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weekly e-journal by Art Epstein, OD, FAAO
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Off the Cuff: COVID-19 - An Unprecedented Healthcare Crisis
The outbreak of COVID-19 in the US has rapidly escalated into a health crisis of historical dimension. While the situation is evolving daily and its real severity obscured by a lack of test kits, like it or not, our frequent contact with patients puts on the front lines. It also creates clinical and patient management challenges. As bad as the situation is, fear and panic are a growing concern. Panic buying of water, toilet paper and a stock market in free fall underscore how bad things are. Without an end in sight and no precedent to use as a model, we need to control and manage what we can. Patient perception is an important part of it. Last week, I sent the following email to our entire staff: As news and hysteria about the viral outbreak increase, I expect our patients to be increasingly anxious about disease transmission. To reassure them, I want everyone to sanitize the equipment in sight of patients – not after the exam or before the patient is roomed. That means wash your hands when you enter the room, wipe down slit lamps, phoropters and other equipment and change chin rest paper in front of them. For other test equipment in screening areas disinfect all contact areas in front of the patient. Personal hygiene is more important now than ever before. The last thing we want is patients to start delaying or canceling appointments because they are too scared to come into the office. It is pretty obvious that the biggest issue most Americans will face is fear and panic, and it is important to do everything we can to make sure patients know that we are protecting them and have their backs. Let's discuss tomorrow to make sure we are on the same page. I also want to discuss how to manage patients that appear ill. We held a staff meeting the following day and have also started sanitizing high-touch areas in the office. Considering what has happened with consumer disinfecting products like wipes and hand sanitizer, I also ordered several months’ worth of essential supplies before they were no longer available. The last thing we want is to have to shut down the office because we ran out of sani-wipes and can’t purchase more.Although I don’t expect this outbreak to be as severe as some fear, it can drag on for a long time and impact patient volume. Anything we can do to reassure our patients is a step in the right direction. Be safe and stay healthy.
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Value of Routine Evaluation in Asymptomatic Soft Contact Lens Wearers | |||
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Limited literature supports the value of routine contact lens examinations. The purpose of this study was to document complications diagnosed when subjectively successful planned replacement soft contact lens patients were evaluated to renew their existing contact lens prescriptions. Asymptomatic soft contact lens patients who presented to the University Eye Center at Ketchum Health (Anaheim, Calif.), and the Eye and Vision Center at the Massachusetts College of Pharmacy and Health Sciences (Worcester, Mass.) for routine contact lens comprehensive exams to renew existing contact lens prescriptions were professionally evaluated and their complications documented. All subjects presented without complaint and had a history of subjectively successful planned replacement soft lens wear for at least one year. A total of 202 subjects were recruited from both sites (age range, 16 to 72 years; 76 male, 126 female; spherical contact lens optical power equivalent range: +7.75D to -19.25D). Considering health issues, 105 (52%) patients were found to exhibit at least one undiagnosed complication: 70% were diagnosed with contact lens driven ocular complications; 54% were diagnosed with non-contact lens driven ocular health issues; and 4% showed signs of undiagnosed systemic disease. Of note, complication prevalence increased to 72% overall if both contact lens fit issues and contact lens care compliance problems were included as complications in analysis. A striking ocular health and contact lens complication rate in asymptomatic soft contact lens wearers was demonstrated across two different study sites. This data suggested that asymptomatic, as well as symptomatic contact lens wearers require routine professional evaluations.
