Optometric Physician

Vol. 21, #15   •   Monday, April 12, 2021


Off the Cuff: The AOA and Seeing the Future

COVID has been an incredibly wild ride. For some, it was tragic loss, for others, an opportunity to reinvent themselves. I’ve been a member of the AOA for more than four decades. I’ve been a volunteer and served as chair of the Contact Lens and Cornea Section. I’ve addressed Congress on behalf of the AOA, and I’ve represented the AOA on Good Morning America. The organization has had its ups and down, and much like the profession, its twists and turns. I’ve not always agreed with the AOA, but I have always supported it. The AOA is the lifeblood of our profession. Despite the challenges of COVID, the AOA has reinvented itself and is stronger today than ever.

Last week, I had the privilege of previewing a new AOA initiative that will help change how our profession is viewed by the public. See and Be Seen is an absolutely brilliant new AOA program, that shares optometry’s story through the eyes of our patients. It underscores optometry’s commitment to caring for vision and eye health, and shines a bright light on the difference we make in our patients’ lives. See and Be Seen also reinforces the critical importance of in-person eye examinations at a time when commercial interests are trying to blur the differences between a real eye examination conducted by a skilled and knowledgeable optometrist, and what is essentially an online acuity check.

The program kicks off this month with Eye Deserve More, a year-long, consumer-focused effort in partnership with USA Surfing and Olympic-bound professional surfer Caroline Marks. It effectively elevates the conversation around the important role doctors of optometry play in managing our nation’s health. Caroline is perhaps the perfect ambassador for our profession, especially during still challenging times.

I was directly involved in the AOA’s extremely successful public health and PR initiative during the Fusarium outbreak of 2006. The AOA response dramatically changed how the profession was seen by the public. I believe that See and Be Seen will easily be an order of magnitude more powerful in showcasing how optometry has evolved into the primary eye care profession in the US today and its important role within the healthcare system.

The impact of See and Be Seen will not only be felt in our offices, but its clear message will resonate for years to come in legislatures throughout the country. I suspect that it will change not only the way we see ourselves, but the way our adversaries see and are forced to deal with us.

I am excited to see this rollout over the next 12 months, and I am certain you will be, too. Sincere thanks to Jon Hymes, AOA executive director; Deirdre Middleton, AOA chief communications officer; and Bill Reynolds, AOA president, and the AOA’s Board of Trustees for their strong commitment to this extraordinarily clear vision of what our profession is all about.


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 Jobson Medical Information LLC (JMI), or any other entities or individuals.



Evaluation of Shared Genetic Susceptibility to High and Low Myopia, and Hyperopia

Uncertainty currently exists about whether the same genetic variants are associated with susceptibility to low myopia (LM) and high myopia (HM), and to myopia and hyperopia. Addressing this question is fundamental to understanding the genetics of refractive error and has clinical relevance for genotype-based prediction of children at risk for HM and for identification of new therapeutic targets. To assess whether a common set of genetic variants are associated with susceptibility to HM, LM and hyperopia, this genetic association study assessed unrelated UK Biobank participants 40 to 69 years of age of European and Asian ancestry. Participants 40 to 69 years of age living in the United Kingdom were recruited from January 1, 2006, to October 31, 2010. Of the total sample of 502,682 participants, 117,279 (23.3%) underwent an ophthalmic assessment. Data analysis was performed from December 12, 2019, to June 23, 2020. Four refractive error groups were defined: HM, -6.00 diopters (D) or less; LM, -3.00 to -1.00 D; hyperopia, +2.00 D or greater; and emmetropia, 0.00 to +1.00 D. Four genome-wide association study (GWAS) analyses were performed in participants of European ancestry: (1) HM vs emmetropia, (2) LM vs emmetropia, (3) hyperopia vs emmetropia and (4) LM vs hyperopia. Polygenic risk scores were generated from GWAS summary statistics, yielding four sets of polygenic risk scores. Performance was assessed in independent replication samples of European and Asian ancestry.

A total of 51,841 unrelated individuals of European ancestry and 2,165 unrelated individuals of Asian ancestry were assigned to a specific refractive error group and included in the analyses. Polygenic risk scores derived from all four GWAS analyses were predictive of all categories of refractive error in both European and Asian replication samples. For example, the polygenic risk score derived from the HM vs. emmetropia GWAS was predictive in the European sample of HM vs. emmetropia (OR, 1.58; 95% CI, 1.41 to 1.77; p=1.54 × 10-15) as well as LM vs. emmetropia (OR, 1.15; 95% CI, 1.07 to 1.23; p=8.14 × 10-5), hyperopia vs. emmetropia (OR, 0.83; 95% CI, 0.77 to 0.89; p=4.18 × 10-7) and LM vs hyperopia (OR, 1.45; 95% CI, 1.33 to 1.59; p=1.43 × 10-16).

Genetic risk variants were shared across HM, LM and hyperopia, and across European and Asian samples. Individuals with HM inherited a higher number of variants from among the same set of myopia-predisposing alleles and similar risk alleles compared with individuals with LM. Researchers wrote that these findings suggested that treatment interventions targeting common genetic risk variants associated with refractive error could be effective against both LM and HM.

