Optometric Physician

Vol. 22, #42   •   Monday, November 1, 2021


Off the Cuff: It’s Time Optometry Broadened Its Focus

Last week, while I was bemoaning the sorry state of continuing education and the fading opportunity of bringing CE into the 21st century, I touched on what is perhaps our profession’s greatest inadequacy: the lack of national uniform licensure and a universally accepted minimal practice standard. Yes, I know, we are a legislated profession governed by 50-plus different optometry acts making national licensure impossible. However, that does not preclude making uniform licensure possible.

A lot has changed since the first optometry law was enacted in Minnesota in 1901. Optometry is unrecognizable from its purely refractive roots, education and clinical training have advanced dramatically, and state boundaries have become virtual rather than real when it comes to contemporary practice and life for that matter. It is patently absurd that an optometrist in Kentucky can practice to the fullest extent of his or her training while that same OD, upon crossing the border into Illinois, falls back in time into one of most restrictive practice environments in the US.

The regulatory status quo that optometry continues to accept hobbles the profession and creates artificial boundaries that have little relevance in today’s world. In some states, Florida being a prime example, exclusion comes first and foremost. ODs wishing to practice in such an exclusionary state face senseless and daunting entry hurdles that most likely originated back when throttling potential competition by limiting the number of ODs practicing was acceptable. The bureaucracy in these states also tends to make the ODs who practice there miserable.

When it comes to scope expansion, we have allowed ourselves to be ensnared into battling state by state for every advance in practice privileges we have made since the 1970s. While this strategy has certainly worked, and the profession continues to expand, advances made in one state have limited if any benefit in other states, even neighboring ones. Essentially, we have been squandering limited resources fighting small local skirmishes rather than planning, fighting and ultimately winning the actual war.

It’s time that we started thinking big rather than small, and for the future rather than just for the moment. We need to develop a strategy that continues our state-by-state advances, but also creates a pathway for national standards of practice and at least a minimal acceptable national scope of practice. As I see it, the AOA would be the logical organization to structure and plan a profession-wide collaborative effort to develop the concepts and strategy to finally move our profession to its rightful place within the national landscape of mainstream healthcare.


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 Retinal Detachments in a Healthy 22-year-old Woman After Moderna SARS-COV-2 Vaccination

Although uncommon, retinal detachments are medically urgent and can result in permanent vision loss if untreated. Bilateral retinal detachments in healthy individuals are even more rare. In addition, there are no cases to date of retinal detachment associated with either coronavirus disease 2019 (COVID-19) or after receiving the Moderna (mRNA-1273) severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine.

A 22-year-old woman with myopia but no ocular trauma or other major medical history presented to the emergency department with five days of progressive, painless vision loss in her right eye. On examination, her visual acuity with corrective lenses was 20/70 in the right eye, 20/20 in the left eye and 20/25 with both eyes open. Point-of-care ultrasound of the eye showed a retinal detachment in the right eye. She was subsequently seen by ophthalmology and diagnosed with bilateral retinal detachments (macula off in the right, macula on in the left), despite being asymptomatic in her left eye. She underwent bilateral vitrectomies for simultaneous rhegmatogenous retinal detachments. Although the patient denied any preceding trauma, she did note having received her second dose of the COVID-19 vaccine 10 days before the onset of symptoms.

Why should an emergency physician be aware of this? Investigators presented a rare and unusual case of simultaneous bilateral retinal detachments in a healthy, young woman with no major medical history or medications. She received the COVID-19 vaccine a few days prior. The case outlines a possible association with the vaccine and emphasizes the importance of ultrasonography in diagnosing time-sensitive medical conditions.

SOURCE: Subramony R, Lin LC, Knight DK, et al. Bilateral retinal detachments in a healthy 22-year-old woman after Moderna SARS-COV-2 Vaccination. J Emerg Med. 2021; Jul 20. [Epub ahead of print].


Efficacy and Safety of 8 Atropine Concentrations for Myopia Control in Children: A Network Meta-Analysis

Investigators assessed comparative efficacy and safety of different concentrations of atropine for myopia control in children. Atropine is known to be an effective intervention to delay childhood myopia progression. Nonetheless, there is as yet no well-supported evidence ranking the clinical outcomes of various concentrations of atropine. Investigators searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform and ClinicalTrials.gov on Apr 14, 2021. They selected studies involving atropine treatment of at least one-year duration for control of myopia in children. They performed a network meta-analysis (NMA) of placebo-controlled and head-to-head randomized controlled trials (RCTs), and compared eight atropine concentrations (1, 0.5, 0.25, 0.1, 0.05, 0.025, 0.02, and 0.01%). They ranked the atropine concentrations for the corresponding outcomes by P-score (estimate of probability of being the best treatment). Their primary outcomes were mean annual changes in refraction (diopters/year) and axial length ([AXL] millimeters/year). They also extracted data on the proportion of eyes showing myopia progression and safety outcomes (photopic/mesopic pupil diameter, accommodation amplitude and distance/near best-corrected visual acuity [BCVA]).

