Menu 18 Updates for October 2010 – March 2011

I have been negligent in updating the menus for my online Journal. So, here is the update for the past six months.

This update contains a number of new writeups, including the first use of gene therapy in treating retinitis pigmentosa; an overview of what happened at the Second Ophthalmic Innovation Symposium (held last year just prior to the AAO Meeting), a couple of interviews conducted by my colleague in China during lat year’s APAO Meeting in Beijing, and an excellent writeup about how femtosecond lasers are being used in ophthalmology.

I have also included several updates on subjects I have been closely following, including the controversy between the use of Avastin or Lucentis in treating AMD; an AMD update; a CATT Study update; five updates on the use of stem cells in ophthalmology; and updates on the latest news from Iluvien and NeoVista.

Here are synopses and links for the recent postings:

Avastin/Lucentis Updates:
Avastin/Lucentis Update 42: One-Year Results of Controlled Comparison Study Published (Oct. 4, 2010)

Last October (2009), I came across the six-month results of one of the first blinded, double-masked comparison studies run between Avastin and Lucentis, sort of a mini-CATT Study. This study was done by researchers at the Boston University School of Medicine in cooperation with the VA Boston, and was published in the American Journal of Ophthalmology. I published their news release describing the study and the six-month results as Avastin/Lucentis Update 29.

This weekend, the same group announced the one-year results of this study, this time published in Eye, a peer-reviewed publication of The Royal College of Ophthalmologists in the UK.

Avastin/Lucentis Update 43: Secret Rebates Offered for Lucentis (Nov. 4, 2010)

First, Genentech refused to provide Lucentis for the CATT Study, being run by NEI/NIH to compare Avastin to Lucentis for AMD (Avastin/Lucentis Update 12); then they threatened to stop supplying Avastin to compounding pharmacies so that ophthalmologists could continue to obtain the drug for their patients (Avastin/Lucentis Update 18); then they decided to provide Lucentis free of charge for the study looking at the use of panretinal laser treatment plus anti-VEGF (Lucentis) in the treatment of diabetic macular edema – at the exclusion of Avastin, in that “pay to play” study (Avastin/ Lucentis Update 37); and now, the company is offering secret rebates to selected large users of Lucentis – obviously to blunt the potential expected to be offered by Avastin when the CATT Study results are released next Spring.

Here, as written by Andrew Pollack online yesterday and published in today’s NYTimes, is the latest story in the ongoing Avastin vs. Lucentis Controversy:


Avastin/Lucentis Update 44: United Kingdom Closer to Allowing Avastin for AMD (Dec. 8, 2010)

While the U.S. comes closer to showing the equivalency of Avastin to Lucentis for treating the wet form of age-related macular degeneration, when the CATT (Comparisons of Age-Related Macular Degeneration Treatments Trials) Study results become public, hopefully, some time this Spring, the UK’s health services are still fighting over whether or not they should study the two drugs to determine if Avastin would be appropriate for the Brits to use in their National Health Service.


Avastin/Lucentis Update 45: Avastin Drug Treatment for ROP Better than Laser (Feb. 26, 2011)

A new study, published earlier this month in the New England Journal of Medicine, describes the use of intravitreal Avastin to treat Retinopathy of Prematurity (ROP) in premature infants.

This study was widely covered by the press, but I would like to reproduce just a few of the presentations to provide you with the information necessary to best understand the results of this study.


AMD Update:

AMD Update 13: Retinal Procedures on the Rise (Oct. 13, 2010)

A new study, just published in the October issue of Archives of Ophthalmology and reported by Ophthalmology Web, MedPage Today, and Medscape Medical News,  shows that among those in the Medicare population (age 65 plus), treatments for retinal conditions nearly doubled between 1997 and 2007 – and this trend is expected to continue with the aging of the population and seniors living longer.


CATT Study Update:
CATT Study Update 12: Status of WorldWide Studies (Jan. 6, 2011)

With the anticipated arrival of the one-year results of the CATT Study this Spring, I thought it would be appropriate to update where the other worldwide studies stand.

During the Retina Subspecialty Day sessions, held prior to the recent 2010 AAO Meeting in Chicago, Daniel Martin, MD provided an update on the various comparative studies underway around the world between Avastin and Lucentis. Here are Dr. Martin’s comments, as reported by the Market Scope team in the November issue of Ophthalmic Market Perspectives.


Stem Cells in Ophthalmology Updates:
Stem Cells in Ophthalmology Update 2: ACT Gets Go-Ahead to Treat Stargardt’s (Nov. 23, 2010)

As I noted in my September report on the Use of Stem Cells in Ophthalmology, it was anticipated that either the program at The London Project to Cure Blindness or Advanced Cell Technology’s program to treat Stargardt’s disease would be the first to get the go-ahead to begin approved human trials. I have not heard any news out of London, but earlier this week ACT received notification from the FDA that it was cleared to begin its human trials with human embryonic stem cells.


