Optometric Physician

A weekly e-journal by Art Epstein, OD, FAAO


Volume 19, Number 33

Monday, August 19, 2019


Inside this issue: (click heading to view article)
######### Off the Cuff: Our Growing Leadership Vacuum
######### Effect of Topical Prostaglandins on the Biomechanics and Shape of The Cornea
######### The Effect of Multiple Vitrectomies and its Indications on Intraocular Pressure
######### Accuracy of Computer-assisted Vertical Cup-to-disk Ratio Grading for Glaucoma Screening
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Our Growing Leadership Vacuum

I am sure that this editorial will ruffle some feathers, but what I am writing needs to be read. This is just the first in a series of what I consider to be reality checks. Consider this: Interest in becoming an optometrist has been on a steady decline for quite a while. While some optometry programs would have you believe that they have substantial waiting lists for admission, friends in academia and the data speak a different story. For many programs, there are barely enough candidates—despite relaxed admission standards—to fill existing seats. Dentistry, which decades ago, saw commercialism growing and a fate similar to what happened to pharmacists looming, shuttered schools to reduce practitioner numbers and bolster their profession’s stability. Optometry’s answer? Open more schools even in areas that clearly do not need more schools or more optometrists.

Who in their right mind thinks that we need two programs in Boston or in Chicago? Don’t get me wrong, some of the newer programs—like Midwestern in Arizona—have become top-notch institutions, while some of the legacy schools continue to sink into the muck of mediocrity. Niswonger College of Optometry at Tusculum University in rural Tennessee is slated to open in 2020, pending approval by the (AOA) Accreditation Council on Optometric Education. Despite being one more school added to already too many, I expect Niswonger to be potentially game changing for the profession. However, if Niswonger is allowed to open, albeit in an area of legitimate need, and it trains ODs that can lead us through future challenges, shouldn’t we be eliminating or cutting back older programs that cause more harm than good by creating more ODs despite shrinking need?

I stumbled upon this social media ad by ASCO a few weeks ago:

It doesn’t take a rocket scientist to know that things are seriously wrong when the trade association for optometry schools has to advertise for students to fill their empty seats. Perhaps the bigger question is, should ASCO be acting as a self-interested trade organization, or, more responsibly, as a patient- and profession-focused advocacy group? If the latter were true, even if solely based on ASCO’s own sponsored manpower needs study, shouldn’t the organization be discussing ways to consolidate programs rather than filling more seats?

About now, I imagine someone at ASCO is thinking about drafting a letter that I have no space or inclination to publish. It is important that the organization understand that I take no glee in addressing this issue and that I am as much, if not more, committed to excellence in optometric education as they are. I know that some within ASCO understand the serious challenges our profession faces, but others, especially those with programs that would be reduced or eliminated if common sense prevailed, seem firmly invested in rearranging the deck chairs on the Titanic. The simple reality is that some who should be leaders are completely out of touch with the reality of the profession today and the bleakness of its future if things aren’t fixed.

More and more of us realize that our profession is facing a crisis. Among the biggest challenges the profession faces is a serious leadership vacuum. The days of Borish, Haffner and Adm. Sullins are past, but we need leaders with their vision and strength today. We can begin with organizations showing leadership by starting to think about the needs of the profession and our patients rather than their own self interests.

Arthur B. Epstein, OD, FAAO
Chief Medical Editor


Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com.

The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Medical Information LLC (JMI), or any other entities or individuals.


Effect of Topical Prostaglandins on the Biomechanics and Shape of The Cornea
This study investigated the effect of topical prostaglandin (PG) eye drops on the biomechanics and shape of the cornea. Consecutive patients with primary open-angle glaucoma who had been treated with the same anti-glaucoma PG (114 eyes, 57 patients) or β-blocker (36 eyes, 18 patients) eye drops in one eye alone for more than three months at Inouye Eye Hospital or Miyata Eye Hospital. The biomechanical properties of the cornea were measured using a Corvis ST device (Oculus, Wetzlar, Germany). Corneal tomography was measured with a Casia 1 or 2 (Tomey Corp.,). The biomechanical parameters and tomographic features of the cornea were compared between PG-treated eyes, β-blocker-treated eyes, and contralateral eyes using a mixed-effect model adjusted for intraocular pressure and corneal thickness; and a linear model adjusted for age, sex, intraocular pressure and corneal thickness.

The PG-treated eyes had a significantly smaller applanation 1 time, the highest concavity radius and a larger deformation amplitude than the contralateral eyes. Also, the PG-treated eyes had a significantly smaller applanation 1 time and applanation 2 velocity, but a larger peak distance than the β-blocker-treated eyes. There were no significant differences in any of the Casia parameters between the PG-treated eyes and the contralateral eyes.

The results of this study suggested that topical PG made biochemical changes to the cornea but did not alter its shape.

SOURCE: Amano S, Nejima R, Inoue K, et al. Effect of topical prostaglandins on the biomechanics and shape of the cornea. Graefes Arch Clin Exp Ophthalmol. 2019; Aug 10. [Epub ahead of print].

The Effect of Multiple Vitrectomies and its Indications on Intraocular Pressure
This study assessed the relationship between different indications for trans pars plana vitrectomies (PPVs) and intraocular pressure (IOP), and the effect of multiple PPVs on the IOP. Researchers also examined whether there were differences in the number of IOP-lowering medications or surgeries before and after PPV. A retrospective study including all patients that underwent at least one PPV in the period from 2001 to 2014 at a clinic. Medical records of all patients were reviewed, and clinically relevant data were entered in a database. Generalized estimating equation models for repeated measurements were used to examine the effect of the number of PPVs on the IOP and the risk of undergoing glaucoma surgery, for each of the indications for PPV.

