New England Eye Center - Advanced Eye Care

New Treatment Found to Reduce Vision Loss
from Central Retinal Vein Occlusion

Eye Injections of corticosteroid medication
may improve patients' vision

BOSTON, MA September 15, 2009– New England Eye Center is pleased to announce that Scientists have identified the first long-term, effective treatment to improve vision and reduce vision loss associated with blockage of large veins in the eye. This research was part of a multi-center, phase III clinical trial supported by the National Eye Institute (NEI) at the National Institutes of Health in which Caroline Baumal, MD an Ophthalmologist for New England Eye Center at Tufts Medical Center was a Principal Investigator.  New England Eye Center is the only eye care institution in Massachusetts that participated in this study.

The Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE) study, conducted at 84 clinical sites, found that eye injections of a corticosteroid medication could reduce vision loss related to the blockage of major blood vessels within the eye, a condition known as central retinal vein occlusion (CRVO). Treated patients were also five times more likely to gain vision after one year than patients who were under observation.

“Occlusion of the central retinal vein is a significant cause of reduced vision in people over 60 in this country and is often associated with diabetes mellitus, hypertension and elevated cholesterol” “The SCORE study is the first, large, multicenter study to show intravitreal steroid treatment can lead to improvement in vision in certain individuals with blockage of the central retinal vein, said Caroline Baumal, M.D., Assistant Professor at the Tufts University School of Medicine and a Principal Investigator of the SCORE study. “This can offer hope of visual improvement in people who suffer from this potentially devastating visual disorder.”

In the United States, vein occlusion is estimated to be the second most common condition affecting blood vessels in the retina. Currently, no treatment exists for CRVO, in which a blood clot slows or stops circulation in a large vein within the eye’s light-sensitive retinal tissue. Reduced retinal circulation may lead to new blood vessel growth and blood vessel leakage, resulting in retinal tissue swelling—a common cause of vision loss from CRVO.

Until now, there has been no proven, effective way to treat CRVO. However, some ophthalmologists have treated patients with eye injections of an anti-inflammatory corticosteroid called triamcinolone, though its effectiveness had not been tested in a clinical trial. The SCORE study was the first to compare the safety and effectiveness of standard care observation with two different dosages of triamcinolone: 1 milligram and 4 milligrams. The results appear in the September 2009 issue of Archives of Ophthalmology, published alongside findings from a separate trial within the SCORE Study, which looked at blockages in smaller retinal veins.

Study participants included 271 people with CRVO who were an average of 68 years old. Patients in the treatment group could receive a maximum of three corticosteroid injections every year for up to three years, based on the state of their disease.

At one year, patients who received either dose of the corticosteroid medication were five times more likely than those who did not receive treatment to experience a substantial visual gain of three or more lines on a vision chart—equivalent to identifying letters that were half as small as they could read before treatment. However, patients in the 1 milligram group had fewer side effects related to increased eye pressure and cataract formation than those in the 4 milligram group.

“These are very welcome results because up to now there has been no effective way to treat patients who have a central retinal vein occlusion,” said Frederick L. Ferris III, M.D., clinical director of the NEI. “Now, clinicians could offer CRVO patients a low-dose corticosteroid injection that may increase their chance of visual improvement.”

The SCORE study was co-chaired by Michael S. Ip, M.D., associate professor at the University of Wisconsin, Madison, and Ingrid U. Scott, M.D., M.P.H., professor at Penn State College of Medicine. Find more information about this clinical trial (NCT00105027) at www.clinicaltrials.gov.

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New England Eye Center

The New England Eye Center (NEEC), is the ophthalmology department at Tufts Medical Center, a major academic and tertiary referral medical center, seeing approximately 85,000 patient visits per year and providing the highest quality tertiary ophthalmic services with referrals from all over the world. Drs. Adam Rogers, Jay Duker and Elias Reichel, members of the Vitreoretinal Service at New England Eye Center, were the first investigators to report the use of intravitreal steroids in the treatment of central retinal vein occlusion in February 2002.  (Intravitreal triamcinolone acetonide for macular edema due to central retinal vein occlusion.  British Journal of Ophthalmology. 2002 Feb; 86(2): 247-8.)  During the last three years, New England Eye Center physicians have led or participated in approximately 30 clinical trials and currently more than a dozen clinical trials are underway.

National Eye Institute

The National Eye Institute (NEI), part of the National Institutes of Health, leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit www.nei.nih.gov.

National Institute of Health

The National Institutes of Health (NIH)—The Nation’s Medical Research Agency— includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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Contact: William R. Sacco, New England Eye Center
(617) 636-1055 or wsacco@tuftsmedicalcenter.org

Contact: National Eye Institute
(301) 496-5248 or neinews@nei.nih.gov