Stem Cells in Ophthalmology Update 3: ACT Files IND to Treat Dry AMD (Nov. 30, 2010)

Furthering its lead in stem cell research in ophthalmology, Advanced Cell Technology Inc., announced today that it  had filed an Investigational New Drug (IND) application with the U.S. Food and Drug Administration, to initiate a Phase I/II multicenter study for the  treatment of dry Age-Related Macular Degeneration (dry AMD) using human embryonic stem cell (hESC) derived retinal pigment epithelial (RPE) cells.


Stem Cells in Ophthalmology Update 4: ACT Receives Receives FDA Approval to Use hESCs to Treat Dry AMD (Jan. 3, 2011)

Advanced Cell Technology Inc., announced today that it  had received approval from the FDA to commence its clinical trial using retinal pigment epithelial (RPE) cells derived from human embryonic stem cells (hESCs) to treat the dry form of age-related macular degeneration. ACT is now permitted to initiate a Phase I/II multicenter clinical trial to treat patients with dry AMD, the most common form of macular degeneration in the world. There are currently no approved treatments available for this prevalent disease of an aging global population. Dry AMD, representing a substantial global market opportunity and afflicts between 10-15 million Americans, and a further 10 million Europeans.

Stem Cells in Ophthalmology Update 5: Gene Defects Common in Induced Stem Cells (Mar. 5, 2011)

As the senior editor, John Gever, of MedPage Today reported, following the publication of three studies about induced pluripotent stem cells in the March 3rd, issue of Nature, “The road to regenerative medicine based on induced pluripotent stem cells (iPSCs) may have developed a giant pothole, with new studies showing that the cells are prone to several types of genetic defects.”

The three studies showed that the reprogramming process and subsequent culture of pluripotent stem cells in vitro can induce genetic and epigenetic abnormalities in these cells. The authors of the studies and the editorialist said that the results raise concerns over the implications of such aberrations for future applications of pluripotent stem cells.


Stem Cells in Ophthalmology Update 6: Stemedica Paper Accepted for Presentation at ARVO (Mar. 19, 2011)

I recently received an update from my contact at Stemedica and would like to share the information with you.

A safety study on the use of  stem cells in the eye, in a clinical study underway at the Fyodorov Federal Institution of Eye Microsurgery in Moscow, to treat diabetic retinopathy and diabetic optical neuropathy with stem cells derived from bone marrow, has been accepted for presentation as a poster at the upcoming ARVO Annual Meeting in Fort Lauderdale at the beginning of May. An abstract is shown below.


Iluvien Update:

Iluvien Update: FDA Marketing Approval Delayed (Jan. 5, 2011)

Last July, I wrote a comprehensive report about Iluvien and the status and promise of other sustained release drug delivery systems (Iluvien and the Future of Ophthalmic Drug Delivery Systems). At that time, Alimera Sciences, the company developing Iluvien (under license from pSivida) had filed a new drug application (NDA) to treat diabetic macula edema (DME). The company obtained priority review status for the NDA at the end of August, raising the expectation that an approvable letter might be obtained by the end of 2010.

However, instead of an approvable letter, Alimera Sciences received a “complete response letter” (CRL) from the FDA, communicating to the company that its NDA application “cannot be approved in its present form”.


NeoVista Update:

NeoVista Epi-Retinal Strontium 90 Treatment for AMD: Update 4 (Jan. 20, 2011)

NeoVista just released an update, discussing the first commercial utilization of its Epimacular Brachytherapy device in Germany. The Epi-Rad device, now renamed as the VIDION ANV (Anti Neo Vascular Therapy System) has been commercialized in Europe since November 2009. The first patients treated were in Pisa, Italy, quickly followed by patients treated in London, UK, also in November of 2009, and now in Hamburg, Germany this month.


And, here are the new writeups:
The Use of Gene Therapy in Treating Retinitis Pigmentosa and Dry AMD by Retrosense (Nov. 6, 2010)

A short while ago, I received a message from someone I did not know, who said that he enjoyed the writeups on my online Journal and was wondering if I might be interested in writing about the use of gene therapy as an approach to vision restoration. Since I knew absolutely nothing about gene therapy, the writer got my attention.

After several discussions with Sean Ainsworth, the founder of RetroSense, and much online research, I think I have learned a little about what gene therapy is about, and its application in ophthalmology, especially in the possible restoration of vision in those who suffer from retinitis pigmentosa (RP). Thanks to Sean for whetting my appetite -- here is what I have learned.

The Second Ophthalmic Innovation Summit (Dec. 10, 2010)

Last October, the Second Ophthalmic Innovation Summit (OIS) was held just prior to the 2010 AAO Meeting in Chicago. As was the case last year, my old friend, Larry Haimovitch,an ophthalmic industry veteran, who attended the meeting and wrote about it for the sponsor’s website, Healthcare Syndicate has given me permission to reproduce his writeup in this space.

