus to mosquitoes Scientists have provided proof that people infected by dengue virus but showing no clinical symptoms can actually infect mosquitoes that bite them. It appears that these asymptomatic people -- who, together with mildly symptomatic patients, represent three-quarters of all dengue infections -- could be involved in the transmission chain of the virus.

'Post-hospital syndrome' found to be a risk factor for elective surgery A condition known as 'post-hospital syndrome' (PHS) is a significant risk factor for patients who undergo elective outpatient surgery, a new study has found. PHS is defined as having been hospitalized during the previous 90 days. This first-of-its-kind study found that among patients with PHS, 7.6 percent had to be readmitted to the hospital within 30 days of undergoing elective outpatient hernia surgery.

Why we look at pretty faces Few visual impressions can be compared to humans' interest for faces. New research suggests that our brain rewards us for looking at pretty faces.

Using copper to prevent the spread of respiratory viruses Copper can effectively help to prevent the spread of respiratory viruses, which are linked to severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), new research shows. Animal coronaviruses that 'host jump' to humans, such as SARS and MERS, result in severe infections with high mortality. Researchers found that a closely-related human coronavirus - 229E - can remain infectious on common surface materials for several days, but is rapidly destroyed on copper

Pulmonary Research: Treating pulmonary diseases using Alaska pollock gelatin ♦ White blood cells guards against tumor lung metastasis ♦ New study explores how anxiety can aggravate asthma

A subpopulation of white blood cells guards against tumor lung metastasis Among foot soldiers on the immune front line is a subpopulation of white blood cells called “patrolling monocytes,” whose job is to cruise the bloodstream, cart off cellular debris, and block invasion of a less benign population of inflammatory cells. Now, a study illustrates that patrolling monocytes may also play an anti-cancer role, particularly in the lung.
Lung cancer surgery can be beneficial for high-risk patients with early stage disease

Surgical lung resection, in which part of a lung is removed, can be a safe and effective treatment option for high-risk patients with early stage lung cancer,

New study explores how anxiety can aggravate asthma A new study involved mimicking asthma symptoms to see how anxiety sensitivity affected asthma sufferers. The researchers recruited 101 college undergraduates who reported having asthma. The experiment aimed to mimic asthma symptoms by having study participants breathe in-and-out through a narrow straw, about the width of a coffee-stirrer straw.
Treating pulmonary diseases using Alaska pollock gelatin In recent years, patients with pulmonary emphysema have been increasing mainly among middle-aged and elderly males due to aging and excessive smoking. Emphysema makes brittle lungs, and in severe cases, holes develop in the lung tissue, causing air leakage. Researchers have developed a new sealant to close holes developed in lungs and blood vessels using Alaska pollock gelatin, and have reported that the sealant is about 12 times stronger than conventional sealants.

Weight Loss Research: Kitchen counter foods that relate to your weigh ♦ Obesity surgery normalizes brain opioids ♦ New study shows that varying walking pace burns more calories

New study shows that varying walking pace burns more calories Engineering researchers have found that walking at varying speeds can burn up to 20 percent more calories compared to maintaining a steady pace. The study is one of the first to measure the metabolic cost, or calories burned, of changing walking speeds

Obesity surgery normalizes brain opioids Researchers have revealed how obesity surgery recovers opioid neurotransmission in the brain. Obesity surgery provides an effective means for rapid weight loss, and the research also shows that obesity surgery also normalizes brain circuits triggering pleasurable sensations when eating

New research focused on cell signaling mechanism linked to obesity A mechanism has been identified for blocking the signal by which the cellular sodium-potassium pump amplifies oxidants (reactive oxygen species). These oxidants lead to obesity and metabolic syndrome.

The 20 lb. cereal box: Kitchen counter foods that relate to your weight Over 200 American kitchens were photographed to determine if the food sitting out on counters could predict the weight of the woman living in each home.

Brain Research: Inflammation in the brain is linked to risk of schizophrenia, ♦ New treatments for Parkinson's ♦ Laser-based imaging tool could increase accuracy, safety of brain tumor surgery

Laser-based imaging tool could increase accuracy, safety of brain tumor surgery Researchers are testing technology that gives brain surgeons real-time microscopic vision of tumors, potentially allowing the surgical decision-making process to become data driven, instead of subjective "best guesses,".

Scientists make advancements that may lead to new treatments for Parkinson's A research team has made breakthrough advancements on a new molecular mechanism that may provide a means to “melt” pathological clumps known as Lewy clumps. These clumps are a hallmark sign of Parkinson's disease.