Thirty (30) pairwise comparisons from 16 RCTs (3,272 participants) were obtained. The investigators’ NMA ranked the 1, 0.5 and 0.05% atropine concentrations as the three most beneficial for myopia control based on P-scores, as assessed for both primary outcomes: 1% atropine (mean difference and 95% CI in refraction compared to control: 0.81 [0.58;1.04]; AXL: -0.35 [-0.46;-0.25]), 0.5% atropine (refraction: 0.70 [0.40;1.00]; AXL: -0.23 [-0.38;-0.07]), 0.05% atropine (refraction: 0.62 [0.17;1.07]; and AXL: -0.25 [-0.44;-0.06]). In terms of myopia control as assessed by relative risk (RR) for overall myopia progression, 0.05% was ranked as the most beneficial atropine concentration (RR:0.39 [95% CI: 0.27;0.57]) followed by 1% (0.43 [0.33;0.56]). The ranking probability for adverse effects (photopic/mesopic pupil diameter and accommodation amplitude) tended to decline as the atropine concentration was increased, though this tendency was not evident for distance BCVA. No valid network was formed for near BCVA.

Investigators found that the ranking probability for efficacy was not proportional to dose (i.e., 0.05% atropine was comparable to that of high-dose [1 and 0.5%]), though those for pupil size and accommodation amplitude were dose-related.

SOURCE: Ha A, Kim SJ, Shim SR, et al. Efficacy and safety of 8 atropine concentrations for myopia control in children: A network meta-analysis. Ophthalmology. 2021; Oct 21. [Epub ahead of print].


Ten-year Outcomes of Intravitreal Bevacizumab for Myopic Choroidal Neovascularization: Analysis of Prognostic Factors

The current standard treatment of myopic choroidal neovascularization (mCNV) is intravitreal injection of VEGF antagonists. This study was proposed to assess efficacy and safety of intravitreal bevacizumab (IVB) for the treatment of mCNV across a 10-year follow-up. Thirty eyes of thirty patients with treatment-naïve mCNV who underwent IVB and were followed up with for a minimum of 10 years were recruited for the present retrospective cohort study. All participants were treated with three monthly IVB at baseline and then evaluated and treated under a pro re nata (PRN) schedule. Outcome measures were to determine BCVA changes over years and identify the predictive factors of both final visual outcome and need for retreatment. Analysis of the main involved prognostic factors with correlations among variables was reported.

Visual acuity remained stable at 10-year follow-up, with the greatest improvement at two years in all CNV locations. Baseline BCVA correlated positively with final BCVA. No predictive factors for the need of additional injections were identified. Retinal and choroidal thickness significantly reduced over time but without correlation with the number of injections. CNV max height and area significantly decreased at 10 years, with complete regression of mCNV lesions in 40% of subjects.

Intravitreal bevacizumab resulted as long-term effective and safe therapy for mCNV with sustained results at 10 years.

SOURCE: Mallone F, Giustolisi R, Franzone F, et al. Ten-year outcomes of intravitreal bevacizumab for myopic choroidal neovascularization: Analysis of prognostic factors. Pharmaceuticals (Basel). 2021; Oct 13;14(10):1042.




Industry News

B+L Launches Biotrue Eye Care Recycling Program With Terracycle

Bausch + Lomb launched the Biotrue Eye Care Recycling program, the first and only eye care recycling program in the United States, according to the company. The new program will allow consumers who participate in the program to properly recycle all brands of their eye drop single dose units, lens cases and lens solution caps, as well as Biotrue Hydration Boost Lubricant Eye Drops multi-dose bottles through a collaboration with TerraCycle, a leader in the collection and repurposing of hard-to-recycle post-consumer waste. Read more.



EyeDeal Solutions Launches

EyeDeal Solutions, a new company targeted to eye care practices of virtually any size and scope, was founded by 25-year industry veteran John Wiley to help doctors, administrators and office managers solve human resource issues. The company has partnered with top HR and PEO (professional employer organization) companies to match the needs and price point of eye care practices with the best HR solutions available. Wiley, who is also CEO, noted that the four biggest HR challenges faced by practitioners are money, time, attracting the best talent and retaining that talent. Learn more.

iCare Acquires Oculo


iCare USA’s parent company, Revenio, announced its acquisition of Oculo, an Australian company dedicated to telehealth, remote patient monitoring and clinical communications. Oculo's software platform enables doctors to communicate and exchange clinical correspondence such as patient referrals, clinical data and images in a secure and HIPAA-compliant way. Oculo recently integrated telemedicine into its platform so clinicians can conduct secure video consultations. Learn more.

Eaglet Eye Announces Three New Lens Design Algorithms


Eaglet Eye announced three new First Lens Fit algorithms for its Eye Surface Profiler (ESP). Two of the new algorithms are scleral designs—one for the new AccuLens Maxim 3D and the other for the new BostonSight SCLERALSmart360. In addition, the company announced the first algorithm in its new OrthoK module is the CooperVision Specialty EyeCare Paragon CRT design, enabling efficient precision fitting while the module allows practitioners to track induced refraction changes over time. Learn more.

Allergan to Present Data on Investigational AGN-190584 for Presbyopia Treatment


Allergan will present new pooled analyses and post hoc results from the Phase III trials of AGN-190584 (pilocarpine HCl ophthalmic solution 1.25%), an investigational novel treatment for presbyopia, at the annual meeting of the American Academy of Optometry, November 3 to 6. Presentations will include clinical results for near and intermediate vision, functional near vision, efficacy for post-LASIK patients and the patient experience. Read more.

Prevent Blindness Declares November Diabetes-related Eye Disease Month


Prevent Blindness declared November Diabetes-related Eye Disease Month to educate the public on the effects of diabetes on vision, risk factors and treatment options. It is offering the no-cost Diabetes & the Eyes Educational Toolkit. Learn more.





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