An Interview with Dr Ronald Krueger (Feb. 17, 2011)

With the permission of Lei Zang, the Managing Editor of Ophthalmology World Report, here is her interview with noted refractive surgeon Dr. Ronald Krueger of the Cleveland Clinic. As noted below, Dr. Krueger was recently in China to perform a corneal transplant on a Mongolian patient and while there, attended the APAO Meeting held last fall in Beijing, where Ms. Zang had the opportunity to interview him.


An Interview with Professor John Marshall (Feb. 17, 2011)   

During the APAO (Asia Pacific Academy of Ophthalmology) Meeting held in Beijing in September, 2010, Lei Zang, the Managing Editor of Ophthalmology World Report,  interviewed Professor John Marshall of St. Thomas Hospital in London and the principal behind the Ellex 2RT (retinal regeneration) program for Ellex Laser, and also an investigator (and inventor?) of the Avedro microwave corneal crosslinking program.

In this interview, Prof. Marshall discussed both his work on 2RT and on microwave crosslinking as well as several other topics that will be of interest to ophthalmic researchers.

              
A Comparison of Commercially Available Femtosecond Lasers for Refractive Surgery (Mar. 17, 2011)

Over the past several years, I have either written or posted other peoples accounts of the use of femtosecond lasers in ophthalmology. Starting with the history of their development in October 2008 (Intrastromal Ablation: A Technology Whose Time Has Come?); an article on the use of the femtosecond laser to treat presbyopia by Dr. Rupal Shah in June 2009  (Another Approach to Intrastromal Ablation); a writeup on the use of femtosecond lasers for performing cataract surgery by Larry Haimovitch, again in June 2009 (Femtosecond Lasers Proposed for Use  in Cataract Surgery); and finally, Dr. Joseph Colin’s writeup about femtosecond laser cataract removal as a second revolution, and my addition about the possibility of using the femtosecond laser to “bleach” the natural lens to delay the onset of needing to remove catatacts, inAugust 2010 (Femtosecond Laser Cataract Removal: The Second Revolution? And, What is Laser Photolysis?).

Earlier this month, I came across an article written by Drs. Ronald Krueger and Glauco Reggiani-Mello, of the Cleveland Clinic, that does an excellent job of summarizing the latest developments in the use of femtosecond lasers in refractive surgery and other applications in ophthalmology. Since the article was written in a professional journal – Expert Review of Ophthalmology, with limited access, I asked the authors for permission to reproduce a significant part of their writeup, along with a link to the original for those that wish to read it in its entirety. Permission was granted, and here is my version of what was presented, along with most of their illustrations and their two tables.

Side Plank Pose for Scoliosis Challenge Conclusions

by Nina

 In the fall, I read some compelling about Dr. Loren Fishman’s study on using Side Plank pose (Vasithasana) to improve scoliosis (see Side Plank Pose (Vastithasana) Could Reduce Spinal Curves in People with Scoliosis!). Because I myself have mild scoliosis, I decided to experiment by doing the practice myself and I issued the Side Plank Pose for Scoliosis Challenge on November 17, 2014. I said that I was going to be doing the pose as Baxter recommended: twice on my convex side (the left side for me) and once on my concave side (the right side for me). I asked you to join me and report back on the results of your experiments.

On December 11, I wrote an update on my experiment so far Honestly? Progress Report on the Side Plank Pose Challenge. At that time I said that because the pose was causing me wrist and hand pain and that I had come to dread practicing the pose every day that decided I would no longer practice it six or seven days a week. I said that because I knew that practicing a strength building pose three or four times a week is often enough to build strength, I decided to go for a more modest strategy of practicing only every other day, which felt much safer to me. And when I told Baxter about the modifications I was making, he wrote me:

“I agree that doing the same pose every day is going to produce some problems for students in the wrist, elbow or shoulder on the weight bearing side, although Loren denies that was a problem in their study.”

Are you wondering what ever happened to me since then? Unfortunately, things got worse for me. Before I go into it, I want to say that I learned that the type of scoliosis I have, low lumbar scoliosis, is very rare (only about 5 percent of all types of scoliosis) so I have a feeling that the people in Loren Fishman’s study did not have the same type of scoliosis that I do. And the feedback I’ve gotten so far from our readers showed that none of them developed the problems that I did. But the truth of what happened to me—despite my hopes and best efforts—is that this practice did not work for me.

Basically what happened was my low back pain got worse. And the last time I did Side Plank pose, I felt a terrible twinge just as I was going into it. So I used common sense and stopped practicing the pose entirely. Then I went to see my favorite MD/yoga teacher for an assessment to see if he thought I was having any serious back problems. After running me through the usual medical tests, checking for disc problems, etc., Baxter (yeah, it was him—I’m lucky, right?) concluded I had no serious problems. But he recommended that I should give up the Side Plank pose experiment permanently as it did not seem to be helping me.

Since then I’ve gone back to practicing Side Plank pose the way I used to do it, about once a week, once on each side, for upper body strength building. And it now feels fine. 

