Optometric Physician

Vol. 21, #18   •   Monday, May 10, 2021


Off the Cuff: A Tale of Two Academies

There are times I find myself writing things that I really don’t want to write, but I feel compelled to because what I have to say is important, and if I don’t say it, it will likely remain unsaid. Last month, I received a copy of President’s Calling from Timothy McMahon, president of the American Academy of Optometry. You should know that Tim is a friend whom I have known for many years. I hold him in extremely high regard, which makes this all the more difficult.

For those who are unaware, the American Academy of Optometry and the American Academy of Ophthalmology have collaborated in the recent past on a number of educational programs. It is important to note that the collaboration between the two organizations hasn’t been exactly balanced nor has it led to increased détente or improved relations. The Academy of Ophthalmology continues to aggressively ban ODs from attending its annual meeting and actively engages in outrageous attacks on our profession including last year’s egregious attempt to overturn already enacted scope expansion in Arkansas through blatant abuse of the referendum process.

In his email, Tim asks for OD cooperation and patient referrals to the Zoster Eye Disease Study (ZEDS), a large NEI/NIH-supported clinical trial examining the utility of extended valacyclovir treatment for reducing complications of herpes zoster ophthalmicus. This was at the request of David Parke, AAO CEO and ZEDS Chair Elizabeth Cohen. Don’t mistake what I am saying, the study is important; its Leadership Committee is outstanding and the participating sites include world-class cornea specialists, several of whom are friends. I agree that optometry should be involved with the study, especially considering our role as primary eye care providers who manage many of these patients. So, while I encourage referral to ZEDS sites, I am disappointed that our involvement is extremely limited and apparently driven more by the need to fill enrollment gaps than being welcomed as valued and willing partners studying an important clinical area of mutual interest. I believe this is a missed opportunity for both professions.

The involvement of the Academy of Ophthalmology in this ask only serves to highlight the disparity between the two AAOs. The Academy of Ophthalmology is a formidable organization combining political and clinical interests for greatest effect. The Academy of Optometry eschews the political, approaches most things with an overly academic and somewhat out-of-touch bent, and remains blind to many of the very real issues that impede continued growth of our profession and eventual rapprochement between optometry and ophthalmology. It reminds us that when it comes to professional organizations, two isn’t better than one and that having two often weakens us.

I was not privy to the conversation Tim McMahon had with David Parke, but if the Academy of Ophthalmology was seeking assistance from optometry, this should have been seen as an opportunity to accomplish more than just passing the message along.

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.



Shape of the Anterior Surface of the Cornea After Extended Wear of Silicone Hydrogel Soft Contact Lenses

To measure geometrical changes in the anterior surface of the cornea after wearing silicone hydrogel (SiH) soft contact lenses continuously for one week, 43 eyes with 3.0D of myopia and 22 eyes with 3.0D of hyperopia were enrolled in the prospective, interventional study. All subjects underwent a general eye examination, corneal tomography with wavefront aberration analysis, corneal thickness measurements and epithelial thickness mapping before and after wearing SiH lenses (Acuvue Oasys) for seven days.

No significant changes in average keratometry were observed in either refractive group. In the myopic group, keratometry findings for the flat meridian (K1) and central corneal thickness decreased significantly. After +3.0D lens wear in the hyperopic group, a significant decrease in epithelial thickness up to 3.19µm was observed in the central and paracentral cornea. In both refractive groups, the largest epithelial thickness increase was seen in the periphery. A decrease in spherical aberration was noted in myopic eyes, while an increase of both higher order corneal aberrations and coma was found in hyperopic subjects.

Researchers wrote extended wear of SiH lenses resulted in a significant change in epithelial thickness leading to alteration in the geometry of the anterior surface of the cornea, particularly in hyperopic patients. These epithelial thickness variations led to changes in the higher order aberrations of the cornea.

SOURCE: Stachura J, Mlyniuk P, Bloch W, et al. Shape of the anterior surface of the cornea after extended wear of silicone hydrogel soft contact lenses. Ophthalmic Physiol Opt. 2021; May 4. [Epub ahead of print].



Treatment of Contact Lens-related Dry Eye with Intense Pulsed Light

The prevalence of contact lens-related dry eye (CLDE) is high and can lead to ocular discomfort, and reduced quality of vision and life. The aim of this study was to assess the efficacy of intense pulsed light (IPL) treatment in alleviating signs and symptoms of CLDE. This prospective study was conducted on 152 eyes of 76 patients (IPL group, n=76 eyes; control group, n=76 eyes) wearing contact lens (CL) and experiencing CLDE for more than one year. The IPL treatment group underwent two IPL treatment sessions at three-week intervals while the control group received sham IPL treatment. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), non-invasive breakup time (NITBUT), tear film lipid layer (TFLL) quality, fluorescein staining (FS), meibum gland (MG) quality and expression, endothelial cell count (ECC) and intraocular pressure (IOP) were assessed at baseline (D-0), day-21 (D-21) and day-42 (D-42) after IPL treatment.

The mean age of the treatment group and control group was 28.47 ± 5.16 years (21 females, 28%) and 28.58 ± 4.33 years (23 females, 30%) respectively. The IPL treatment group had clinically and statistically significant improvement in mean NITBUT observed at D14 (5.24 s) and D28 (6.08 s). OSDI, TFLL score and MG quality and expressibility all improved significantly at D-42, whereas BCVA, ECC and IOP showed no significant changes at D-21 and D-42 in the IPL treatment group. The control group showed no significant improvement in all parameters at D-21 and D-42.

