New treatment helps end newborn blindness

New treatment helps end newborn blindness

UCLA researchers find inexpensive solution for developing
countries

By Janice Luo

UCLA researchers have discovered a new, inexpensive eye
treatment that will help reduce the incidences of blindness around
the world.

Each year worldwide, neonatal conjunctivitis, a serious
infection of the eye, blinds thousands of newborn babies, who catch
the disease from infectious organisms in the mother’s birth canal.
A new eye drop developed by UCLA researchers can kill the
infectious bacteria and prevent sight loss.

"By being universally available, it should have an impact on the
estimated 10,000 babies born each year who now go blind from this
disease ­ mainly in the developing world where no preventive
measures are used," said Dr. Sherwin Isenberg, professor and vice
chair of the ophthalmology department at UCLA’s Jules Stein Eye
Institute.

For over a century, doctors have used a drop of silver nitrate
in newborn babies’ eyes to combat conjunctivitis, which was passed
by mothers who were infected with sexually transmitted diseases.
Today, chlamydia is the leading infection passed from mothers.

Studies have found that silver nitrate proves ineffective
against such diseases, and that it can also cause toxic side
effects which inhibit mother-baby bonding after birth. Doctors have
tried to substitute antibiotics like erythromycin and tetracycline,
but they showed only slight decreases in infectious organisms that
cause the newborn blindness.

The inefficiency of these drugs, said Isenberg, led him on an
investigative study for an improved treatment with Dr. Leonard Apt,
an ophthalmology professor and director emeritus of the UCLA
division of pediatric ophthalmology.

Isenberg and Apt tested povidone-iodine solutions, which are
used for cleaning patients’ eyes before optical surgery and as a
skin antiseptic to heal cuts. The researchers adapted the drug so
it would be non-irritating to babies’ eyes.

To test its safety, they conducted a study last December at the
UCLA Harbor Medical Center on 100 babies with samples of normal
bacterial flora. The experimentation proved that povidone-iodine is
more effective and less toxic than the standardly-used silver
nitrate and erythromycin.

U.S. laws require doctors to administer preventative drops to
babies’ eyes after birth. But in third-world countries such as
Kenya, drugs like silver nitrate are too expensive and limited to
use and must be imported from European countries.

"Because infections occur less frequently in the U.S., we only
looked at bacteria of normal count in the babies eye, we did not
look at the actual disease. That’s when we decided to go to where
the action is," Isenberg said.

The Kenyan Ministry of Health approved a two-and-a-half-year
test of the povidone-iodine drug after Apt said he convinced the
government they "could prevent thousands of cases of blindness for
just pennies." In that African nation, more than one-third of women
have sexually transmitted diseases such as syphilis, gonorrhea,
AIDS and chlamydia. Up to 25 percent of babies have an infective
type of conjunctivitis without treatment.

"What makes povidone-iodine so phenomenal for the world, is that
it’s used throughout the world as an antiseptic for pennies. It’s
common and cheap because it’s made from powder. One of the biggest
breakthroughs of this drug is it’s availability. There’s no excuse
for countries like Thailand or Kenya to say they can’t afford it,"
Apt said.

Not only is it cost-effective for developing countries, but
povidone-iodine is non-irritating, in contrast to currently used
drugs, they explained.

In their Kenyan study, Apt and Isenberg rotated the use of three
different drugs by the week to compare their efficacy and found
povidone-iodine to be the best of those used. Mothers were shown
pictures of infections and offered blankets and cab fare to bring
their babies back to the Nairobi lab if infection occurred,
Isenberg said.

In Nairobi, where their study was done, government posters
spread word about the phenomenal new drug povidone-iodine. Apt and
Isenberg hope that this word will keep spreading so that "every
country in the third world is going to want to use povidone-iodine
and prevent their children from going blind."

The drug also does not cause chemical conjunctivitis, as did the
commonly used silver nitrate. The irritation leads to red, swollen
eyes with discharge, which usually disappears in a day or two.

"So far every study made with povidone-iodine has resulted in no
toxic or allergic reactions we have seen, so it has been very
safe," Isenberg said.

Furthermore, swollen eyes also inhibit mother-baby bonding. It
is believed that they bond within the first few hours of life, but
this is made difficult if the infant cannot see.

Another important advantage is that so far there has been no
bacterial resistance to the drug, the researchers explained. The
brown color of povidone-iodine helps determine if the drop has been
applied correctly, an improvement over the clear silver
nitrate.

Apt added that he hopes the United States will adopt this new
drug soon because "it has all the advantages of the old drugs plus
more."