Parkinson's disease protein controls movement of precious cargo inside cells, A new study marks a step toward understanding the Huntingtin protein (Htt) is responsible for Huntington's disease. The research shows that Htt controls the movement of precious cargo traveling up and down neurons, the cells that form the core of the nervous system in animals.

Inflammation in the brain is linked to risk of schizophrenia,  A new study is the first to find that immune cells are more active in the brains of people at risk of schizophrenia as well as those already diagnosed with the disease.

Cancer Research:Gold-diamond nano device for hyper localized cancer therapy ♦ Robotic surgery for kidney cancer ♦ New therapeutic target for breast cancer

Gold-diamond nano device for hyper localized cancer therapy Precise targeting biological molecules, such as cancer cells, for treatment is a challenge, due to their sheer size. Now, scientists have proposed an advanced solution that can potentially be applied to thermal cancer therapy. An improved sensing technique for nanometer-scale heating and temperature sensing uses a chemical method to attach gold nanorods to the surface of a diamond nanocrystal, the authors have invented a new biocompatible nanodevice.

Newly identified mechanism of p53-induced cell death could aid cancer therapy Research reveals how the tumor suppressor protein p53 works in the cytoplasm to trigger death via apoptosis and identifies a potential cancer treatment strategy.

HPV16 detection in oral rinses for oropharyngeal cancer The presence of persistent human papillomavirus type 16 DNA in oral rinses after treatment for HPV-related oropharyngeal cancer was rare but it appears to be associated with poor prognosis and therefore may have potential as a long-term tool for tumor surveillance.

First reports of robotic surgery for advanced vena cava tumor thrombus due to kidney cancer Surgery is required when cancer of the kidney causes a Level III thrombus, or clot, to develop in the major vein leading back to the heart. Traditionally this complicated procedure, inferior vena cava (IVC) thrombectomy, is performed using a large open incision, primarily because the vein is often difficult to reach. In a new article, a team of surgeons describe the first cases in which this procedure has been successfully performed robotically, using only seven small incisions and four robotic tools.

New cancer marker identified; possible therapeutic target for breast cancer Basal-like breast cancer (BLBC) is an aggressive form of breast cancer and is often referred to as "triple negative," which means it is not responsive to the common medical therapeutics. BLBC is more likely to metastasize -- or spread to different areas of the body -- quicker and earlier, and is associated with a poor prognosis. A new way to detect - and perhaps treat -- this deadly form of breast cancer has now been found.

Senior's Health: Food safety for seniors ♦ Road traffic noise linked to deaths, increased strokes ♦ Functional class helps predict mortality risk after surgery

Food safety for seniors All food can carry microorganisms or chemical agents that may cause illness when eaten. But, safe food handling practices can prevent growth of bacteria to lessen the possibility of foodborne illness. Most cases can be controlled by proper production, processing and preparation.

Road traffic noise linked to deaths, increased strokes Living in an area with noisy road traffic may reduce life expectancy. Research has found a link between long-term exposure to road traffic noise and deaths, as well as a greater risk of stroke, particularly in the elderly.

Multiple pathways progressing to Alzheimer's disease The amyloid cascade hypothesis of Alzheimer's disease (AD) posits that sticky aggregations or plaques of amyloid-beta peptides accumulate over time in the brain, triggering a series of events that ultimately result in the full-blown neurodegenerative disorder. The hypothesis has been a major driver of AD research for more than 20 years.

Functional class helps predict mortality risk after surgery Information on functional status—whether or not a person can carry out routine daily tasks independently—improves the ability to predict risk of death in patients undergoing surgery.

Patient outcomes could improve by preparing nursing homes for health information exchange When older adults transfer between nursing homes and hospitals, inefficient and unclear communication between the organizations can hinder patient care. Now, a team of researchers is working to improve patients' health outcomes by increasing efficient, secure communication between nursing homes and hospitals using an electronic communication system called a health information exchange.

Health News: MRSA in pork:♦ Patients give high marks to prepping for surgery online ♦ Patients give high marks to prepping for surgery online

MRSA in pork: farming leaders join calls for clampdown on illegal antibiotic use

Britain’s farming leaders are urging the government to clamp down on the illegal use of powerful antibiotics following a Guardian investigation that found evidence that the superbug MRSA – linked to the overuse of antibiotics in livestock – has entered the UK’s food chain.

Thick cortex could be key in Down syndrome The thickness of the brain's cerebral cortex could be a key to unlocking answers about intellectual development in youth with Down syndrome. It could also provide new insights to why individuals with this genetic neurodevelopmental disorder are highly susceptible to early onset Alzheimer's disease.