Of course, I’m a bit disappointed I didn’t find an easy yoga solution for my scoliosis, but I’m also realistic to know that everyone has a unique body, and that works well for one person might not work for another. 

How about you? Are you still practicing? If so, how are you doing? And, if not, why did you give it up?

By the way, if you'd like to listen to Loren Fishman and Ellen Saltonstall discuss the original study, Yoga U Online now has a free download of there discussion here. And since we now have good photos of all four versions of Side Plank pose, I thought I'd include them all in this post. For information on practicing them, see Featured Pose: Side Plank Pose (Vasithasana).

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15 Minutes at a Time The FlyLady and Exposure Therapy for OCD

In January, faced with increased difficulty finding things in my house, and general chaos, I remembered reading about the FlyLady, and went to her site. Just going there was an exposure for me, since my perfectionism starting raring up, but what I like about the FlyLady is an explicit acknowledgment of how much of the home clutter chaos stems from this very perfectionism. The fear that you have to do it "right" and all at once, and rip apart every closet and scrub every surface.

She advocates doing 15 minutes at a time, and then stopping. That's the hardest part for me. My perfectionism OCD gets entangled in this, and once I start a task, I feel anxiety at the thought of stopping before the task is done, even if there's no clear ending point, and so I keep going until I exhaust myself and it seems preferable to avoid cleaning at all. For someone with contamination OCD the feared consequence may be that nothing is clean enough after only 15 minutes.

The FlyLady is practicing a form of Exposure Therapy. She dares her readers to do housework imperfectly, incompletely, incorrectly. The irony of OCD is that it's all about the anxiety not about reality. Avoiding cleaning altogether is not more "perfect" than doing 15 minutes at a time. A refrain on the FlyLady forums is "I've got so much to clean up that 15 minutes isn't enough time." This kind of thinking is part of why I didn't start actually doing exposures right away when I finally found an Exposure Therapist.

I saw the enormity of my compulsions and anxiety, and I wanted to be better immediately because I was in pain, but also because my perfectionist OCD made it seem dangerous to have a learning curve, to proceed slowly, by trial and error, imperfectly, haltingly, erratically. I needed to do things instantly, the first time, or my feared consequence was that I was a worthless failure. Again, the reality is that avoiding learning or taking small steps serves to give a relief from the anxiety of facing the fear, and yet paradoxically, set me even further behind in getting better from my OCD.

What I have learned in therapy is that anything above zero is good. 30 seconds of resisting compulsions is good. 1 minute. 5 minutes. 15 minutes. It's all good. Exposing myself to something I fear, even if it is the least of my fears, is good. Perfectionism says that you either get better all at once, or you don't get better. This doesn't give me my life back. It keeps me trapped in my compulsions. In 15 minute increments I have cleared through the chaos of my house. The FlyLady motto is that you can do anything for 15 minutes, but for 2011 she's challenging us with a new motto: Let's Go for Seven in 2011

Seven minutes on the timer, because 15 minutes can still be too daunting. The FlyLady says that housework done incorrectly still blesses your family, and in the case of debilitating rituals, this is a powerful statement.

Yoga for Mutiple Sclerosis Proof of the Benefits!

by Ram

Eric Small, Iyengar Yoga Teacher

A neuron is the core component of the brain and spinal cord of the central nervous system and of the ganglia of the peripheral nervous system. Neurons by nature are electrically excitable cells that process and transmit information via electrical and chemical signals. These signals travel between neurons through specialized connections called synapses. Thus, neurons connect to each other to form neural networks. In order to ensure efficient communication between neurons and faster propagation of nerve impulses, some neurons are endowed with an insulating sheath called “myelin.” The molecular process of the synthesis of the myelin sheath is called “myelination.” The main purpose of the myelin sheath is to increase the speed at which electrical impulses propagate along the myelinated neuron to the next neighboring neuron. Myelination helps prevent the electric current from randomly leaving the axon thereby permitting agile communication for long-distance signaling and to sustain such signals. 

Myelinated axons are white in appearance, hence the term "white matter" of the brain. Under a microscope, myelinated axons appear like strings of sausages. The main constituent of myelin is cholesterol and it also has about 15–30% proteins. The predominant protein is myelin basic protein (MBP). For reasons that are still not clear, in some people, the body’s defense system recognizes the myelin basic protein as “foreign” and starts attacking it (Chronic Inflammation). This autoimmune inflammatory condition is multiple sclerosis (MS). When the body’s defense system lays seize on the myelin, the protective sheath loses its structural and functional integrity, resulting in disruption of the smooth neural communication. The more myelin is destroyed, the slower and less efficient the nerve impulses are. Eventually, as the disease progresses, it can cause the nerves themselves to deteriorate or become permanently damaged. While MS is not hereditary, having someone in the family with MS does significantly increase an individual's risk of developing the disease.

