Optometric Physician

Vol. 22, #44   •   Monday, November 15, 2021


Off the Cuff: Optometrists Are Not Second-Class Citizens

The other day I got an email from PHOENIX magazine, a popular metro Phoenix print publication. For the second year in a row, I was contacted by a sales rep who thought I might be interested in running an ad in the magazine’s Annual Medical Directory and Annual Top Doctors issues.

We typically don’t do any advertising, but both issues have broad reach and year-long reference value, so last year I requested more information. The rep asked about our practice and I explained that our office was an important community resource in several key specialty areas and we were well-integrated within the Phoenix medical community. Hearing that, the rep excitedly shared we would be a great fit. That was until she found out that we were ODs. It seems that PHOENIX magazine doesn’t cover optometry. I figured they only covered medicine and thanked her but explained that an ad placement obviously wouldn’t be appropriate for us.

This year, the PHOENIX magazine email went into more detail. It shared the breakdown of the Medical Directory issue. The issue included: medical doctors, osteopaths, naturopaths, podiatrists and dentists, which were then further subdivided by specialties and geographical office locations.

So, pretty much any doctoral level health care professional was included—except for ODs. This time I responded that we would love to be included in their two medical issues, but unfortunately, for reasons that weren’t clear, they don’t include OD listings. I explained that optometry is the primary provider of eyecare in the US and that not including the profession was a lost opportunity. I offered to discuss the matter further, hoping to educate them, but having experienced this kind of discrimination many times during my career, I didn’t expect to hear back. So far I haven’t.

Although this particular slap in the face was for some reason especially galling, the reality is that many ODs experience far worse and more insidious forms of discrimination. ODs are still routinely barred from hospital staffs, and many insurance plans will not allow ODs on provider panels.

Our profession has come too far to allow this kind of discrimination to persist. Perhaps it’s time for a national strategy for dealing with this both actively and, when feasible, proactively. After more than a century of being treated like second-class citizens in healthcare, enough is enough.


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.





Effect of Refractive Error Type in Amblyopic Eyes on Factors for Treatment Success in Anisometropic Amblyopia

Medical records of 397 children with anisometropic amblyopia ages three to 12 years who presented in a secondary referral eye hospital between 2010 and 2016 were retrospectively reviewed to investigate the factors for treatment success in anisometropic amblyopia according to the spherical equivalent (SE) type of amblyopic eyes. Anisometropia was defined as ≥1 diopter (D) difference in SE, or ≥1.5D difference of cylindrical error between the eyes. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE≥1D), emmetropia (- 1<SE<+1) and myopia (SE≤-1D) groups. Treatment success was defined as achieving interocular logMAR visual acuity difference <0.2. Multivariate logistic regression was used to analyze the factors for treatment success.

Significant factors for the amblyopia treatment success in hyperopia group (n=270) were younger age [adjusted odds ratio (aOR) (95% confidence interval, CI)=0.529 (0.353, 0.792)], better BCVA in amblyopic eyes at presentation [aOR (95% CI) 0.004 (0, 0.096)], longer follow-up period [aOR (95%CI)=1.098 (1.036, 1.162)] and no previous amblyopia treatment history [aOR (95% CI) 0.059 (0.010, 0.364)]. In myopia group (n=68), younger age [aOR (95% CI) 0.440 (0.208, 0.928)] and better BCVA in amblyopic eyes [aOR (95% CI) 0.034 (0.003, 0.469)] were associated with higher odds of treatment success. There was no significant factor for treatment success in the emmetropia group (n=59) in this population.

Researchers found that the refractive error type of amblyopic eyes at presentation affects the factors for treatment success in anisometropic amblyopia.

SOURCE: Choi DD, Kim DH, Kim US, et al. Effect of refractive error type in the amblyopic eyes on factors for treatment success in anisometropic amblyopia. Sci Rep. 2021 Nov 9;11(1):21927.