Zebrafish provide a novel model to study short bowel syndrome Investigators are providing new hope for babies with short bowel syndrome (SBS) by developing a novel model of SBS in zebrafish,

'Real world' link between type 2 diabetes, low blood sugar risk Hypoglycaemia is an issue amongst people with type 2 diabetes, particularly for those on insulin, yet is still fairly common for other treatment regimens. Now the hypoglycaemic events in the ‘real world’ type 2 diabetes population have been examined in a first-of-its-kind review. The study highlights the need for patient education to raise awareness of hypoglycaemia and for healthcare professionals to consider a patient’s hypoglycaemia risk when prescribing diabetes treatments.

Patients give high marks to prepping for surgery online First-time surgery can be concerning to any patient. Knee surgery -- even arthroscopic surgery to treat a torn meniscus -- can require significant preparation and rehabilitation. According to a new study, a web-based tutorial can not only increase a patient's understanding of the surgery but also provide a better experience.

Cancer Research:Higher risk for robotic prostate surgery patients ♦ Revealing breast cancer using nanoscale polymers ♦ RNA splicing machinery offers new drug target

Pactamycin analogs offer new, gentler approach to cancer treatment Researchers are pursuing a new concept in treatment of cancer, by using two promising 'analogs' of an old compound that was once studied as a potent anti-tumor agent, but long ago abandoned because it was too toxic. The idea put cancer cells to sleep - lessening problems with resistance to chemotherapeutic drugs, and also the side effects of chemotherapy.

Fee-for-service health care may lead to higher risk for robotic prostate surgery patients A 'perverse disincentive' for hospitals that have invested in expensive technology for robotic surgery may be jeopardizing prostate cancer patients who seek out the procedure.

Nerve involvement explains why some cancers are very painful More than half of all cancer patients experience pain, most often associated with the malignancy type, body location and disease progression. Pain researchers report that the relationship between tumors and nerves drives persistent and breakthrough pain and tumor progression in certain types of cancers

RNA splicing machinery offers new drug target A widespread cancer-causing protein called MYC promotes the growth of tumor cells in part by ensuring that RNA transcripts are properly spliced, according to new research. Drugs that block parts of the cell's splicing machinery may provide a new way to halt the proliferation of MYC-driven cancers.

Revealing breast cancer using nanoscale polymers A biocompatible polymer selectively targets and lights up cancer tumors for a noninvasive imaging system, investigator's report. Generating photoacoustic signals requires an ultrafast laser pulse to irradiate a small area of tissue. By 'listening' to the pressure differences created by the acoustic waves, researchers can reconstruct and visualize the inner structures of complex objects such as the brain and cardiovascular systems. Diagnosing cancer with photoacoustic imaging requires contrast agents that deeply penetrate tissue and selectively bind to malignant cells.

Health Research: Antibacterial plastic: Plastic plus egg whites ♦ Harmless bacteria helpful against meningococcal outbreaks ♦ Painful knee and hand osteoarthritis

Black patients more likely to be readmitted after hip, knee replacement surgery  A new study found that black and Hispanic patients were 62 and 50 percent, respectively, more likely to be readmitted to the hospital within 30 days after total joint replacement surgery

Harmless bacteria may be helpful against meningococcal outbreaks  Nasal drops of harmless bacteria can inhibit a related bug that sometimes causes meningococcal disease, according to new findings. The study -- conducted among college students, a group at higher risk for this often serious illness -- suggests a new approach that could help suppress outbreaks of the disease,

Recycling histones through transcription  Cells reuse a part of the histones which are used to pack DNA, according to research conducted on yeast cells. However, researchers say that it is likely that similar mechanisms are important for human beings as well.

Recipe for antibacterial plastic: Plastic plus egg whites  Bioplastics made from protein sources such as albumin and whey have shown significant antibacterial properties, findings that could eventually lead to their use in plastics used in medical applications such as wound healing dressings, sutures, catheter tubes and drug delivery, according to a recent study.

Is painful knee and hand osteoarthritis in women associated with excess mortality?  Researchers present a study that compares mortality rates of women with painful knee and hand osteoarthritis with the mortality of unaffected women from the same community; demonstrates higher risk of early death in the group with painful knee osteoarthritis.

