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Renewed interest in scleral strengthening
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Renewed interest in scleral strengthening

I know you are all probably bored to death of my posts regarding myopia treatment so I will keep this brief. Just wanted to alert everyone to a new study into scleral strengthening using modern techniques. See hear for an outline.

http://www.ncbi.nlm.nih.gov/pubmed/19109950?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The results are modest but the important point is that I believe there is a real effort now to solve this problem and there are groups in the USA getting involved, which is a very positive thing. I have been moaning all year that these kind of studies need to be done because I think that in this day and age, it is a "relatively" simple problem that should be easy...ish to solve. I think within 5-10 years, we can expect some kind of therapy to arrest sclera growth in pathological myopia, and perhaps even reduce axial length. My money is strongly on UV cross-linking to achieve this (see previous posts). Watch this space. Happy new year everyone.  
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673691_tn?1226714270
Haven't seen this study yet. Crosslinking shows some promise with keratoconus which is a thining of the cornea not the sclera. I fail to see how the riboflavin can be applied to the posterior sclera at the back of the eye which is what thins in progressive myopia. Also the arrangement of parallel collagen fibers which need crosslinking  in the cornea is much different than the non parallel irregular arrangement in the sclera. I don't see how crosslinking would help. Don't hold your breath on a "cure" for progressive myopia.  
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Avatar_f_tn
What makes you put your bet on UV cross-linking as opposed to 7-methylxanthine?

How would you respond to Dr. Pernoud's comment regarding the non parallel irregular arrangement in the sclera?

And no, I'm not bored with your posts.  Since I have no background in molecular biology, I appreciate your explanations.
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Avatar_n_tn
With the greatest of respect, I would respond to Dr Pernoud with some disdain! Clearly he is not aware of the current literature regarding myopia treatment and is a typical (American, I hate to say it) eye MD with a very negative attitude regarding future therapies for myopia, particularly the pathological kind.

Firstly, to comment that cross linking "shows promise" for treatment for keratoconus is a laughable understatement and is just plain outdated. It is already approved in Europe and I have not been able to find a single published study where its use has not lead to at least a stabilisation of the condition and in many cases significant regression. It is already the standard of care in Europe as far as I understand it!!!!!  

Secondly, to comment that "I don't see how crosslinking would help" and "I fail to see how the riboflavin can be applied to the posterior sclera" just worries me to be honest. I could list a number of already advanced studies regarding the potential use of UV cross-linking on POSTERIOR SCLERA (from 2004 onwards, many in the last year) but I wont because, quite frankly, I am a little bit bored of doing the donkey work for my own as well as other MD's on this topic. If Dr Pernoud read just one study, he would note the impressive results obtained using both UV and glyceraldehyde to strengthen the sclera in the back of the eye (i.e. 200-500% increase in youngs modulus, 50% reductions in ultimate strain), both ex vivo and in vivo in animal models. This effect has also been shown to be long term in animals (up to 8 months so far). He would also note that it is a relatively simple procedure to treat the back of the eye in this manner and that toxicity and dosages have already been considered in some detail. Whilst it is true that it has yet to be tried on myopic eyes in humans or animals, I know for a fact these studies are underway. Based on this available literature, it would be hard to make any sensible argument against pursuing this treatment in much more detail. It would also be short-sighted in my opinion to not get a little bit excited about this.

I am sure that Dr Pernoud is a very good eye MD and I accept that it is not possible to have an up to date knowledge on every single condition, especially rare ones like pathological myopia. The knowledge on this condition is woeful at best, particularly in the USA. But with the greatest of respect to him, he should think twice about rubbishing something before he has fully read the evidence and is able to have a sensible conversation about it. It is pretty clear from his comments that he is at least a few years out of touch here and I would encourage him to pay more attention to the current myopic literature.



    

      
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Avatar_n_tn
Dude, I don't know about everyone else, but I am most definitely NOT bored with your myopia posts!!!!
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Avatar_n_tn
Ditto that, Dukey, not only am I not bored with your posts, I look forward to them with relish.  I have gotten more information from you (and Dr. Ward) than anyone else on this condition.
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Avatar_m_tn
The following clinical trial dates back to 1997.
http://www.ncbi.nlm.nih.gov/pubmed/9527318

Looking at the results, I wonder why didn't it became popular.
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Avatar_m_tn
There has been lot of research on scleral crosslinking in last 5 years (http://scholar.google.co.in/scholar?q=scleral+crosslinking&hl=en) but no information of clinical trials using them (or perhaps no clinical trials happening).

I wonder what would happen to stocks of ICL/PIOL companies, if myopia could be controlled at earlier stages.
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