Optometric Physician

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


Volume 19, Number 36

Monday, September 9, 2019


Inside this issue: (click heading to view article)
######### Off the Cuff: Ray and Perry Brill and Eyetrepreneur
######### Bilateral Viral Keratitis Following Corneal Collagen Crosslinking for Progressive Keratoconus
######### Slit-lamp Based Assessment of Peripheral vs. Central Regions of the Human Corneal Endothelium
######### Risk Factors Associated with Contamination of Orthokeratology Lens Cases
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Ray and Perry Brill and Eyetrepreneur

I’ve known Ray Brill for many years. Practicing in Kansas City at Brill Eye Center, he is among the most innovative and forward-thinking colleagues I know. To me, Ray represents a lot of what’s good about optometry and, for that matter, what’s good about people in general. Ray has an inquisitive mind, excellent clinical skills and a good business head. I imagine he doesn’t let a day go by without learning something new that he’s either figured out on his own or gleaned from someone else. The best thing about Ray is his even mix of curiosity and generosity.

Working closely with Ray is his son Perry. I don’t know Perry as well or as long, but it is pretty clear that the apple has not fallen far from the tree. Together Ray and Perry have created Eyetrepreneur, a podcast that captures the essence of the entrepreneurial spirit that has defined the best of independent optometric practice since the profession’s inception.

Ray was kind enough to invite me to be interviewed when he first launched it, but as is so often the reality of my life, I was busy, buried in the practice or flying across the country doing what I do best—being busy. Finally, relatively early (for me) one Sunday morning, it came time to fulfill my promise, and I joined Ray and Perry for Eyetrepreneur Podcast #8

Ray and Perry told me they thought the recording went really well, but I actually don’t like listening to myself, so, it took 20 episodes after the podcast was recorded before I finally sat down and listened to it. Ray and Perry are excellent hosts and skilled interviewers. Aside from some Sunday morning grogginess and a microphone level set a bit too high that made me sound asthmatic, the podcast captures my approach to managing dry eye in amazing depth. Interesting to me is how much my perspective has changed over just a few short months, but what I shared can help just about anyone create a successful dry eye practice. So, if you are considering a greater dry eye focus in your practice, it’s definitely worth a listen.

The Eyetrepreneur episodes cover a broad expanse of our field. With my dry eye focus, I have special interest in Episode 1 with the innovative Dr. Allan Panzer, Episode 18 with the brilliant Dr. Laura Periman and Episode 25, an in-depth interview with Anu Chiarelli, a Canadian dry eye patient and advocate that I had the pleasure of treating when she was in Phoenix.

I recommend that you check out Eyetrepreneur. I think you’ll understand why Ray is a one of the colleagues whose opinions and perspective I value the most.

Reminder: Filling up fast. Join me, Laura Periman and Doug Devries for dinner at Vision Expo West. We'll be covering the latest innovations in IPL and management of dry eye at Bouchon Thurs at 6 PM. Register here.

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.


Bilateral Viral Keratitis Following Corneal Collagen Crosslinking for Progressive Keratoconus
Corneal collagen crosslinking has been proven to be a useful technique to slow the progression of keratoconus. With its increasing use, we are encountering rare complications. We describe a case that developed bilateral viral keratitis after corneal collagen crosslinking with riboflavin and ultraviolet A for progressive keratoconus.

An 18-year-old boy underwent corneal collagen crosslinking in both eyes at the same setting for bilateral progressive keratoconus. He was discharged with a soft bandage contact lens and asked to follow up in five days. Seven days later, the patient returned with severe pain, redness and photophobia for the last two days. The bandage contact lens was removed. There was a central corneal lesion in a branching dendritic pattern in both eyes and reduced corneal sensation. Based on the findings, a clinical diagnosis of bilateral viral keratitis was made. The dendrite healed completely in 10 days with oral and topical acyclovir treatment. The cornea had a faint scar at one month follow-up with best-corrected visual acuity of 20/30 in both eyes with a rigid gas permeable lens.

Researchers concluded that ultraviolet A light could be a stimulus to trigger reactivation of latent HSV even in patients with no prior clinical history of herpes ocular infections. Early diagnosis and timely treatment can have good visual outcomes. Prophylactic antiviral medication may be useful to prevent this complication in individuals with prior history of viral keratitis.

SOURCE: Sitaula S, Singh SK, Gurung A. Bilateral viral keratitis following corneal collagen crosslinking for progressive keratoconus. J Ophthalmic Inflamm Infect. 2019;9(1):16.

Slit-lamp Based Assessment of Peripheral vs. Central Regions of the Human Corneal Endothelium
These researchers compared the central and peripheral (<2mm from the limbus) endothelial regions of the human cornea of young contact lens (CL) neophytes, in terms of endothelial cell density (ECD), polymorphism through cell hexagonality (HEX) and polymegethism through the coefficient of variation of cell areas (CoV). In vivo, central, temporal, and nasal ECDs, HEXs and CoVs were determined for 30 healthy right eyes (age: 22 to 30 years) using a Takagi 700 G L LED slit-lamp biomicroscope equipped with the centre-dot EndoKer© for the analysis of endothelium images.

The mean central ECD (2,586 ±233 mm-2) was lower than peripheral ECDs (nasal 2,733 ± 225 mm-2, temporal 2674 ±260 mm-2) (p=0.03 and p=0.02, respectively). The mean central HEX (53 ±4.6%) was lower than peripheral HEXs (nasal 57.2 ±4.3%, temporal 57.1 ±4.5%) (both p<0.005), while the mean central CoV (28.2 ±2.5%) was higher than peripheral CoVs (nasal 25.8 ±2.2%, temporal 26.1 ±2.2%) (both p≤ 0.001).