Signs and symptoms of MS will vary depending on the extent of nerve damage and which nerves get affected. The symptoms, severity, and duration can vary from person to person. Some people may be asymptomatic most of their lives, while others may suffer from severe chronic symptoms that never go away. Women are more than twice as likely to develop multiple sclerosis as men. MS usually affects people between the ages of 20 and 50 years, and the average age of onset is approximately 30 years. Common early signs of MS include: vision problems, tingling and numbness in joints, fingers, and toes, pains and spasms, weakness or fatigue, balance problems, dizziness, bladder issues, sexual dysfunction, and cognitive problems. As the disease progresses, symptoms become more severe.

There is currently no cure for MS. However, MS is not a fatal disease. In fact, MS patients have essentially the same life expectancy as the general population. Treatments can help speed recovery from the inflammatory attacks, modify the course of the disease, and manage symptoms. Physical and occupational therapies are a great way to manage the condition. While yoga does not cure MS, through its postures and breathing techniques, it helps to focus the mind and pay attention to the body. For example, for people with full-blown symptoms of MS, mornings can be an ordeal as the body is tight and rigid from the night’s sleep. The practice of yoga can ease many of the physical symptoms and improve the emotional upheaval through breathing and stretching exercises, and individuals are able to do successfully complete tasks and do things for the rest of the day with less pain and discomfort. 

According to Eric Small, a senior Iyengar yoga instructor and author of Yoga and Multiple Sclerosis: A Journey to Health and Healing, Iyengar yoga techniques address many MS symptoms, such as loss of bladder control, balance, and fatigue. Eric has been practicing Iyengar yoga for nearly 50 years with his mornings devoted to asanas and his afternoons to pranayama. He credits Iyengar yoga with helping him maintain both balance and range of motion (Multiple Sclerosis and Yoga). And now several research studies discuss the benefits and potential role of yoga as an alternative treatment of symptom management for individuals with MS and describe how yoga can improve the patients’ quality of life (see Yoga, MS & Stress, Yoga, MS &Physiological Indices; Yoga, MS & Postural Balance and MS & Therapeutic Yoga). In all of the research studies, the opinion among MS subjects was unanimous: subjects reported improvements in mental and emotional health, concentration, bladder control, vision, and ability to withstand the pain better. Furthermore, subjects also revealed improved motor coordination, better capacities for walking without losing balance or coordination of gait, and improvement in being able to stand up from a sitting position.

In most of these research studies, for rehabilitative and/or maintenance treatments the emphasis was on asanas to improve strength and flexibility (Mountain pose, Warrior 1 and 2, and Arms Overhead pose), balance poses (using the wall and/or props to keep steady), and agility practices (start with slow, precise changes of position in asana practices, such a slow Sun Salutation). MS individuals can easily adapt the postures and use suitable props that will help them to do to the pose and benefit from it (Yoga Props We Can't Live Without). All of the research studies together with anecdotal reports are steps in the right direction as they show that a yoga program is very effective in improving the quality of life in MS patients.

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Finding a Good Therapist for OCD In US and Canada

The International OCD Foundation(IOCDF)has an an OCD Treatment Provider List for the United States and Canada. There is a dearth of qualified Exposure and Response Prevention(ERP)/Cognitive Behavioral therapists, and it can be frustrating to find effective therapy, but this is the place to start.

What to look for:

• Behavior Therapy Training Institute(BTTI) faculty
  
• Graduates of BTTI
• If they are a graduate of BTTI and have a website, check to see if they mention ERP at all. Some take the training, but their sites show no trace of it.
  
• Specific mention of ERP in their listing
  
• Cognitive Behavorial Therapy(CBT) in combination with ERP
  

Keep in mind that this list is made up of therapists who requested to be on it, and there is a disclaimer that the IOCDF does not screen or research any of the therapists, but I do think it increases your odds of finding someone who is well versed in current treatment.

Related Link:
Tips on Finding a Therapist from Austin OCD Center
Finding a CBT Therapist

Restorative Yoga Better Than Stretching for Reducing Subcutaneous Fat in Overweight Women

by Nina

Just a quick announcement today about some research findings I think you’ll all enjoy learning about. Baxter and I read about a recent study, designed by Maria G. Araneta, PhD, MPH, of the University of California, San Diego, to determine whether obese women lose fat from less intense exercise instead of aerobic activity. Although not a huge study, the groups were larger than most of those we see in recent studies, with the yoga group of 88 having a mean age of 55 years with an average BMI of 36 kg/m2 and the stretch group of 83 having a mean age of 54 years with an average BMI of 32.5 kg/m2.

Along with her co-authors Matthew A. Allison, MD, MPH, Elizabeth Barrett-Connor, MD, and Alka M. Kanaya, MD, Dr. Araneta presented the results at the 73rd Scientific Sessions of the American Diabetes Association in Chicago (June 21-25). And the results showed that the practitioners of restorative yoga lost significantly more subcutaneous fat over the initial six months of the study. They also kept losing subcutaneous fat during a maintenance period when they had less direct supervision. This is important because all the women participating in study had metabolic syndrome. And reducing abdominal fat may help reverse the syndrome.