Heart Research:Heart bypass surgery outperforms new generation stents ♦ Patients 80 years old benefit from aggressive treatment ♦ Healthy diet reduces risk of cardiovascular disease + more

Heart bypass surgery outperforms new generation stents Despite the advent of a new generation of stents, patients with multiple narrowed arteries in the heart who received coronary artery bypass grafting fared better than those whose arteries were opened with balloon angioplasty and stents Continue Reading

Acute coronary syndromes: Patients 80 years and older would benefit from aggressive treatment  Patients over age 80 with acute coronary syndromes would likely benefit from more invasive tests and therapies that may otherwise be denied them due to their age, according to research .Continue Reading

Frequency of blood tests in heart surgery patients may lead to anemia. Laboratory testing among patients undergoing cardiac surgery can lead to excessive bloodletting, which can increase the risk of developing hospital-acquired anemia and the need for blood transfusion, according to a new article. Continue Reading

Healthy diet reduces risk of cardiovascular disease by a third in over-40s  Men and women who adapt their daily diet to meet current UK dietary guidelines could reduce their risk of a heart attack or a stroke by up to a third. Those on the modified diet ate oily fish once a week, more fruit and vegetables, replaced refined with wholegrain cereals, swapped high-fat dairy products and meats for low-fat alternatives, and restricted their intake of added sugar and salt  Continue Reading

1/26/15 Health News:Undisclosed Superbug sickened dozens in Virginia ♦ New cancer-fighting strategy ♦ BPA exposure during pregnancy causes oxidative stress in child

Undisclosed superbug sickened dozens at Virginia Mason.

Virginia Mason Medical Center officials in Seattle stated that they overhauled their cleaning protocol for medical scopes after an outbreak of drugresistant superbugs spread by contaminated specialized endoscopes infected at least 32 patients between 2012 and 2014. Authorities believe the bacterium was likely transferred from patient to patient after the devices were cleaned, but still harbored the germs.Continue Reading

New cancer-fighting strategy would harden cells to prevent metastasis

Existing cancer therapies are geared toward massacring tumor cells, but researchers propose a different strategy: subtly hardening cancer cells to prevent them from invading new areas of the body. They devised a way of screening compounds for the desired effect and have identified a compound that shows promise in fighting pancreatic cancer. Continue Reading

Scientists invent system to improve effectiveness of cancer surgery

With the goal of making it easier for surgeons to detect malignant tissue during surgery and hopefully reduce the rate of cancer recurrence, scientists have invented a new imaging system that causes tumors to “light up” when a hand-held laser is directed at them Continue Reading

BPA exposure during pregnancy causes oxidative stress in child, mother

Exposure to the endocrine-disrupting chemical bisphenol A (BPA) during pregnancy can cause oxidative damage that may put the baby at risk of developing diabetes or heart disease later in life, according to a new study. Continue Reading

11/2/14 Health News: Robotically assisted surgery cuts recovery time ♦ Tea, citrus lower ovarian cancer risk ♦ Antisocial behavior a consequence of homelessness ♦ psoriasis cure

Robotically assisted bypass surgery reduces complications after surgery, cuts recovery

Robotically assisted coronary artery bypass grafting surgery is a rapidly evolving technology that shortens hospital stays and reduces the need for blood products, while decreasing recovery times, making the procedure safer and less risky, experts say. Continue Reading

Tea, citrus products could lower ovarian cancer risk, new research finds

Tea and citrus fruits and juices are associated with a lower risk of developing ovarian cancer, according to new research. The research reveals that women who consume foods containing flavonols and flavanones (both subclasses of dietary flavonoids) significantly decrease their risk of developing epithelial ovarian cancer, the fifth-leading cause of cancer death among women Continue Reading

Antisocial behavior a consequence, rather than cause of homelessness

Anti-social behaviors such as drug and alcohol abuse are often the consequence, rather than the cause of homelessness, according to a series of studies that suggest that contrary to common belief, unexpected life events could lead to anyone becoming homeless. Continue Reading

Lesion-healing mechanism in psoriasis discovered

The underlying genetic factors that help repair skin lesions caused by psoriasis has been discovered by researchers, which could engender new methods of controlling the lingering condition. "Our research suggests that targeting this mechanism of healing may lead to pharmaceutical products that limit the itchy, painful lesions all psoriasis sufferers must endure," the lead researcher said. Continue Reading

Contacts Better for Babies after Cataract Surgery

Permanent lenses lead to more repeat eye surgeries,

For adults and children who undergo cataract surgery, implantation of an artificial lens is the standard of care. But a clinical trial suggests that for most infants, surgery followed by the use of contact lenses for several years — and an eventual lens implant — may be the better solution. The trial was funded in part by the National Eye Institute (NEI), a component of the National Institutes of Health.

A child wearing a contact lens. A green dye is used to evaluate the fit of hard lenses. Credit: Dr. Scott Lambert, Emory.

A cataract is a clouding of the eye’s lens, and can be removed through a safe, quick surgical procedure. After cataract removal, most adults and children receive a permanent artificial lens, called an intraocular lens (IOL). This is an option for infants, too, but the trial found that the use of contact lenses is safer than, and just as effective as, an IOL for infants under seven months old. The most recent data from the trial were published today in JAMA Ophthalmology.

