Optometric Physician

Vol. 22, #19   •   Monday, May 17, 2021


Off the Cuff: Sometimes We Forget

By the very definition of routine, most of our days are just that – routine. Occasionally, we see an interesting patient and, if we are really lucky, we learn something new. However, for many of us, the routine of our profession sets in and what we do over and over again every day lulls us into a false sense of unimportance. As a result, we underestimate how important what we do is. Even worse, we forget how precious sight is.

The other day I stumbled upon a YouTube interview of Congressman Dan Crenshaw by chance. Crenshaw, for those who don’t know, is a former Navy Seal who lost an eye to an IED while serving in Afghanistan. What I didn’t know was that his other eye was severely damaged and recently required surgery for retinal detachment repair.

Regardless of your politics (which I don’t want to hear about), as a human being, fellow American and as an OD, I think you will be touched by Crenshaw’s humility and inner strength as he describes his ordeal and the impact it’s had on his life. Particularly poignant was his description of his vision both before the detachment when he was aphakic and now, as he waits for a gas bubble to dissipate before seeing the success or failure of the surgery. I sensed only determination and grace in his words and calm demeanor, but I was overcome with the magnitude of what he faced. I was also thankful for his service and sacrifice for our country.

Hearing Crenshaw’s words made me think about what we do every day and how important vision is, especially when one faces the prospect of life without sight. I was moved by the interview and urge you to take a moment to listen to it. For Rep. Crenshaw, I will be praying for a speedy and complete recovery. I would be obliged if you would as well.

Editor’s Note: Earlier this week the US CDC, national embarrassment that they are, announced that it had finally figured out that COVID-19 is an airborne virus, something I had figured out and shared here well over a year ago. Soon afterward, the CDC geniuses declared that, with rare exceptions, it is now safe to forgo wearing masks indoors if you have been fully vaccinated. In my opinion, the US CDC has the credibility of a South Bronx used car salesman. I speak with some knowledge of this, having done a stint as the service manager of a used car lot in the South Bronx. I think a blanket you-can-stop-wearing-masks advisory is way too early and that this brilliant advice puts the country at significant risk of another, more disastrous wave of COVID infection. You are welcome to do what you think is best, but in our office, staff and patients will continue to wear masks for the foreseeable future.

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.



Intraocular Pressure According to Eye Gaze by iCare Rebound Tonometry in Normal Participants and Glaucoma Patients

Researchers investigated changes of intraocular pressure according to eye gaze. Intraocular pressure was significantly elevated in adduction, abduction and supraduction. However, there was no significant difference between the glaucoma and control groups. Researchers assessed changes in intraocular pressure (IOP) according to eye gaze and identified their correlations with various risk factors of glaucoma. In this prospective observational study that included 56 glaucoma patients and 34 healthy participants, researchers measured IOP in the primary position with a Goldmann applanation tonometry (GAT) and rebound tonometer. Then, that IOP was measured in abduction, adduction and supraduction using a rebound tonometer. IOP changes according to eye gaze were measured based on the baseline IOP, and IOP changes between the glaucoma and the control groups were compared. Correlations between IOP changes and risk factors of glaucoma were evaluated.

The baseline IOP wasn’t significantly different between the glaucoma and the control groups. Compared to the IOP in the primary position, a significant increase in IOP was 2.3 ± 2.7mmHg during abduction, 0.7 ± 2.7mmHg during adduction, and 1.2 ± 2.8mmHg during supraduction. However, there was no significant difference in the amount of IOP elevation or the ratio of IOP change between the glaucoma and the control groups in all gazes. The baseline IOP measured by GAT and IOP changes according to eye gaze showed a significant negative correlation in all gazes.

IOP was significantly elevated in adduction, abduction and supraduction compared with the primary position in both the normal and glaucoma groups. However, researchers found no significant difference of IOP changes between the glaucoma and normal groups.

SOURCE: Kim YJ, Moon Y, Kwon B, et al. Intraocular pressure according to eye gaze by iCare rebound tonometry in normal participants and glaucoma patients. J Glaucoma. 2021; May 12. [Epub ahead of print].



Patient Concerns Regarding Suspended Ophthalmic Care Due to COVID-19

The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the COVID-19 pandemic have yet to be fully understood. Our objective is to assess patients' self-reported impact of healthcare lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City. Investigators conducted a digital, self-reported, patient care survey distributed by electronic mail (e-mail) at Columbia University's department of ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma, and a cancelled or rescheduled ophthalmology-established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical record were excluded. The survey occurred between March 2, 2020, and May 30, 2020. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as: visual acuity, intraocular pressure (IOP), diagnosis, disease severity, follow up urgency, recent treatments and diagnostic testing data.

Of the 2,594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression and access to care all showed positive correlations (p<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. Additionally, 55% of patients were afraid of contracting COVID-19 during an office visit.

Investigators found a majority of their patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. Additionally, they found a number of demographic and clinical factors that correlated with increased anxiety in our patients.

SOURCE: Dar S, De Moraes CG, Karani R, et al. Patient concerns regarding suspended ophthalmic care due to COVID-19. J Glaucoma. 2021; May 12. [Epub ahead of print].



