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Lupine Publishers | Role of Communities to Prevent Corneal Blindness

 
Lupine Publishers | Trends in Ophthalmology Open Access Journal 

 

Editorial

Therapeutic Role of Drugs and Methods of Drug Delivery

The community needs to take appropriate actions itself, as well as actions by government and non-governmental organizations. Prevention of corneal blindness can take place at three stages:
a) Level-1 Prevention: Actions taken to prevent the onset of disease
b) Level-2 Prevention: Actions taken to prevent complications and the development of visual disability due to an existing disease
c) Level-3 Prevention: After the immediate resolution of the problem by surgery or other treatment, actions should be taken to reduce existing disability from disease complications right up to the point when some patient either seen by an eye care worker or admitted to hospital, the community should influence and trace out the ground reality or the actual reasons .An eye care worker must have little control over the following:
a. The risk factors and immediate medical causes
b. The contributing and social factors.
The community has the capacity to influence these factors, either through change in the behavior of individuals, or by bringing improvements at the community level. The eye care worker's role is very vital when they participating in programmes to reduce corneal blindness. Progressive and active campaign of community awareness will ultimately result to build up a role of active partner in the prevention of corneal blindness.

First steps

A model prevention programme does address the complete list of causes of corneal blindness in the community rather it aim community to understand and build on their existing knowledge, and encourage them to support a programme to avail existing services available and build upon the better ongoing services. This kind of approach is progressive and would help to understand the community the upcoming needs. Situation analysis help to design the needs and programmes to involve community right from the start, it would also help the community to identify any gaps in your knowledge so that those could be filled. There are few questions to keep in mind before designing an awareness programme.
a) Q-What are the community's knowledge and perceptions regarding the causes and treatment of corneal blindness.
b) Q-What are the prevailing methods of communication within the community?
c) Q- How we can utilize present systems effectively to transmit the new awareness message. Q- How we can take benefit of current community knowledge and perceptions.
d) Q- What kind of expertise and skills exist within the community that may be exercised to design a effective awareness programme.

PP-Primary Prevention

The deficiency of vitamin-A and eye injuries are directly relevant to corneal blindness. Corneal blindness is also associated with some there socio/economy factors. For example inadequate water supply and sanitation, poor nutrition, and pathetic agricultural practices. Inadequate supplies and cost of medicine particularly in low line areas contribute hugely in corneal blindness. An effective programme and comprehensive plans should support the community to obtain the health care needs, either by asking community help and sources or by using government resources and infrastructure. The programme should provide health education to address socio/economy factors and methods to avoid corneal blindness. The close collaboration between health units and national health system which will strengthen the programme. Good and effective communication is most essential tool and part between different health units. . Village elders and Government official can play a significant role to obtain desirable results. Where as in urban areas other marketing tools like use of media and billboards can be effective contributing factors. A health messages into the school curriculum is another possibility.
SP-Secondary Prevention
Patients with corneal disease or injuries are usually in pain and may suffer from photophobia. Their eyes could be watery and they may have blurred vision as well. Generally in rural areas people having serve pain, may go for self-medication Such practices always delay the process of obtaining correct and in time treatment which may result corneal opacity or visual loss.
Strengthen health systems
The strength of prevailing health system is important if the health units make best use of it to prevent corneal blindness and build new programme to strengthen the system without over loading it. The objective of a new programme should eliminate the weak and opportunity areas or to replace those with fresh and effective means to get the best use of it. Many health and community development programmes already exists in community through health units like measles immunization, perinatal care, nutrition, water supply, and sanitation, It is important to get best benefit of these programmes by informing competent authorities and policy makers and funding agencies to extend help in prevention of corneal blindness.
Data gathering from the affected areas will to improve programme design and service. It is also important to ensure that the emergency eye care for corneal infections or trauma, particularly in children, is free.. Encourage communities to take the lead on health matters, for example by working with community development groups. Even the general public can take responsibility for a range of interventions and support to led health activities such as face washing to demanding better services. Motivate and support communication between the community and decision makers within the health system, as well as between different groups or specialties in the health system.

