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Clin Med 210: NEI

QuestionAnswer
Was the beginning of the NIH, created by President Adams. Started when people began to immigrate from Europe to Atlantic coast and brought diseases. Formed hygenic laboratory (precursor to NIH) Merchant/Marine Health Service (MHS)
Established ~1930. Gathers info on disease and does studies to determine treatment National Institute of Health (NIH)
Part of NIH, became own agency in 1968. Gives guidlines for proven treatments. Developed once ophthalmology became own specialty. National Eye Institute (NEI)
Studies using plus lenses to stop forward progression of myopia. Does accommodation cause nearsightedness to become worse? Shown not to be effective. Correction of Myopia Evaluation Trial (COMET)
Studied to see if atroprine works as a patch for strabismic amblyopia, an if so, do you need some form of near work as well? Found that patching and atropine equally effective. Most effective treatment is 2 hrs patching and 1 hour near work Congenital Esotropia Observation Study (CEOS)
Atropine good eye to force bad eye to be used during near activities. Atropine is as effective and may increase compliance. No loss of VA if wait to treat ATS II
Studied how long to atropine eye. Two hours of patching = atropine ATS I
Studied RGP lenses to decrease progression of myopia. Found it no effective. Contact Lens AND Myopia Study (CLAMP)
Gave info about course of keratoconus. Pts with normal K's did better. Poor RGP fits needed corneal transplant. RGP is best option to maximize vision. Came up with FDACCL. Established parameters for keratoconus Tx and prognosis. Collaborative Longitudinal Evaluation of Keratoconus (CLEK I)
Studies the possibility of putting steroids on herpes keratits that has invaded the stroma, if you keep administering antivirals. Answer = YES SKN(Stromal Keratitis NOT on steroids) branch of HEDS I Study
When a patient has stromal inflammation with herpes and is on steroids, will adding oral antivirals hasten recovery? Answer = No SKS (Stromal Keratitis on steroids) branch of HEDS I Study
If herpetic reaction is severe enough to get inflammation, will adding oral meds (acyclovir) hasten recovery? Answer = unsure, seemed to help IRT (Iritis Response Trial)branch of HEDS I Study
3 Branches of HEDS I Study *SKN, SKS, and IRT
3 Branches of HEDS II Study *APT, RFS, and EKT
If a patient is on low-dose antivirals without keratopathic changes, will this prevent recurrence? Answer = YES APT (Acyclovir Prevention Trial) branch of HEDS II
What are the precipitating factors for a herpes breakout? Answer = Sunlight, heat, stree, illness, poor diet, fever RFS (Recurrent Factor Study) branch of HEDS II
If you had topical keratitis, could you prevent it from going stromal with ocular antivirals? Answer = NO (but doesn't hurt) EKT (Epithelial Keratitis Trial) branch of HEDS II
Allowed us to understand the potential risk of treating individuals with high IOP without damage yet. Controlling pressure with meds or surgery WILL prevent progression. CCT was found to have relationship. Lower pressures with thin corneas have higher ris *Ocular Hypertension Treatment Study (OHTS)
ALT/SLT work as well, if not better than topical meds to decrease IOP. ALT = heat/tightening/contracting. SLT = stimulate cells to clean up. Must have pigmented TM for SLT/ALT! Glaucoma Laser Trial (GLT)
Does trabeculectomy/filtering surgery work as well as topical meds for preventing progression? Results did not prove that filtering is any better. End points of study were VF and VA. Results = filtering works as well as drops (risks outweigh benefits) Collaborative Initial Glaucoma Treatment Study (CIGTS)
What do you do for pts not responding to topical meds? ALT or filtering? People of color should get ALT/SLT. Light-skinned people should get filter. Advanced Glaucoma Intervention Study (AGIS)
Took away meds from pts with documented glaucoma loss and pts did get worse. Results: increaed IOP does lead to progression! *Early Manifest Glaucoma Trial (EMGT)
First NEI Study. Told us that PRP works Diabetic Retinopathy Study (DRS)
Results included: Focal laser used to treat CSME, Aspirin is of no benefit for DR, CSME definition ETDRS
Results: Early vitrectomy works and is preferred over waiting-- get better VA! Diabetic Retinopathy Vitrectomy Study (DRVS)
Treat CSME first, because PRP can worsen CSME. Pilot Study of Laser Photocoagulation for CSME
Trials to compare the efficacy and safety of intravitreal injections of triamcinolone vs. standard of car treatment for macular edema. Will IV steroids prevent neo? Study is ongoing. Changes treatment possibilities for CRVO. *SCORE
Concluded that only subfoveal membranes can be treated in AMD *Macular Photocoagulation Study (MPS)
Vitamins will not prevent cataracts. Vitamins can prevent wet AMD in other eye. Vitamins can prevent conversion of dry to wet. Vitamins will not prevent AMD. AREDS I
Study looking at AREDS formula. Give smokers lutein instead of beta-carotene. AREDS II
Study of Lucentis in pts with wet AMD MARINA
No ORAL steroids for optic neuritis! IV steroids should be considered if MRI suggests MS. *Optic Neuritis Treatment Trial (ONTT)
Edings and Billing were critical of _____ *IOP lowering as a control for glaucoma
Created by: LaurenLofdahl