Optometric Physician

Vol. 22, #47   •   Monday, November 22, 2021


Off the Cuff: A Thimbleful

When we started the Dry Eye Center of Arizona a little over eight years ago, it quickly became apparent that what I knew about dry eye was barely a thimbleful out of an ocean of knowledge. As the years ticked by, after limiting my practice to dry eye and ocular surface disease, successfully managing hundreds and hundreds of patients, and devoting countless hours to trying to figure out how the ocular surface and tear film actually worked, I think I have managed to accumulate a bucketful of what is now an even larger and more complex sea of knowledge.

The Dry Eye Center of Arizona has been successful well beyond what I could have imagined. It’s allowed me to care for and help patients from around the country and around the world, while providing an incredible opportunity to learn far more than I thought possible.

Understand that I am sharing this not to tell you about what I have accomplished, but rather to share what you can accomplish. There is nothing that I do that any reasonably competent clinician with a modicum of effort and interest can’t do. Indeed, instead of keeping my secret sauce secret, I spend a tremendous amount of time and energy sharing what I know and how I do things with as many colleagues as will listen.

The reason I do this is because it has become obvious that expanding beyond traditional optometric practice is incredibly important and will become even more important for the profession’s future. There is tremendous opportunity for optometry, just not for the optometry that was, but rather for what optometry can be.

A recent hour spent scrolling through a dry eye patient forum was a horror show of testimonies from frustrated, frightened and desperate patients. Many were unable to find competent care. Dry eye and ocular surface disease is a specialty area that is literally exploding in prevalence with more and more patients begging for help. The opportunity is tremendous. At the same time, learning the skills and being able to help these patients will help push optometric practice closer to a much-needed safe harbor as traditional non-medical optometric practice becomes increasingly untenable.

I am anticipating a very busy 2022 leveraging technology to provide interactive virtual educational programs as well as live dedicated programs, as long as the ever-changing COVID situation permits. Stand by for more information.

With Thanksgiving arriving in just a few days there will be no issue of Optometric Physician next week. I and the entire staff of Optometric Physician wish you and yours a happy, safe and healthy holiday.



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.





Real-World Visual Outcomes of Laser and Anti-VEGF Treatments for Retinopathy of Prematurity

This retrospective, interventional case series characterized visual outcomes in children screened for retinopathy of prematurity (ROP). Patients who received ROP screening examinations at UCLA Medical Centers and were followed with outpatient eye exams at Stein Eye Institute and/or Doheny Eye Institute (Los Angeles) were included. Data was collected on birth characteristics, worst type of ROP and ROP treatment. Adverse visual outcomes included myopia, strabismus, amblyopia, macular dragging and optic atrophy. Snellen visual acuity was reported for children 4 years and older.

A total of 175 infants (350 eyes) were included for analysis (mean gestational age=28.2 weeks and birth weight=1059 grams) from a screening population of 539 infants (1078 eyes, 32.4% follow-up) over a nine-year period. Fifteen eyes received primary anti-vascular endothelial growth factor (anti-VEGF) therapy, while 59 eyes received primary laser therapy. Primary anti-VEGF therapy, as compared to primary laser treatment, was associated with a decreased incidence of amblyopia (aOR=0.6 to 0.86, p<0.0001) after controlling for gestational age and birth weight. The rates of optic atrophy (p=0.79), strabismus (p=0.98), and myopia (p=0.93) were not different between anti-VEGF and laser treatment groups. Infants receiving anti-VEGF therapy had more posterior disease than laser treated infants (p=0.041). Infants receiving laser therapy were more likely to have severe myopia (aOR=1.02 to 1.3, p=0.023), amblyopia (aOR=1.12 to 1.61, p=0.002), and optic atrophy (aOR=1.01 to 1.32, p=0.045) than infants not treated.

These findings add to the advantages of anti-VEGF treatment compared to primary laser treatment, particularly in posterior ROP.

SOURCE: Gundlach BS, Kokhanov A, Altendahl M, et al. Real-world visual outcomes of laser and anti-VEGF treatments for retinopathy of prematurity. Am J Ophthalmol. 2021; Nov 14. [Epub ahead of print].


Lowering Intraocular Pressure: A Potential Approach for Controlling High Myopia Progression

High myopia is among the most common causes of vision impairment, and it is mainly characterized by abnormal elongation of the axial length, leading to pathologic changes in the ocular structures. Owing to the close relationship between high myopia and glaucoma, the association between intraocular pressure (IOP) and high myopia progression has garnered attention. However, whether lowering IOP can retard the progression of high myopia is unclear. On reviewing previous studies, researchers suggested that lowering IOP plays a role in progressive axial length elongation in high myopia, particularly in pathologic myopia, wherein the sclera is more remodeled. Based on the responses of the ocular layers, they further proposed the potential mechanisms.