Conclusion

As an eye health worker one should understand both the medical causes of corneal scarring, and the non-medical and social factors that lead to corneal blindness.

https://lupinepublishers.com/ophthalmology-journal/pdf/TOOAJ.MS.ID.000103.pdf

https://lupinepublishers.com/ophthalmology-journal/fulltext/role-of-communities-to-prevent-corneal-blindness.ID.000103.php

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Lupine Publishers | Drug Targets and its Delivery in Glaucoma -Current Trend and Future Prospects

 Lupine Publishers | Trends in Ophthalmology Open Access Journal 

Editorial

Therapeutic Role of Drugs and Methods of Drug Delivery

Topical route of drug delivery always remained a route of choice for delivering all glaucoma [1] medications rather than systemic route. Upon topical instillation drug reaches interior tissues of eye mainly through corneal route and route and therefore epithelial and stromal layer of the cornea act as barrier to transcorneal permeability of both hydrophilic and lipophilic drugs respectively. TTanscellular and Para cellular pathways are the two major corneal transportation routes for the topically applied drugs. Lipophillic drugs cross the cornea through transcellular pathway while the hydrophilic drugs cross through para cellular pathway. For treatment of glaucoma effective drugs are present mainly beta blockers, cholinergic agonists, carbonic anhydrase inhibitors, adrenergic agonists and prostaglandin derivatives but lack effective delivery system to improve patient care and clinical outcomes. Currently available drugs for ocular conditions need to be administered two or more i.e. multiple times a day, as well the poor patient adherence makes the treatment less clinically effective. Studies suggest that <1% of topically administered drug reaches aqueous humor. Up to 80% of systemic absorption of drug occurs followed by topical administration of eye drop causing systemic side effects.
Thus all this factors make topical ocular drug delivery challenging prominently in infants and elderly due to poor adherence and systemic side effects. Novel drug delivery systems such as micro emulsions [2,3], liposomes, dendrimers, nanopartcles, and transparent high viscosity gels have a improved corneal permeation and proven to have a great potential to overcome the problems of patient compliance and provide local, sustained delivery of drugs along with minimizing side effects. Furthermore it is known that p-blockers and adrenergic agents reduce choroidal and optic disc blood flow. Timolol has a better influence on visual field and is considered as an outstanding agent for the management of glaucoma. Latanoprost and brimonidine represent a promising approach to Intra ocular pressure (IOP) lowering with the potential of enhancing retinal ganglion cell survival. In addition, retinal ganglionic cell (RGC) death elicited by the high levels of glutamate may be overcome by neuroprotective action. These novel targets are ongoing areas of research interests for future glaucoma management.

Neuroprotection

Neuroprotection approach [4,5] involves direct protection of optic nerves (marginally damaged, undamaged but at risk) through the promotion of cellular survival or inhibition of cell death signals. Recent research in the field of neuroprotection in glaucoma has triggered focusing on to various receptor systems.

N-Methyl-D-Aspartate (NMDA) and a-2 Adrenergic Receptor Systems

This receptor can be probed among one of the promising future treatment targets. Brimonidine (BMD), a specific a-2 adrenoceptor agonist, and is found to protect against loss in mitochondrial membrane potential during oxidative stress, and preserve anterograde axonal transport. Secondly Memantine, which is a selective blocker of the NMDA-type glutamatergic type ion channel. It has unique open channel blocker properties that result in a preferential inhibition of excessive (excitotoxic) neuronal activation by high levels of glutamate without interfering with the channel's normal functions. Research in animal glaucoma model evidenced with neuroprotective effects with remarkable shrinking observed in the lateral geniculate nucleus. Both drugs are currently in clinical trials for glaucoma.
Apart from the above two targets several other targets have been proposed for neuroprotection. Adenylate cyclase receptor system activation. Forskolin is a diterpene isolated from the root extract of Coleus forskohlii species which activates adenylate cyclase (ACL). ACL activation produces outflow of aqueous humor in ciliary body and trabecular meshwork thereby regulates increased IOP. Evidences are found in Saffron (Crocus sativus) which is a traditional antioxidant agent with key ingredient crocin and crocetin, reduced elevated IOP in glaucoma patients. It also appeared to reverse the effects of photo oxidative toxicity induced in experimental rat models. Citicholine an intermediate in the synthesis of phospholipids such as phosphatidyl choline is found to show neuromodulator and a protective role in RGC's. Citicoline has been shown to protect the retina in vivo against kainate-induced neurotoxicity.
Melatonin a hormone secreted during dark hours by pineal gland. It modulates the body's sleep pattern. Melatonin receptors are found in all the cells of body also in the eye, mainly in the retina and ciliary body. It protects human retinal pigment epithelial cells against oxidative stress and slows down photoreceptor degeneration. Presence of melatonin receptors in ciliary body also suggests that they are involved in IOP regulation by regulating release of cyclic AMP. Due to presence of large number of melatonin receptors in eye, it has becoming attention-grabbing for development of new targets. Few of the naturally occurring plant extracts have shown neuroprotective effects in conditions of increased IOP such as Ginkgo biloba Extract, Epigallocatechin Gallate, Resveratrol, and Rutin. These compounds are currently under extensive investigation and under clinical studies.