The Mayo Clinic defines metabolic syndrome as follows:

"Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes."

Metabolic syndrome affects 44% of the U.S. population older than age 50. 

Although the team is still reviewing the data, they speculated that one explanation for the difference between the effects found with restorative yoga and stretching may be that restorative yoga reduces cortisol levels. As Timothy wrote in his background post Stress, Your Health and Yoga, cortisol levels rise during times of stress and is known to increase abdominal fat. And in Baxter’s post Cortisol and Good Health Baxter wrote about the dangers of prolonged periods of stress and high levels of cortisol. I wrote specifically about the relationship between stress, cortiso,l and weight management in my post Yoga, Stress and Weight Management. So we'll be very interested to see the follow-up studies.

In Baxter's post on cortisol, he actually recommended restorative yoga along with yoga nidra as stress reduction—and cortisol-lowering—solutions. However, meditation (see Starting a Meditation Practice) and supported inversion poses (see All About Supported Inverted Poses) are also helpful. For a complete overview of how to use yoga to switch your nervous system from the Stress Response (Fight or Flight) to the Relaxation Response (Rest and Digest), see The Relaxation Response and Yoga.

In her presentation, Dr. Araneta did not recommend restorative yoga as a replacement for aerobic activity; instead, she said this “complementary” practice could provide a means of gentle movement for severely obese patients for whom other activity is not practical. But as I wrote in Restorative Yoga: An Introduction, restorative yoga is a complementary practice that benefits all of us.

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Falling for Yoga Myths Yawning and Sighing and the Nervous System

by Nina

Heart and Lungs

I hope you realize by now that there are a lot of myths out there in the yoga world, such as that yoga nidra is an ancient practice or that Sun Salutations have been practiced for thousands of years. So here at Yoga for Healthy Aging, we try to do a bit of fact checking before we go ahead and write about a subject, whether it is medical, scientific, or historical. And when I edit a post, I try to confirm anything that looks a bit, well, suspect. But once in a while, I’m less than meticulous, and that can result in an error or two. After I read what Baxter wrote about the relationship between the breath and the nervous system in his post How Your Breath Affects Your Nervous System, I asked him to take a look at a related post I wrote some time ago called Your Key to Your Nervous System: Your Breath because I was concerned that perhaps my original post had errors in it. Although at the time I had been writing about what I was convinced were facts, Baxter confirmed that some of the information in my post about yawning and the affect of the breath on the nervous system, which I had learned from a yoga teacher, was actually incorrect. Baxter identified this misinformation as a yoga myth—ideas that seems to get perpetuated, despite the fact there is no proof of their validity.

So this post today is an update to my original post, with Baxter’s comments/corrections on my original statements. Well, it’s a journey for us, too, right?

YOGA MYTH: Nina wrote, “Have you ever wondered why you tend to yawn when you’re sleepy? Well, a yawn is a great big inhalation. And because your heart rate tends to speed up on your inhalation, that yawn in the middle of that boring lecture or business meeting is little message to your nervous system: wake up! On the other hand, when you are upset about something, you tend to sigh. That sigh—try one!—is an extra long exhalation. Because your heart rate tends to slow on your exhalation, that sigh while you are feeling emotional turmoil or are just stuck in traffic is a little message to your nervous system: take it easy, buddy, slow down a bit.”

BAXTER’S CORRECTION: Here’s what I found…and it does not seem to confirm your suggestions that it is the heart rate effects that are driving the yawn or sigh. There are four theories about why we yawn, none proven or much studied:

• Physiologic theory: Our bodies induce yawning to draw in more oxygen or remove a buildup of carbon dioxide. At least one studied seems to have disproved this theory.
• Evolutionary theory: Some think that yawning began with our ancestors, who used yawning to show their teeth and intimidate others. An offshoot of this theory is the idea that yawning developed from early man as a signal for us to change activities.
• Boredom theory: Although we do tend to yawn when bored or tired, this theory doesn't explain why Olympic athletes yawn right before they compete in their event or why dogs tend to yawn just before they attack. It's doubtful either is bored.
• Brain-Cooling theory: a more recent proposal is that since people yawn more in situations where their brains are likely to be warmer—tested by having some subjects breathe through their noses or press hot or cold packs to their foreheads—it's a way to cool down their brains. Cool brains think more clearly.

Why do we sigh? As it turns out, sighs do seem to work like the brain’s reboot button for regular breathing. According to a 2010 study Take a deep breath: The relief effect of spontaneous and instructed sighs, during mental stress, the volunteers’ breathing became more and more irregular as participants increasingly relied on deliberate breath control, at which point, a sigh occurred, causing automatic regular respiration to kick in again. Furthermore, muscle tension steadily built up before a spontaneous sigh and decreased afterward, supporting the idea that sighing helps release tension.