In young healthy non-CL wearers, the peripheral corneal endothelium displayed a higher ECD and significantly better cell regularity (higher HEX and lower CoV) compared with the central cornea. Investigators wrote that the findings suggested that a clinical evaluation of the corneal endothelium requires a full characterization of the different areas.

SOUTH: Tavazzi S, Cozza F, Colciago S, et al. Slit-lamp based assessment of peripheral versus central regions of the human corneal endothelium. Cont Lens Anterior Eye. 2019; Aug 28. [Epub ahead of print].



Risk Factors Associated with Contamination of Orthokeratology Lens Cases
Orthokeratology Ortho-k patients attending the contact lens clinic of a hospital were required to complete a checklist about their routine daily care and handling of lens cases to evaluate the risk factors associated with contamination of lens cases in a group of ortho-k lens wearers. Their cases were then collected for analysis. Contamination was evaluated by determining the optical density (OD) of crystal violet stained biofilm present in the cases. OD values were divided into three groups: lower, middle and upper tertiles, and associations between risk factors were determined by multivariate analysis.

A total of 194 subjects were recruited. Twenty-five subjects used cylindrical lens cases (CC), 98 flat cases with ridges (FCR) and 71 flat cases without ridges (FC). FCRs were the most heavily contaminated, and CC showed least contamination (FCR > FC, OR 2.16; CI, 1.11 to 4.18; p=0.023; FCR > CC, OR 8.86; CI, 2.97 to 26.44; p<0.001; FC > CC, OR 2.33; CI, 1.35 to 12.45; p= 0.013). Replacing lens cases monthly significantly reduced the risk of high contamination (OR 0.013; CI, 0.06-0.30; p< 0.001), compared to those used for three months. Cases that were not rinsed (OR 3.44; CI, 1.50 to 7.86, p=0.003) or rinsed by other methods (OR 4.07; CI, 1.67 to 9.92; p=0.002) had significantly more contamination, compared to those rinsed with multipurpose solution. Lens cases, which were not dried (OR 11.36; CI, 2.06 to 62.93, p=0.005) or air-dried (OR 8.71; CI, 1.16 to 65.56; p=0.036), showed more contamination compared to those wiped with tissue daily.

The study revealed that case design (cylindrical), monthly replacement, daily rinsing with MPS and wiping with tissue daily can effectively reduce biofilm formation in contact lens cases.

SOURCE: Wang J, Liu L, Boost M, et al. Risk factors associated with contamination of orthokeratology lens cases. Cont Lens Anterior Eye. 2019; Aug 26. [Epub ahead of print].

News & Notes
2019 American Academy of Optometry Student Travel Fellowship Recipients Announced
The American Academy of Optometry announced the recipients of the 2019 Student Travel Fellowship Awards. These travel fellowships allow students to attend Academy 2019 Orlando and 3rd World Congress of Optometry, Oct. 23-27. View the recipients.

AAOF Announces 2019 Bert C. and Lydia M. Corwin Contact Lens Residency Award recipient, 2019 AAOF Student Travel Fellowship Recipients, Johnson & Johnson Residency Award Recipients
The American Academy of Optometry Foundation announced Jocelyn Ou, OD, as this year’s recipient of the Bert C. and Lydia M. Corwin Contact Lens Residency award. Dr. Ou is a cornea and contact lens resident at the Ketchum Health University Eye Center.. Read more.
In addition, the AAOF announced the recipients of the 2019 AAOF Student Travel Fellowships. Each recipient will receive a travel grant to attend Academy 2019 Orlando and 3rd World Congress of Optometry. View the recipients.
Furthermore, the AAOF announced the recipients of the 2019 Johnson & Johnson Vision Residency Awards. View the recipients.

MST Introduces Scleral IOL Fixation Solutions Pack
MicroSurgical Technology’s latest offering streamlines the double-needle scleral IOL fixation technique with several new instruments conveniently packaged to support the procedure end-to-end. The offering integrates all the necessary instrumentation into a single-packaged solution, enabling the procedure to be performed efficiently. Read more.

Research Demonstrates Reliability of RightEye’s Eye Tracking Data
RightEye announced the results from a recent study published in the peer-reviewed journal Concussion that shows how RightEye’s FDA-cleared technology accurately measured deficits in certain eye movements that result from a concussion. The data provided by RightEye eye tracking technology offered an objective, reliable and quantifiable way of differentiating between individuals with different severities of concussion, as well as providing guidance on the path to recovery. Read more.

Allegro to Present Phase II Risuteganib Intermediate Dry AMD Study at EURETINA Congress & The Retina Society Annual Meeting
Allegro Ophthalmics announced that results of its U.S. Phase II study evaluating risuteganib (Luminate) for the treatment of intermediate nonexudative age-related macular degeneration will be presented during the 19th European Society of Retina Specialists (EURETINA) Congress being held Sept. 5-8 in Paris, and at The Retina Society 2019 Annual Meeting, which is being held Sept. 11-15 in London. In June, Allegro announced topline results of the risuteganib Phase II intermediate dry AMD clinical trial, which met its primary endpoint with 48 percent of patients in the risuteganib arm at week 28 gaining ≥8 letters in visual acuity from baseline, compared with 7 percent of patients in the sham group at week 12 (p=0.013). Risuteganib was found to be safe with no reported drug related serious adverse events. Read more.



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



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