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SOURCE: Chen EY, Myung Lee E, Loc-Nguyen A, et al. Value of routine evaluation in asymptomatic soft contact lens wearers. Cont Lens Anterior Eye. 2020; Mar 4. [Epub ahead of print]. |
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Rebound Tonometry Measurements Over Extended-wear Bandage Contact Lenses | |||
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The aim of this study was to assess the validity of rebound tonometry measurements obtained over eyes wearing extended-wear bandage contact lenses with the highest oxygen transmissibility (Dk/t) value of 175 @ -3.00D. A total of 151 normal eyes were included in this prospective pretest-posttest study. A rebound tonometer (iCare PRO) was used to collect intraocular pressure readings from "naked" eyes (eyes without contact lenses) and the same eyes wearing extended-wear lotrafilcon A bandage contact lenses (Alcon Air Optix Night & Day Aqua Contact Lenses). The mean pre- and post-application values were pooled and compared using the paired t-test. The application of extended-wear lotrafilcon A contact lenses over normal eyes did not cause a statistically significant change in the intraocular pressure measurements obtained using an iCare PRO tonometer (13.74 ± 2.15 mmHg vs. 13.77 ± 2.26 mmHg). Based on this study conducted on normal eyes, the removal of extended-wear bandage contact lenses was not necessary when taking intraocular pressure measurements using the iCare PRO rebound tonometer. |
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SOURCE: Azarcon CP, Dela Cruz RC. Rebound tonometry measurements over extended-wear bandage contact lenses. Cont Lens Anterior Eye. 2020; Mar 7. [Epub ahead of print]. |
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Comparison of Microbiome Isolated from the Conjunctiva, Contact Lens and Lens Storage Case of Symptomatic and Asymptomatic Contact Lens Users | |||
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Contact lenses (CLs) are increasingly being used for cosmetic or therapeutic purposes. Lack of compliance and poor hygiene towards lens care are strongly associated with microbial contamination and have been proved to result in eye infections. The present study was done to compare the microbial flora between symptomatic and asymptomatic contact lens users. The study also attempted to analyze the contact lens hygiene practices of CL users. Six samples each were collected from both the eyes, CLs and lens cases of 40 CL users (n=240) divided into two groups based on symptoms present as asymptomatic CL users and symptomatic CL users. Organisms were identified using standard microbiological techniques. The proportion GNB obtained in symptomatic CL users was significantly higher when compared to asymptomatic CL users. In 56.2% eyes, the microbial flora of conjunctiva was similar to either the contact lens isolate/storage case. Enterococcal microbial keratitis was seen in one case. There was significant microbial contamination present in CL users despite compliance with contact lens hygiene practices. There were a significant number of bacteria present that were resistant to ampicillin, amoxicillin-clavulanate and cefotaxime in both the groups. |
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SOURCE: Raksha L, Shantala GB, Gangashettappa N, et al. Comparison of microbiome isolated from the conjunctiva, contact lens and lens storage case of symptomatic and asymptomatic contact lens users. Iran J Microbiol. 2019;11(5):349-356. |
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| News & Notes | ||||||||
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Kala Pharmaceuticals Announces Positive Topline Results for STRIDE 3 Trial Evaluating EYSUVIS Kala Pharmaceuticals announced positive topline results from STRIDE 3, a Phase III clinical trial evaluating KPI-121 0.25%, which Kala plans to commercialize under the brand name EYSUVIS (loteprednol etabonate ophthalmic suspension) 0.25%, for the treatment of dry eye disease. STRIDE 3 met both of its primary efficacy endpoints, demonstrating a statistically significant improvement in the symptom endpoint of ocular discomfort severity (ODS) at day 15 in the overall intent-to-treat (ITT) population (p=0.0002) and in the predefined subgroup of ITT patients with more severe ocular discomfort at baseline (p=0.0007). Statistical significance was also achieved in the key secondary endpoints of conjunctival hyperemia at day 15 in the ITT population (p<0.0001) and ODS at day eight in the ITT population (p=0.0282). Significant results were also observed for total corneal staining at day 15 in the ITT population (p=0.0042). EYSUVIS was well tolerated, with adverse events and intraocular pressure increases comparable to vehicle. Read more. |
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Registration Open for NORA Registration is now open for the Neuro-Optometric Rehabilitation Association, International Clinical Skills Pre-Conference (Sept. 10 to 11) and 29th annual General Conference (Sept. 12 to 13) at the Hyatt Regency Columbus in Columbus, Ohio. The Clinical Skills program provides 16 hours of continuing education and includes both hands-on and lecture style presentations with emphasis on integrated therapeutic approaches to rehabilitation. It offers three different levels that run concurrently and cannot be taken simultaneously. Register for the conference. |
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Zeiss Announces Change in Leadership Zeiss announced that, effective 1 May, Jim Mazzo will retire from his position as president ophthalmic devices and head of the ophthalmic devices strategic business unit. He will continue to support Zeiss as an advisor. Euan Thomson, PhD, will succeed Mazzo. Dr. Thomson is head of the digital business unit for Zeiss and will continue to guide digital activities. Before joining Zeiss in September 2019, Dr. Thomson served as president and CEO of Photoelectron, and president and CEO of Accuray, among other posts. Most recently, he led digital technology development for Johnson & Johnson Medical Devices. Read more. |
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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), 19 Campus Boulevard, Newtown Square, PA 19073. HOW TO ADVERTISE |