SOURCE: Tideman JWL, Pärssinen O, Haarman AEG, et al; UK Biobank Eye and Vision Consortium and the Consortium for Refractive Error and Myopia (CREAM Consortium). Evaluation of shared genetic susceptibility to high and low myopia and hyperopia. JAMA Ophthalmol. 2021; Apr 8. [Epub ahead of print].




Optical Coherence Tomography Angiography Artifacts in Glaucoma

To determine the prevalence of different types of artifacts seen in optical coherence tomography angiography (OCTA) images of healthy and glaucoma eyes and to evaluate the characteristics associated with the increased likelihood of obtaining poor quality images, a total of 649 eyes of 368 healthy, glaucoma suspect and glaucoma patients underwent Angiovue high density (HD) and non-HD optic nerve head and macula OCTA. Images of participants were evaluated by four expert reviewers for the presence of different artifacts including eye movement, defocus, shadow, decentration, segmentation error, blink and Z offset in the superficial vascular layer. Each OCTA scan was designated to have good or poor quality based on the presence of artifacts. The association of demographic and ocular characteristics with the likelihood of obtaining poor-quality OCTA images was evaluated using a generalized linear mixed model. The main outcome measures included the prevalence of OCTA artifacts and the factors associated with increased likelihood of capturing poor-quality OCTA images.

A total of 5,263 OCTA images were evaluated. Overall, 33.9% of the OCTA images had poor quality. The majority of images with acceptable quality scores (QS>=4) had no artifacts (76.6%). Other images had one (13.6%) or two or more artifacts (9.8%). Older age, male gender, worse visual field mean deviation, absence of eye tracking and macular scan area were associated with a higher likelihood of obtaining poor quality images. In images with acceptable QS, the commercially available quality measures including QS and signal strength index had the area under the receiver operating characteristic curves of 0.65 (95% CI: 0.62, 0.69) and 0.70 (95% CI: 0.68, 0.73), respectively, to detect good quality images.

Investigators wrote that OCTA artifacts associated with poor-quality images were frequent, and their prevalence was affected by ocular and patient characteristics. They suggested that clinicians should not rely solely on the quantitative assessments provided automatically by OCTA instruments and that a systematic scan review should be conducted to ensure appropriate interpretation of OCTA images. Furthermore, investigators wrote, given the high prevalence of poor-quality OCTA images, images should be reacquired whenever an apparent and correctable artifact is present on a captured image.

SOURCE: Kamalipour A, Moghimi S, Hou H, et al. Optical coherence tomography angiography artifacts in glaucoma. Ophthalmology. 2021; Apr 2. [Epub ahead of print].



One-year Results of Health- and Vision-related Quality of Life after Clear Lens Extraction and Multifocal IOL Implantation

Multifocal intraocular lenses (MIOLs) are effective in treating presbyopia before cataracts develop. This study measured health-related quality of life (HRQoL) and vision-related quality of life (VRQoL) factors after clear lens extraction (CLE) and MIOL implantation. Patients were treated in Medilaser Coronaria, CorGroup, Oulu, Finland. HRQoL was measured by a generic 15-dimension (15D) instrument. VRQoL was measured with VF-14 questionnaire.

CLE and MIOL implantation were performed in 137 patients. The patient age was 57 ± 6.2 years (mean ± standard deviation), and 58% were women. The near add was 2.1 ± 0.3 diopters. The overall HRQoL 15D score increased from 0.938 ± 0.058 to 0.955 ± 0.057 at six months (p<0.0001 vs. baseline) and to 0.948 ± 0.060 at one year (p=0.02 vs. baseline). The VRQoL VF14 score increased from 85.32 ± 15.57 to 96.57 ± 5.07 at six months (p<0.0001 vs. baseline) and to 96.61 ± 6.48 at one year (p<0.0001 vs. baseline). The increase of HRQoL was correlated with the increase of VRQoL (p<0.04).

Researchers found that CLE and MIOL implantation improved HRQoL and VRQoL compared to spectacles in this one-year follow-up study. Improvement of HRQoL was correlated with VRQoL.

SOURCE: Viljanen A, Koskela K, Koskela H, et al. One-year results of health-related and vision-related quality of life after clear lens extraction and multifocal iol implantation. Am J Ophthalmol. 2021; Apr 3. [Epub ahead of print].





Industry News

J&J Vision Announces Global Collaboration with Menicon to Address Myopia in Children

Johnson & Johnson Vision announced a global strategic collaboration with Menicon, a manufacturer of innovative contact lenses. The collaboration is part of a broader commitment from Johnson & Johnson Vision to bring forward a novel portfolio of products and services to manage the progression of myopia in children. As part of the collaboration, Menicon will develop and manufacture therapeutic contact lenses to help manage myopia progression in children, and Johnson & Johnson Vision will focus on increasing availability of the lenses around the world. Learn more.




ISVA and Zyloware Offer Educational Resource on Importance of Eye Protection in Sports/Recreational Activities

The International Sports Vision Association and Zyloware Eyewear launched “Protect. Prevent. Play.,” an educational resource designed to help eye care professionals educate parents, coaches, teachers, athletic trainers and athletes of all ages and skill levels about the importance of wearing appropriate protective eyewear to help reduce the chance of eye injury. This resource can be found on the ISVA website. View the resource.







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