YOGA MYTH: Nina wrote, “It turns out that by intentionally taking in more oxygen (either by speeding up your breath or by lengthening your inhalation) you can stimulate your nervous system and that by taking in less oxygen (by slowing your breath or lengthening your exhalation), you can calm yourself down. It’s that simple.

BAXTER’S CORRECTION: It is actually likely not that simple, as the effect I described in my post How Your Breath Affects Your Nervous System really more clearly explains what happens: the inhale speeds up the heart rate (not because of O2 levels) and the exhale slows it down (not due to O2 levels, but due to the nerve input from breath cycle to heart). As the heart rate slows more over the course of five minutes of 1:2 ratio breathing, for instance, the slower heart rate is monitored by the brain and leads to even further turning on of the parasympathetic Rest and Digest response. And, in fact, carbon dioxide levels in the blood stream have a much greater influence on the rate of breathing than O2 levels, and are monitored much more closely by the brain moment by moment and lead to adjustments in the ANS tone of whether sympathetic or parasympathetic nerves are stimulated. The importance of “getting more oxygen” in is a myth that has been propagated for a long time by yoga teachers in this country. For further information, see Leslie Kaminoff’s article What Yoga Therapists Should Know About the Anatomy of Breathing.

CONCLUSION: Well, we're all learning this stuff together. Even Baxter went ahead and did a bunch of new research. And, sigh, at least I was right about sighing.

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Yoga for Healthy Aging Certified Teachers!

by Nina

Baxter and I are pleased to announce a new feature on the blog: a list of yoga teachers who have been certified by the two us as Yoga for Healthy Aging teachers. You can find the list of these teachers (which we expect to grow—we’re still waiting for some of the written tests to come in) on our Certified Teachers page.

These yoga teachers all attended our Yoga for Healthy Aging intensive, passed a written test, and did a teaching demonstration that we approved:

• Susan Bronson
• Nora Berklich
• Barbara Haxo-Phillips
• Joan G. Manuel 
• Carol Mermey
• Liz Moss
• Nina Rook
• Susan Urquhart-Brown

For those of you who are interested in receiving certification yourself and could not attend our 2015 intensive, we will be having another intensive at Namaste Berkeley in 2016. We will be announcing the date in the near future.

Honorary Mention goes to Bayle Emlein who, while not a yoga teacher, passed her written test and the teaching demo just for her own edification.

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Its hard to imagine I didnt drive for 12 years

I learned to drive at 15. I had the spectre of perfectionism looming over my lessons, where I assumed that I should be able to just learn without trial and error, and that something was seriously wrong with me because I did indeed make errors, like changing lanes without putting on my signal. My instructor was patient, and even gave a particularly riled up driver the finger when I was struggling along. I started a list of all the driving mistakes I made, and felt overwhelmed with all I had to fix. I kept driving through college, maneuvering a Chevette, which had absolutely no oomph after 35 mph. Then on to driving a van as part of my workstudy.

But when my husband and I got married during graduate school, his car was a stick shift, and I had learned on an automatic. I only had one experience with a manual transmission, and that was the day I got my driver's license and my father took me out in his tiny Honda, and expected me to know how to operate the clutch. It was the longest block of my life. I started by rolling backward and ended with much lurching, and felt entirely responsible for my deficiency, rather than realizing my father was expecting me to learn by magic.

My husband took me to a parking lot with the stick shift car, and I was sufficiently scared of making any mistakes that I didn't ask for another lesson. In the meantime, my husband was more than glad to drive me anywhere I wanted to go. He'd wait for me, find a place to sit or walk. When we got a new car 5 years later, I asked that it be an automatic transmission so I could drive if I needed to. But after one nerve wracking trek down to the grocery store, with every muscle tense, and my hands clamped on the steering wheel, I shied away from driving again.

Later, my husband told me that he was so willing because he was afraid that if I had an accident while driving, that it would send me over the edge with my anxiety. For 12 years we did everything together, "joined at the hip". Anxiety can tell you something important, an actual threat that needs to be heeded, but parasitic anxiety lives only to perpetuate itself. Much of my perfectionism was a child's way of dealing with the world--"If I am perfect, then I will be loved. Don't ever make a mistake." And the OCD latched onto this, amplifying the fear. I couldn't imagine myself driving, and therefore, until I could be certain I could drive, I avoided it.

AMD Update 5 Emerging Technologies for Treating AMD

Over the past year and a half, I have been tracking several new technologies that have a good chance to become breakthrough technologies in the treatment of both wet and dry age-related macular degeneration (AMD). I have written about several of these (as shown below), and would like to introduce you to an exciting new approach, using embryonic stem cells, that looks like a winner.

First, a summary of some of the newer technologies that I have been tracking and writing about:

The Ellex 2RT Retina Regeneration Therapy

Just prior to the 2007 AAO meeting, I became aware of a new potential laser treatment for retinal diseases. I met with the then president of the company, Peter Falzone, and decided to write about what Professor John Marshall and his colleague Dr. Ali Hussain were proposing.

