Optometric Physician

Vol. 21, #17   •   Monday, April 26, 2021


Off the Cuff: Opportunity Lies Right Beneath Those Droopy Eyelids

As part of a profession that focuses so intensely on the eyes, I sometimes wonder how many of us actually look at our patients’ faces. We view ourselves in the mirror every day, and while familiarity would seem to breed acceptance, I recently became shockingly aware of just how many of our patients are unhappy with the way their eyes look. While we gladly accept our role in making our patients see better, as a profession, we have almost completely ignored the opportunity to make our patients’ eyes look better.

Many of you are probably aware of a new Rx eyedrop for acquired blepharoptosis called Upneeq. Launched by RVL Pharmaceuticals a few months back, the drug initially confused me and seemed to be a solution in search of a problem. That was until one of my patients asked me about it. This was a dry eye patient who was undergoing IPL. After finishing the procedure, while my tech was removing her gel and eye shields, she mentioned Upneeq and asked if I had heard of it. When I asked why she was interested in it, she mentioned that she had long been distressed by her sleepy-looking lids and became aware of the drop on social media.

I explained that I was quite familiar with Upneeq and actually had samples in the office. A minute later, with a drop in each eye, I asked why she never shared any of her lid concerns with me. Her answer was surprising. She said she didn’t think I could do anything to help her and didn’t relish the idea of surgery as an option. Mind you that this was the very first time that I had any idea that what I saw as a minor and insignificant amount of ptosis was such a big issue for her.

Her lids quickly lifted and I literally watched her face transform. As she began to leave the exam room, I had her look in the mirror and asked what she thought. She literally shrieked with delight and then started crying. She was so happy that it filled the room. That moment remains an important reminder of how easy it is to miss important things.

Over the following weeks, other patients started to ask about Upneeq. Initially confused by the increased interest, I finally figured out its source. The mild ptosis that we write off as normal or insignificant is important to many of our patients. And while most of us continue to ignore a bit of lid droop, interest in addressing it is skyrocketing among our patients. The March issue of Elle Magazine ran the article “Can This Eye Drop Make You Look Dramatically More Awake?” The cover story in the April issue of Vogue was “Can a New Eye Treatment Deliver a Lid Lift in a Bottle?” Uqneeq is all over social media, and the buzz is only increasing.

At a time when the landscape of eye care is changing, when we face increased competition from commercial forces that are trying to blur the lines between patient and consumer, having an easily prescribed Rx eyedrop that can transform a patient in front of their own eyes is a powerful tool, not just for meeting our patient’s needs, but for our profession’s survival. Don’t underestimate the power of looking awake.


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.



Bilateral Angle-closure During Hospitalization for Coronavirus Disease-19 (Covid-19): A Case Report

This report described a case of bilateral primary angle closure (PAC) progressing to unilateral end-stage primary angle-closure glaucoma (PACG) associated with treatment for coronavirus disease-19 (COVID-19) infection. A 64-year-old man came to the attention of investigators because of blurred vision after a two-month hospital stay for treatment of COVID-19 infection. Examination findings revealed PACG, with severe visual impairment in the right eye and PAC in the left eye due to plateau iris syndrome. The patient's severe clinical condition and prolonged systemic therapy masked the symptoms and delayed the diagnosis. Medical chart review disclosed the multifactorial causes of the visual impairment. Ultrasound biomicroscopy (UBM) aided in diagnosis and subsequent therapy.

The cause behind the primary angle closure and the iridotrabecular contact was eliminated by bilateral cataract extraction, goniosynechialysis and miotic therapy.

Investigators found that COVID-19 treatment may pose an increased risk for PAC. Accurate recording of patient and family ophthalmic history is essential to prevent its onset. Recognition of early signs of PAC is key to averting its progression to PACG.

SOURCE: Barosco G, Morbio R, Chemello F, et al. Bilateral angle-closure during hospitalization for coronavirus disease-19 (COVID-19): A case report. Eur J Ophthalmol. 2021; Apr 22. Epub ahead of print].




Quarter of a Century of Contact Lens Prescribing Trends in the United Kingdom (1996 - 2020)

An annual survey of contact lens prescribing was conducted each year from 1996 to 2020. It asked a random selection of optometrists and contact lens opticians to provide information relating to 10 consecutive contact lens fits between January and March, to document contact lens prescribing trends in the United Kingdom over the past quarter of a century.

Over the 25-year survey period, 2,671 practitioners returned survey forms, reporting a total of 25,575 contact lens fits. The mean (± standard deviation) age of lens wearers was 35 ± 15 years, of which 64% were female.