A Systematic Review of the Association Between Tear Film Metrics and Higher Order Aberrations in Dry Eye Disease and Treatment

Investigators systematically reviewed published research on dry eye disease and its association with higher order aberrations (HOAs). The purpose of this review was to first determine if an association between tear film metrics and HOAs existed and second to determine if the treatment of dry eyes could improve tear film metrics and HOAs together. A search was conducted in Entrez PubMed on April 25, 2021, using the keywords "higher order aberrations" and "dry eye."

The initial search yielded 61 articles. After publications were restricted to only original articles measuring HOA outcomes in patients with dry eye, the final yield was 27 relevant articles. Of these 27 papers, 12 directly looked at associations and correlations between dry eyes and HOA parameters. The remaining 15 studies looked at dry eye interventions, and HOA outcomes and parameters. Investigators found clear evidence demonstrating that dry eyes and HOAs had an association, and that the tear film was one of the most important factors in this relationship. There was also a direct correlation between tear film metrics and HOAs. Improvements in HOAs with dry eye interventions provided further evidence to support the intricate relationship between the two.

Investigators wrote that, despite the clear association between HOAs and dry eye disease, further research was still needed in the realm of clinical application, as dry eye interventions vary depending on many factors, including patient severity and eye drop viscosity.

SOURCE: Rhee J, Chan TC, Chow SS, et al. A systematic review on the association between tear film metrics and higher order aberrations in dry eye disease and treatment. Ophthalmol Ther. 2021; Nov 11. [Epub ahead of print].


Ocular Manifestations in COVID-19 Patients: A Systematic Review and Meta-Analysis

With the accumulating evidence of ocular manifestations of the 2019 novel coronavirus disease (COVID-19), this study aimed to systematically summarize ocular manifestations in COVID-19 patients. PubMed, EMBASE and Web of Science databases were searched through June 2021. Studies that provided clinical characteristics and outcomes, and reported on ocular manifestations or conjunctival swab RT-PCR tests among COVID-19 patients were included.

A total of 30 studies involving 5,717 patients were identified. Ocular manifestations including conjunctival hyperemia (7.6%; 95%confidence interval [CI], 1.8% to 8.9%), conjunctival discharge (4.8%; 95% CI, 1.8% to 8.9%), epiphora (6.9%; 95% CI, 2.8% to 12.8%), and foreign body sensation (6.9%; 95% CI, 2.4% to 13.0%) were observed. The positive rate of conjunctival swab tests was 3.9% (95% CI, 0.2% to 6.4%). Severe cases of COVID-19 were associated with an increased risk of developing ocular complications (odds ratio [OR]=2.77, 95% CI, 1.75 to 4.40).

Investigators concluded that, despite their relatively low incidence rate in COVID-19 patients, ocular manifestations may be nonspecific and present as the initial symptoms of infection. The presence of SARS-CoV-2 in conjunctival swabs implicated the virus as a potential source of infection. Investigators suggested that early diagnosis and proper eye protection would help prevent viral transmission.

SOURCE: Zhong Y, Wang K, Zhu Y, et al. Ocular manifestations in COVID-19 patients: A systematic review and meta-analysis. Travel Med Infect Dis. 2021; Nov 8:102191.




Industry News

AAOF Announces J&J Vision J. Pat Cummings and Vincent Salierno Scholarship Recipients

The American Academy of Optometry Foundation, in collaboration with Johnson & Johnson Vision, announced the 2021 J. Pat Cummings Scholarship recipients. Learn more about the scholarship and view the participants.
In addition, the Foundation announced the recipients of the 2021 Vincent Salierno Scholarships. Learn more about the scholarship and view the participants.



Prevent Blindness Declares Second Annual TED Awareness Week

Prevent Blindness announced that November 14 to 20 will be the second annual “Thyroid Eye Disease Awareness Week.” The newest episode in the Focus on Eye Health Expert Series, “Thyroid Eye Disease,” will feature Sara Wester, MD, associate professor of clinical ophthalmology, Bascom Palmer Eye Institute, TED specialist and oculoplastic surgeon. Learn more.








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