Researchers’ findings suggested that CL-related DE can be safely alleviated with IPL treatment as it reduced the severity of symptoms, improved the overall tear film stability and reduced artificial tear use in participants with CLDE.

SOURCE: Yang L, Pazo EE, Zhang Q, et al. Treatment of contact lens related dry eye with intense pulsed light. Cont Lens Anterior Eye. 2021; Apr 28;101449. [Epub ahead of print].



Efficacy and Safety of 1% Progesterone Gel to the Forehead for Ocular Chronic Graft-versus-Host Disease

No FDA-approved treatments for ocular chronic graft-versus-host disease (oGVHD) exist to date, and current therapeutic options are limited. Forehead application of 1% progesterone gel provides corneal antinociception in preclinical models, suggesting it may be useful in alleviating ocular irritations. This study was conducted to evaluate the efficacy and safety of 1% progesterone gel in treating moderate to severe symptomatic oGVHD. Thirty-three patients with oGVHD following allogeneic stem cell transplantation were enrolled in this single-center, sponsor-initiated, prospective, exploratory randomized double-masked placebo-controlled Phase II clinical trial. The inclusion criteria included a National Institutes of Health consensus score of ≥2, moderate to severe ocular discomfort level and receipt of a stable immunosuppression regimen.

Twenty-one of the 22 patients in the progesterone arm, and all 11 patients in the placebo arm completed the course of twice-daily forehead drug application for 10 weeks. The changes from baseline of self-reported ocular symptom scores and physician-recorded cornea fluorescein staining scores were analyzed using mixed-model repeated-measures regression models in an intention-to-treat population. The 33 patients included 12 women and 21 men, with a median age of 66 years (range, 24 to 75 years). At 10 weeks, a significant reduction in ocular symptoms was observed from baseline in the progesterone group compared with the placebo group in symptom frequency (-30.7 vs. -2.2) and severity (-19.8 vs. +1.6). At 10 weeks, greater reduction of cornea fluorescein staining centrally (-1.2 vs. +.1) and inferiorly (-1.4 vs. -0.2) was also observed. No difference was noted in superior cornea staining. No severe adverse events were reported in the progesterone group.

Forehead application of 1% progesterone gel significantly improved ocular signs and symptoms within 10 weeks. It appeared to be a safe and effective new therapy for oGVHD, and a novel mechanism for neuroaxis drug delivery. A multicenter phase III clinical trial is planned for further validation.

SOURCE: Luo ZK, Domenech-Estarellas EA, Han A, et al. Efficacy and safety of 1% progesterone gel to the forehead for ocular chronic graft-versus-host disease. Transplant Cell Ther. 2021; Feb 14. [Enews ahead of print.]





Industry News

Refractive Surgery Council Reports Nearly 30% Rise in Laser Vision Correction Procedures

The Refractive Surgery Council, which helps consumers make informed choices about their vision correction options, reported the start of 2021 had a nearly 30% rise in laser vision correction procedures over 2020. More than 220,000 LASIK, SMILE and PRK procedures have been performed so far this year, reflecting demand fueled by a renewed consumer focus on self-care and safety. Learn more about the council.



Euclid Systems Hosts Roundtable on Next Generation of Ortho-K Lenses

Euclid Systems will be hosting a roundtable discussion among top myopia management practitioners on modern orthokeratology and updates in designs and materials, which will include the unveiling of an innovative new lens from the company. The title of the discussion is “Shifting the Paradigm: Maximize Performance with the Next Generation of Ortho-K Lenses.” Learn more and register.

J&J Vision Announces Approval of Tecnis Synergy and Tecnis Synergy Toric II

Johnson & Johnson Vision announced the FDA approval of Tecnis Synergy and Tecnis Synergy Toric II IOLs. The company says the next-generation PCIOL, built on the legacy Tecnis platform, delivers the widest range of continuous vision with the best near vision among leading PCIOLs, superior contrast even in low-light conditions and reduced spectacle wear. In a company sponsored study, nine out of 10 patients who received TECNIS Synergy IOL lenses didn’t need glasses after surgery. Read for more information and references.

Surface Ophthalmics' Chronic Dry Eye Study Reaches 50 Percent Enrollment

Surface Ophthalmics announced that 50 percent of patients have been enrolled and randomized in the Phase II clinical trial for its investigational product SURF-100 (mycophenolate sodium and betamethasone sodium phosphate in Klarity vehicle) for the treatment of chronic dry eye disease. Having reached this milestone, the company is on track to announce top-line results from the trial in the first quarter of 2022. Read more.

AGTC Reports Positive Data from Ongoing XLRP Trial

Applied Genetic Technologies, a biotechnology company conducting human clinical trials of adeno-associated virus-based gene therapies for the treatment of rare retinal diseases, reported additional positive data from the ongoing X-linked retinitis pigmentosa (XLRP) Phase I/II clinical trial, including 12-month data from groups 5 and 6 reflecting a 50 percent response rate among patients who met the inclusion criteria for the Skyline and Vista trials and 24-month data from two of three group 4 patients providing preliminary evidence of response durability. The third patient was not a responder at month 12, and no early data are available for the remaining four group 4 patients. Read more.





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