Conclusion

Among recent decades ample of research in ocular drug delivery technologies evolved with constant progress in newer delivery methods and devices, nevertheless not a single one could emerge as effectual as eye drops. Still trials are ongoing in the search of effective ocular drug delivery. Even though IOP reduction remains main stay for glaucoma management, there is always scope in investigating new targets that could mitigate the progression of apoptosis and degeneration of optic nerve and provide neuroprotection to RGC's.

https://lupinepublishers.com/ophthalmology-journal/pdf/TOOAJ.MS.ID.000102.pdf

https://lupinepublishers.com/ophthalmology-journal/fulltext/drug-targets-and-its-delivery-in-glaucoma-current-trend-and-future-prospects.ID.000102.php

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Lupine Publisher | Ophthalmology and Ionizing Radiation

Lupine Publishers | Trends in Ophthalmology Open Access Journal 

 

Editorial

Due to the sensitive nature and low radiation tolerance of eye and its contents radiation to eye is sparingly and selectively used. Delivering ionizing radiation to eye associated with complications, however the intraocular tumors are highly radiosensitive and radiation can be delivered both by external beam therapy and brachytheray. Due to recent advances in radiotherapy now particle beam therapy is preferred for best vision sparing therapy due its selective nature. External and brachytherapy can radiation used with intent of radiacal, adjuvant and palliative intent to most common intraocular tumors like retinoblastoma, choroidal melanoma and metastatic tumors. Brachytherapy rarely is used only in selective centers with high technical expertise due high professional exposure to ionizing radiation. Radiation plaques are used in brachytherapy and these are the preloaded sources kept near the tumors either temporarily or permanently. Brachytherapy most commonly used for choroid melanomas [1]. Brachytherapy plaques come in different sizes and shapes or can be customized according to the needs. Brachytherapy basically delivers high radiation to tumor and less radiation to surrounding normal tissues.

There are different brachytherapy radio isotopes used most commonly iodine-125, palladium-103, ruthenium-104.most important factor in delivering radiation by brachytherapy is minimum tolerable dose to macula, fovea and optic nerve so that that good adequate vision and visual acuity can be maintained [2]. External radiation can be delivered by 3DCRT, IMRT or by SRS-SRT and more recently proton beam therapy, the last one preferred because of its accuracy due its bragg-peack. Due to the non-invasive nature, reproducibility and easy availability external RT preferred over brachytherapy. External radiation produces most commonly anterior eye side effects and brachytherapy produces posterior eye side effects. Conventional and best supportive care by radiation and ophthalmologic care is needed post treatment for 3-4 weeks [3]. Radiation induced cataract is one of the most common side effect in ophthalmology cancer survivors and professional ionizing radiation exposure to eye ball. Recently NCRP recommended that the professional exposure of ionizing radiation to eye ball should be less than 50 mili Sieverts annually. The good thing about radiation induced is completely treatable and curable [4].

https://lupinepublishers.com/ophthalmology-journal/pdf/TOOAJ.MS.ID.000101.pdf

https://lupinepublishers.com/ophthalmology-journal/fulltext/ophthalmology-and-Ionizing-radiation.ID.000101.php

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