Nutritional Factors and Myopia: An Analysis of National Health and Nutrition Examination Survey Data

The rise in the prevalence of myopia, a significant worldwide public health concern, has been too rapid to be explained by genetic factors alone and thus suggests environmental influences. Relatively little attention has been paid to the possible role of nutrition in myopia. The availability of the large National Health and Nutrition Examination Survey data set, which includes results from vision examinations, offers the opportunity to investigate the relationship between several nutrition-related factors, including body metrics, and the presence and magnitude of myopia. Cross-sectional survey data sets with vision examination, demographic, body metrics and nutritional data, collected as part of the National Health and Nutrition Examination Survey over the years of 2003 to 2008, were extracted for analysis. Based on already published basic and epidemiological studies, the following parameters were selected for study: body height and body mass index, demographics, serum vitamin D and glucose/insulin levels, and caffeine intake, using multivariable models and objectively measured refractive errors as the main outcome measure.

Data from a total of 6,855 ethnically diverse Americans ages 12 to 25 years were analyzed. In final multivariate models, female sex and age were the most significant factors related to myopia status and refractive error. In general, body metrics (body mass index) or nutritional factors (serum vitamin D, glucose levels and caffeine intake) were found to be associated with refractive error or myopia status; however, increased insulin levels were related to increased odds of having myopia.

These largely negative findings suggest that other environmental factors, such as those related to the visual environment, may contribute more to the development and/or progression of myopia and would argue for continued research in these areas in support of more evidence-based myopia clinical management.

SOURCE: Harb EN, Wildsoet CF. Nutritional factors and myopia: an analysis of national health and nutrition examination survey data. Optom Vis Sci. 2021; May 7. [Epub ahead of print].





Industry News

J&J Vision Announces FDA Approval of Acuvue Abiliti Overnight Therapeutic Lenses for Myopia Management

Johnson & Johnson Vision announced the FDA approved Acuvue Abiliti Overnight Therapeutic Lenses. The company says this is the first and only FDA approved orthokeratology (ortho-k) contact lens for the management of myopia. Abiliti Overnight ortho-k contact lenses are specifically designed and fitted to match the eye based on its unique corneal shape to temporarily reshape the cornea. Abiliti Overnight will be available in two different contact lens designs: Abiliti Overnight Therapeutic Lenses and Abiliti Overnight Therapeutic Lenses for Astigmatism. Read more.



Euclid Introduces Euclid MAX Ortho-K Lens

Euclid Systems announced the U.S. launch of Euclid MAX, a development in overnight orthokeratology. Used in children and adult patients with progressive myopia, but especially children, ortho-k contact lenses gently reshape the cornea to manage myopia while the patient sleeps. Euclid will host two live roundtable discussions focused on the innovation with top ortho-k practitioners. “Shifting the Paradigm: Maximize Performance with the Next Generation of Ortho-K Lenses” will be held May 19 and 20. For more details and to register.

Alcon Partners with BlephEx

Alcon announced an agreement that provides Alcon exclusive rights to sell BlephEx technology and accompanying products in the United States, effective May 1. The partnership with BlephEx, a device and eyelid cleaning procedure removing excess bacteria and biofilm, means the BlephEx eyelid cleaning device and LashCam iR WIFI camera will join Alcon’s Systane iLux technology to help meet the in-office, ocular surface health needs of patients. Read more.

NEI Data Show AREDS2 Nutrient Formula Continues to Reduce Moderate to Advanced AMD Progression Risk

Bausch + Lomb announced new data from the National Eye Institute 10-year follow-on study of Age-Related Eye Disease Study 2 (AREDS2) that reaffirms the clinical outcomes of AREDS2. Based on this data, the NEI continues to recommend a specific nutrient formula to help reduce the risk of progression in patients with moderate to advanced age-related macular degeneration. That formula is found in Bausch + Lomb PreserVision AREDS 2 Formula eye vitamins, which was provided to participants in the last five years of the follow-on study. Read more.

Innovega’s eMacula System May Increase Independence for Visually Impaired

The use of Innovega’s eMacula system, which pairs smart contact lenses with eye wear, demonstrated positive results with partially sighted subjects for their daily tasks including reading, smart phone use and distance vision according to research conducted at The Ohio State University. The research was presented in a scientific poster at the annual meeting of the Association for Research in Vision and Ophthalmology, held virtually. The OSU study, funded in part by a grant from the National Eye Institute of the National Institutes of Health, was conducted in nine visually impaired participants recruited from the OSU Low Vision Rehabilitation Service. Visual acuity was improved in each eye tested with the device. Read more.

RVL’s Upneeq Wins 2021 MedTech Breakthrough Award

RVL Pharmaceuticals, a subsidiary of Osmotica Pharmaceuticals, announced that its Upneeq (oxymetazoline hydrochloride ophthalmic solution) 0.1% was selected as the winner of the Best New Technology Solution for Drug Delivery award in the fifth annual MedTech Breakthrough Awards program conducted by MedTech Breakthrough. Read more.

IDOC Announces Enhancements to Metrics Tool

IDOC announced updates to IDOC Insider, a data and analytics tool introduced as an IDOC membership benefit in 2019. The latest version includes a simplified format and expanded analytics that help members identify potential areas for growth. The platform includes dynamic charts, easy-to-read performance dashboards, targeted monthly topics, indexed practice comparisons and access to EdgePro practice analytics software.







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