Over the survey period, rigid lens new fits decreased from 22% to 2%. The prescribing of silicone hydrogel lenses increased steadily since their introduction toward the end of the 1990s, and now represent 80% of soft lens fits. Soft toric lens prescribing has gradually increased to 47%--a value at which astigmatism ≥0.75DC is theoretically corrected in all contact lens wearers. Daily disposable prescribing increased steadily over the survey period and now represents 63% of lenses prescribed. Extended wear fits remain at very low levels, except for some prescribing for overnight orthokeratology. Multipurpose lens care solutions are ubiquitous; peroxide and other systems are now seldom prescribed. Rigid lenses and monthly replacement soft lenses are predominantly worn on a full-time basis, whereas daily disposable soft lenses are mainly worn part time.

This report documented the evolution of contact lens fitting in the United Kingdom over the past 25 years. The most likely lens fit is a spherical design silicone hydrogel daily disposable contact lens prescribed for a 35-year old female and worn on a part-time basis.

SOURCE: Morgan PB, Efron N. Quarter of a century of contact lens prescribing trends in the United Kingdom (1996 - 2020). Cont Lens Anterior Eye. 2021; Apr 13. [Epub ahead of print].



Keratoconus in Africa: A Systematic Review and Meta-analysis

The aim of this review was to evaluate the prevalence of and factors associated with keratoconus in Africa. A systematic online literature search and meta-analysis was conducted for keratoconus in Africa. The Freeman-Tukey double arcsine transformation was used to minimize the effects of studies with extremely high or low prevalence estimates on the overall pooled estimates. Leave-one-out sensitivity analysis was used to assess the robustness of the pooled effects and potential outliers. Meta-regression was performed to explore associations between keratoconus, gender and age.

Twelve studies were included in the review: five from Egypt, two from South Africa, two from Kenya, one from Sudan, one from Ghana and one from Nigeria. Two studies were conducted in allergic conjunctivitis patients, four in keratoconus patients, one in contact lens service seekers, one in pre-LASIK patients, one in refractive patients and one in a student population. Eight studies were included in the meta-analysis. The overall prevalence estimate of keratoconus in Africa was 7.9% (95% CI: 2.5% to 16.0%). The prevalence of keratoconus among males and females in Africa was estimated to be 9.3% (95% CI: 2.5% to 19.5%) and 5.8% (95% CI: 1.5% to 12.7%) respectively. The estimated prevalence of unilateral and bilateral keratoconus was 2.6% (95% CI: 0.4% to 6.5%) and 5.8% (95% CI: 1.6% to 12.3%), respectively. The estimated prevalence of mild keratoconus was 2.2% (95% CI: 0.7% to 4.7%), moderate keratoconus was 3.5% (95% CI: 0.0% to 11.8%) and severe keratoconus was 4% (95% CI: 0.0% to 19.6%). There was no significant association between gender and the prevalence of keratoconus in Africa (p=0.63), and age and the prevalence of keratoconus in Africa (p=0.78).

The estimated prevalence of keratoconus reported in Africa was higher than prevalence values reported in other meta-analyses or different geographical locations. Researchers suggested this was mainly because studies included in this meta-analysis were either conducted on a cohort at high risk of keratoconus or a population with a high possibility of finding keratoconus patients. They added that a dearth of well-designed population-based studies exist on keratoconus in Africa, resulting in a lack of epidemiological information. They added further that this finding highlights the urgent need for research on keratoconus in Africa.

SOURCE: Akowuah PK, Kobia-Acquah E, Donkor R, et al. Keratoconus in Africa: A systematic review and meta-analysis. Ophthalmic Physiol Opt. 2021; Apr 16. [Epub ahead of print].





Industry News

J&J Vision Introduces Acuvue Abiliti to Address Myopia in Children, Reinforces Sustainability Commitment

Johnson & Johnson Vision announced Acuvue Abiliti—a new brand for future products and services to help parents and eye care providers address the growing prevalence and progression of myopia in children. Abiliti will provide parents and eye care providers with comprehensive resources, including products and services, to address the progression of myopia in children. Each annual purchase of an Abiliti product will provide a free comprehensive eye health exam to a child in need through Sight for Kids—a joint program from Johnson & Johnson Vision and the not-for-profit program from the Lions Clubs International Foundation. Sight for Kids is one of the largest-known, school-based eye health programs that mobilizes Lions and eye care professionals to provide comprehensive eye health services in low-income schools around the world. Read more.
In addition, the company signed a 10-year deal with JEA—the eighth largest community-owned electric and water utility, serving Northeast Florida—to use 100% of electricity at its global headquarters in Jacksonville, Fla., from solar power. The agreement reinforces the company’s commitment to sourcing 100% of its electricity from renewable sources by 2025, and to achieve carbon neutrality across all its operations by 2030, as part of the company’s global climate goals. Read more.








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