From what I understand, 2RT is the use of non-thermal laser pulses to “stimulate” the retinal pigment epithelial (RPE) cells. This in turn causes the RPE cells to migrate and release metalloproteinases, which are the enzymes that “clean” Bruch’s membrane. This, in turn increases the transport of water and chemicals through Bruchs to rejuvinate the retina.

For more on this, see my writeup: Ellex 2RT Retina Regeneration Therapy: A First Report

Collaboration Between Lumenis and Stemedica

In May of 2008, I became aware of the collaboration agreement between Lumenis and Stemedica, to use the Lumenis SRT laser to target RPE cells (similar to what John Marshall, above, was doing in London), and then to use Stemedica’s stem cell lines to regenerate the damaged retinal cells.

I contacted friends at Lumenis and the people at Stemedica, offering to write up what they were trying to do, and compare it with what John Marshall in London was doing.

Unfortunately, my friends at Lumenis were no longer with the company, and no-one at Stemedica was willing to talk to me.

Recently, a new-found friend at Lumenis informed me that the Lumenis SRT laser was no longer in the picture and that Stemedica was continuing on its own. I then got an offer from a researcher at Stemedica to tell me what they were doing, but upon followup, no further information was forthcoming. (I do know, however, that research on the project is continuing and being carried out at the Fyodorov Eye Institute in Russia.)

Also, one of my old friends from Lumenis, the former program manager, got in touch with me and said he was interested in pursuing the Lumenis SRT development project if he could obtain outside financing. So, this approach is still alive and ticking.

Visualization of Living RPE Cells

In February of this year, David Williams and his research group at the Institute of Optics at the University of Rochester announced that they had used adaptive optics to image RPE cells in vivo.

I have written up this announcement in more detail: AMD Update 4: Does Visualizing RPE Cells Hold the Key to Understanding AMD?

Now we have a diagnostic mechanism to see changes in RPE cells, possibly when applying some of the new techniques discussed above and below.

And, now, the breakthrough that could hold the key to finally finding a “cure” for AMD:

Embryonic Stem Cell Treatment for AMD

Finally, as noted above, I came across an article that appeared in the April 19, 2009 issue of the London Times Online, describing the work of Professor Peter Coffey of the London Project to Cure Blindness and Dr. Lyndon da Cruz, a surgeon at Moorfields Eye Hospital in London.

Their process involves replacing a layer of degenerated retinal cells with new ones, created from embryonic stem cells, pioneered by scientists and surgeons from the Institute of Ophthalmology at University College London and Moorfields Eye Hospital. Further, Pfizer has announced one of its new companies, Pfizer Regenerative Medicine, launched last year, will be providing financial backing of this project to bring the therapy to fruition. The undifferentiated embryonic stem cells will be transformed into differentiated replicas of the degenerated RPE cells, placed on a membrane and inserted into the back of the retina.

Professor Coffey believes that the insertion process could be accomplished in less than an hour, making this a potential outpatient process.

A clinical trial is expected to begin within two years and become the second in the world to use embryonic stem cells in humans. (The first being the work by Geron on patients with spinal cord injuries.)

This technology could become ground-breaking breakthrough technology in the treatment of dry AMD and Geographical Atrophy.

In their own words, here is how The London Project to Cure Blindness describes their process:

“Neuralised human embryonic stem cells (HESCs) represent a potentially unlimited source of progenitor cells for use in the repair of retinal disease. In addition to the genesis of retinal neurons, there is now compelling evidence that RPE can also be derived from undifferentiated HESCs. These ES-derived RPE cells not only appear to behave like normal RPE in culture but also have a gene expression profile more akin to primary human RPE. This is of particular clinical relevance to any RPE based transplantation strategies designed to treat AMD.”

“HESCs will be used to generate precursors of retinal pigment epithelium (RPE) cells in vitro in order to provide a candidate therapeutic for age related macular degeneration (ARMD). The previously used method will be optimized with respect to RPE cells to improve both yield and reproducibility. RPE transplantation has already been shown to be capable of restoring the subretinal anatomy and improving photoreceptor function in a variety of retinal diseases. The sourcing of appropriate cell lines with the prerequisite characteristics of RPE will allow transplantation to enter the mainstream of retinal therapy at a time when the treatment of previously blinding retinal diseases is finally becoming a reality.”

Pfizer Regenerative Medicine’s role will be to focus on clinical study design, product manufacturing (the membrane), and securing worldwide regulatory approvals.

Under the terms of the collaborative agreement, Pfizer will fund University College London's preclinical research. In turn, Pfizer will retain exclusive worldwide rights to proceed with efficacy trials to develop and commercialize any resulting retinal pigment epithelium stem cell-based therapies.

"We are excited to be working with pioneers in the field of stem cell ophthalmology from UCL," Ruth McKernan, PhD, chief scientific officer for Pfizer Regenerative Medicine, said. "While we have much to learn about how stem cells can be used therapeutically, we are confident that this relationship will increase that understanding and help us advance to a time when our work may benefit patients worldwide."