For the sclera, lowering the IOP could inhibit the activation of scleral fibroblasts and then reduce scleral remodeling, and a decrease in the scleral distending force would retard the ocular expansion like a balloon. For the choroid, lowering IOP results in an increase in choroidal blood perfusion, thereby reducing scleral hypoxia and slowing down scleral remodeling. The final effect of these pathways is slowing axial elongation and the development of scleral staphyloma. Investigators wrote that further animal and clinical studies regarding high myopia with varied degree of IOP and the changes of choroid and sclera during IOP fluctuation in high myopia would be needed to verify the role of IOP in the pathogenesis and progression of high myopia.

It is hoped that this may lead to the development of a prospective treatment option to prevent and control high myopia progression.

SOURCE: Wang P, Chen S, Liu Y, et al; GSHM study group. Lowering intraocular pressure: a potential approach for controlling high myopia progression. Invest Ophthalmol Vis Sci. 2021 Nov 1;62(14):17.


Efficacy, Predictability and Safety of Long-Term Orthokeratology: An 18-Year Follow-Up Study

Case histories of 300 orthokeratology patients (596 eyes: 34.3% children; 65.7% adults) were reviewed to collect information on demographics, corneal and refractive parameters, visual acuity, residual refraction and adverse effects to determine the efficacy, predictability and safety of long-term orthokeratology in children and adults. Predictability was defined as the percentage of eyes with absolute values of spherical equivalent refraction ≤0.5D of emmetropia, and efficacy as the ratio of post-orthokeratology uncorrected and pre-orthokeratology corrected distance visual acuity.

Median duration of treatment was 37 and 28.5 months in children and adults, respectively (p=0.022). During the first year, 17.2% of children and 33% of adults ceased lens wear (p<0.001). For children and adults with a successful ortho-k treatment of at least one year of duration, 88.7% and 95.9% of eyes had a predictable refractive outcome, and efficacy was 0.98 and 1.01, respectively. A larger percentage of children (65.7%) were free of complications than of adults (55.4%) (p=0.015). One event of microbial keratitis occurred in adults (6.8 cases per 10,000 patient-years) and none in children. Corneal staining was the most frequent complication, with a higher incidence in adults (p=0.007) and in higher myopia (p<0.001), higher anterior corneal eccentricity (p=0.019) and smaller anterior horizontal radius (p=0.027).

Researchers determined that orthokeratology was a safe and predictable long-term procedure in children and adults, with a low incidence of serious adverse effects. Corneal staining episodes were relatively frequent throughout the course of the treatment, thus highlighting the relevance of education of experienced users.

SOURCE: Gispets J, Yébana P, Lupón N, et al. Efficacy, predictability and safety of long-term orthokeratology: An 18-year follow-up study. Cont Lens Anterior Eye. 2021; Nov 13. [Epub ahead of print].




Industry News

More Than 41 Million Units of B+L CLs, Eye/Lens Care Materials Recycled

Bausch + Lomb announced its One by One and Biotrue Eye Care Recycling programs have recycled a total of 41,358,603 million units, or 248,516 pounds, of used contact lens, eye and lens care materials. The programs are made possible through a collaboration with TerraCycle. Read more.



OcuTerra Raises $35 Million Series B Financing, Appoints Dr. Karpecki to Board

OcuTerra Therapeutics announced the close of a $35 million Series B financing. Proceeds will support the “DR-EAM” Phase II study of OTT166 in patients with moderate to severe non-proliferative and mild proliferative diabetic retinopathy. Phase Ib clinical trials of OTT166 eye drops in patients with diabetic retinopathy and wet AMD have demonstrated safety, tolerability and clear clinical evidence of biological activity. OTT166 is a novel small molecule selective integrin inhibitor that OcuTerra engineered to have the physiochemical characteristics to reach the retina from eye drop application and designed to be administered by the patient at home. In addition, OcuTerra appointed Paul M. Karpecki, OD, FAAO, to its scientific advisory board. Dr. Karpecki serves as director of cornea and external disease for the Kentucky Eye Institute in Lexington KY. Read more.

Findings: Hydrus Microstent Lowers VF Loss by 47 Percent

Ivantis, developer of the novel Hydrus Microstent, a minimally invasive glaucoma surgery device intended to lower eye pressure for open-angle glaucoma patients, announced new data from its five-year HORIZON pivotal trial showing the Hydrus Microstent lowered the rate of visual field loss by 47 percent vs. cataract surgery alone. Read more.

Upneeq Win's 2021 Allure’s Best of Beauty Breakthrough Award

RVL was presented with a 2021 Best of Beauty Breakthrough Award by Allure magazine. Upneeq is an FDA-approved prescription eye drop to treat adults with acquired blepharoptosis. Allure wrote about the award, “We present seven of the most revolutionary innovations we’ve ever seen—ones that have changed the way we approach beauty.” Read more.




Hilco Vision Acquires Simovision BV

Hilco Vision has acquired Belgium and Netherlands-based Simovision BV, effective November 17. Simovision is a distributor of ophthalmic products, with dedicated divisions providing consumables and equipment for refractive, cataract and retina surgery, and dry eye patients throughout Belgium and the Netherlands. The business, established by Marc Simonet in 2002, will continue to be based out of its Overijse headquarters in Belgium.





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