Of 1,072 PPVs, 447 eyes fulfilled the inclusion criteria. The IOP increased with 3mm Hg after a PPV with indication of retinal detachment, but remained stable after PPV for epiretinal membrane, macular hole and vitreous hemorrhage. At the end of the follow-up period, the number of IOP-lowering medications was significantly higher compared with baseline, except in the macular hole group. Also, the number of eyes that underwent glaucoma surgery was significantly higher compared with the fellow (non-operated) eyes. There was a significant association between the number of PPVs and the final IOP for the indication of retinal detachment, and between the number of PPVs and glaucoma surgery (odds ratio [95% confidence interval]: 2.60 [1.62-4.15]).

Researchers found that the IOP rose significantly after PPV with indication of retinal detachment. This association was not found for other indications for PPV. Also, the risk of IOP-lowering surgeries was higher after PPV, but not different between the PPV indications. Researchers suggested that IOP should be monitored carefully after PPV, since there might be a higher risk of secondary glaucoma.

SOURCE: Kovacic H, Wolfs RCW, Kılıç E, et al. The effect of multiple vitrectomies and its indications on intraocular pressure. BMC Ophthalmol. 2019;19(1):175.



Accuracy of Computer-assisted Vertical Cup-to-disk Ratio Grading for Glaucoma Screening
Glaucoma screening can be performed by assessing the vertical-cup-to-disk ratio (VCDR) of the optic nerve head from fundus photography, but VCDR grading is inherently subjective. This study investigated whether computer software could improve the accuracy and repeatability of VCDR assessment. In this cross-sectional diagnostic accuracy study, five ophthalmologists independently assessed the VCDR from a set of 200 optic disk images, with the median grade used as the reference standard for subsequent analyses. Eight non-ophthalmologists graded each image by two different methods: by visual inspection and with assistance from a custom-made publicly available software program. Agreement with the reference standard grade was assessed for each method by calculating the intraclass correlation coefficient (ICC), and the sensitivity and specificity determined relative to a median ophthalmologist grade of ≥0.7.

VCDR grades ranged from 0.1 to 0.9 for visual assessment and from 0.1 to 1.0 for software-assisted grading, with a median grade of 0.4 for each. Agreement between each of the eight graders and the reference standard was higher for visual inspection (median ICC, 0.65; interquartile range, 0.57 to 0.82) than for software-assisted grading (median ICC, 0.59; IQR, 0.44 to 0.71, Wilcoxon signed-rank test). Visual inspection and software assistance had similar sensitivity and specificity for detecting glaucomatous cupping.

Investigators wrote that the computer software used in this study did not improve the reproducibility or validity of VCDR grading from fundus photographs compared with simple visual inspection. More clinical experience was correlated with higher agreement with the ophthalmologist VCDR reference standard.

SOURCE: Snyder BM, Nam SM, Khunsongkiet P, et al. Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. PLoS One. 2019;14(8):e0220362.

News & Notes
MyopiaCare Welcomes New Members
Pascal Blaser, founder of MyopiaCare, an online educational platform for myopia specialists and parents, welcomed the following new team members.
Ross Grant BSc (Hons), MSc, FCOptom, PDipM, joined as chief business development officer. Grant trained as an optometrist at Aston University, Birmingham, UK, and has more than 40 years experience in clinical practice, academia, research, marketing and general management.
Thomas Aller, OD, FBCLA, joined as a clinical advisor. Dr. Aller has been researching for the past 27 years the use of bifocal contacts for the control of myopia. After receiving the world’s earliest patent for a method of myopia progression control, he collaborated for 10 years with Brien Holden and the Vision CRC on their anti-myopia program. Dr. Aller is currently conducting clinical trials on myopia management with an EDOF multifocal contact lens as well as an anti-hyperopia multifocal lens design.
Oliver Woo, Optometrist UNSW, FIAOMC, joined as a clinical consultant. A University of New South Wales Australia graduate, Dr. Woo’s special interests are pediatric optometry, myopia prevention and control contact lens fitting with orthokeratology and specialty contact lenses. In 2007, Dr. Woo became the first Australian fellow of International Academy of Orthokeratology and Myopic Control, and opened an orthokeratology and myopic control clinic in 2010.
Giancarlo Montani, Optometrist FIACLE, FBCLA, joined as a clinical advisor. He is professor of clinical contact lens application at the University of Salento, Lecce, Italy. In 2007, Professor Montani co-founded the Centre for Contact Lens Research of the University of Salento.
MyopiaCare, founded in 2015, is an online platform developed to educate parents and support eye care specialists in their fight against myopia.



Optometric Physician™ Editorial Board

Chief Medical Editor
Arthur B. Epstein, OD, FAAO

Journal Reviews
Shannon Steinhäuser, OD, FAAO

Contributing Editors
• Katherine M. Mastrota, MS, OD, FAAO
• Barry A. Weissman, OD, PhD, FAAO (Dip CL)

Editorial Board
• William Jones, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO



Optometric Physician™ (OP) newsletter is owned and published by Dr. Arthur Epstein. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add Optometricphysician@jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Optometric Physician.

E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

For information on advertising in this e-mail newsletter or other creative advertising opportunities with Optometric Physician, please click here for advertising information.