“When we began this study, the prevailing theory was that IOLs would be the better option for cataract in infants because they correct vision constantly, while contact lenses can be removed or dislodged from the eye. But our data suggest that if the family can manage it, contact lenses are the better option until the child gets older,” said Scott Lambert, M.D., the study’s lead investigator and a professor of ophthalmology at Emory University in Atlanta.

Although cataracts are often tied to aging, it’s estimated that 1,200-1,600 infants are diagnosed with congenital cataracts (present from birth) each year in the United States. The condition can affect both eyes, but it often affects just one, which is called unilateral cataract. The new study compared the use of IOLs versus the use of contact lenses during infancy for treating congenital unilateral cataract.

In the United States most children with cataract will eventually receive an IOL, but the timing varies, Dr. Lambert said. “I’ve had patients wait until they were in college whereas others will have it done when they are 5 or 6 years old,” he said.

Some prior research suggested that using an IOL to treat cataract during infancy can improve long-term visual outcomes, he said. IOLs can also spare babies — and their parents — the discomfort of daily contact lens changes, and reduce the risk of introducing germs into the eye. On the other hand, the use of IOLs during infancy also has some drawbacks. Surgeons have difficulty judging the right focusing power of the artificial lens for an infant, because it’s a time of rapid eye growth. Also, while IOL implants are typically safe and complication-free for adults, they are more likely to cause postoperative problems for infants.

“Cataract surgery and the use of IOLs for infants have become more sophisticated and more widely practiced over time. In this study, the goal was to determine if the beneficial effects of IOLs outweigh their known complications,” said Donald Everett, M.A., who is NEI’s director of collaborative clinical research.

The Infant Aphakia Treatment Study began in 2004 (aphakia refers to an eye without a lens). The study involved 12 clinical centers, and enrolled infants with a cataract in one eye. Parents visiting these clinics were informed about the study, and about the potential benefits and risks of cataract surgery with and without an IOL. The study ultimately enrolled 114 infants who were between 1 to 6 months old at the time of surgery. By random assignment, about half of the infants received an IOL and the other half received contact lenses. The lenses were soft silicon or hard gas-permeable plastic, and designed to fit small eyes.

The children in the study are now toddlers, and the investigators have examined visual acuity and other outcomes over the long term in both treatment groups. Of note, visual acuity testing in studies like this one presents unique challenges. An adult visual acuity test involves that familiar eye chart with rows of progressively smaller letters, and isn’t feasible for a child who hasn’t learned the alphabet. The 1-year-olds in the study were tested with Teller acuity cards, which are flash cards imprinted with finer and finer grating patterns — the idea being that a visible pattern will grab a baby’s attention while a card that looks blank will not. At 4 1/2 years old, the children were evaluated with the HOTV test, which requires kids to read the letters H-O-T-V or match flash cards containing one of the letters to a response card in their hands.

There were no significant differences in visual acuity between the two groups at age 1, or at age 4 1/2. However, there were more post-surgical complications in the IOL group, which in turn led to more corrective surgeries. The most frequent complication was lens reproliferation — which is when lens cells left behind after cataract surgery migrate into the pupil and interfere with vision. By age 5, lens reproliferation was 10 times more common with IOLs, occurring in 23 (40 percent) of infants in that group, compared to two infants (4 percent) in the contact lens group. This complication and others led to the need for one or more additional eye surgeries among 41 (72 percent) of the infants in the IOL group, and 12 (21 percent) in the contact lens group.

By age 5, nine children in the contact lens group developed minor eye infections that cleared up with antibiotic drops, and in one child, a contact lens  broke during wear. None of these issues had permanent effects on vision. Three infants in the contact lens group had IOLs implanted before age 5, because their families had difficulty with day-to-day contact lens changing and maintenance.

“We think that for most infants with unilateral cataract, contact lenses are a better option than an IOL,” Dr. Lambert said. “However, in some cases, the parents and their physician may decide that contact lens wear proves to be too challenging, and ultimately not in the child’s best interests.”

Aside from potential discomfort for the child and anxiety for the parents, there may be less obvious challenges to wearing contact lenses in infancy. Congenital cataract is sometimes hereditary, which means that some parents may have vision problems of their own that would make it difficult to change their kids’ contacts. Affordability could also be a challenge for some families. Although health insurance plans generally pay for an IOL, most plans do not pay for contact lenses.

Why not delay both the cataract removal and the IOL until later in childhood? In that scenario, the loss of visual experience in early life could cause some permanent vision loss later, Dr. Lambert said.