Optometric Physician

Vol. 22, #43   •   Monday, November 8, 2021


Off the Cuff: Lessons in Incompetent Management – How to Run an Airline or a Practice into the Ground

I am a great believer in finding nuggets of learning in almost every situation. Perhaps because I’ve have spent so much of my life in the air, airlines have been a frequent inspiration for editorials. One of my favorites described an experience I had on a delayed Delta Airlines flight. A small number of us made it onboard before boarding was halted and for the next two hours we spent the time hanging out with the crew. I got a personal tour of a 757 cockpit which I still recall vividly and an invitation from the cabin crew to become a flight attendant. I’m still considering it.

That editorial eventually made its way to Delta management and I later received a personal thank you note from Delta’s CEO. While unexpected, the personal touch was typical of Delta back then. They cared about me and I cared about them. They watched my back and I felt safe when I flew on Delta. Like too many good things, my love affair with Delta came to an end when they became more interested in milking a few extra bucks out of passengers than long-term loyalty. They eventually went bankrupt. By the time I relocated to Arizona, I had moved to American Airlines and have flown on a Delta flight only once since then. I quickly learned that American was not Delta. There was nothing warm and fuzzy about my relationship with American, but travel was predictable and my loyalty was appreciated and reciprocated.

Last Monday morning, excited about the upcoming Academy meeting, Shannon and I boarded AA flight 1569 to Boston. I hadn’t slept well Sunday night, checking flight status every hour or so since American had cancelled nearly 2,000 flights over the weekend. As we boarded, the gate agent advised us to keep our fingers crossed as they were still missing a pilot. Minutes after settling into our seats, still-boarding passengers suddenly stopped and announced that the flight had been cancelled. Ours was one of more than 400 flights, or 14% of American’s schedule cancelled on Monday.

If this were the old Delta, we would have already been rebooked on a flight that would have gotten us to Boston that day. But this wasn’t Delta, it was the new American. I have been a top tier frequent flier with American for at least a dozen years. I thought surely, they would take care of us. My first call was to the American Executive Platinum line, which placed me in a lengthy call-back queue. Since I had booked with American Express Travel, I figured I might have better luck with them. Given the ongoing chaos, they had me on hold for nearly an hour. When I finally got through, I asked them for alternatives to get us to Boston. Other than a few scattered middle coach seats on connecting flights that wouldn’t get us in until after most of the meeting was over, there was nothing. American offered a red eye that would have likewise gotten us in too late for most of the meeting. Given the ongoing meltdown, the last thing I wanted was for us to be stranded in Los Angles. So, despite weeks of planning, many scheduled meetings and talks and tons of friends to see, with no good alternative, we cancelled our trip. I spent hours on the phone texting and emailing, apologizing and arranging coverage for commitments I had. It was a punch in the gut for both of us.

The media, with spin no-doubt supplied by American, reported that the American’s problems began the prior Thursday when high winds in North Texas slowed down takeoffs and landings at DFW, the airline’s main hub in Dallas. That purportedly led to flight disruptions, put crews out of position and caused the subsequent days-long cascade of cancellations. The truth is considerably different. American’s problems didn’t start last Thursday, they began in 2013 when US Airlines merged with bankrupt American Airlines and Doug Parker became CEO.

I don’t know Doug Parker personally. Mutual acquaintances tell me he is a nice guy, but it’s hard to see nice judging by his actions. Under Parker’s leadership, AA has lost whatever connection it had to its customers. Its once top-notch AAdvantage frequent flyer program, a driver of loyalty and revenue, has been completely gutted. When the perversely named project Oasis 737 cabin refresh was introduced, passengers complained bitterly about the lack of room and horrible seat comfort. One pilot described the lavatories as “the most miserable experience in the world.” Parker described the interior as “just fine.” Loyalty, which was once measured by butt-in-seat-miles, is now measured by how much money the airline is able to extract from you. You can actually now earn top tier frequent flyer status using a credit card without having flown a mile.

You’re probably wondering what the lesson is in all of this and the real reason why American cancelled all of those flights, which undoubtedly cost them a bundle. The answer is the same to both. Complete and total mismanagement. Before COVID hit, American was over leveraged. They lobbied for and were given $10 billion in taxpayer money supposedly to keep employees ready to fly when passengers returned, but it did the exact opposite. American didn’t have pilots or cabin crew because of furloughs, incentivized early retirements and leaves.

If you are an airline, your primary job is to get your customer to their destination as safely, quickly and reliably as possible. If you want to be a successful airline and not eventually go bankrupt, understand your customer and make them feel cared for and safe. In the process, create an emotional connection. At the very least, reliably get them to where they are going. The last thing I expected from my airline of choice was to be stranded, and I know it was far worse for others who were not able to drive home. While we didn’t make it to the Academy meeting, we were reminded of how important it is to take good care of our patients and to view their experience from their perspective. While we sat home sad and frustrated at not being able to attend the meeting, we did book flights for the holidays. On United.


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.





Dome-Shaped Macula vs. Ridge-Shaped Macula Eyes in High Myopia Based on Optical Coherence Tomography

A retrospective observational study including 49 highly myopic eyes from 31 patients who underwent swept-source optical coherence tomography (SS-OCT) looked at the clinical features in patients with ridge-shaped macula (RSM) compared with those with dome-shaped macula (DSM), having been previously classified by the number of SS-OCT radial scans. DSM eyes were defined as those that showed a complete round inward convexity in all their axes, presenting an inward convexity ≥50 µm in the 12-line radial OCT scans. Eyes that did not meet this criterion and had at least one flat radial scan were grouped into the RSM group, defined as a macular inward convexity in some meridians across the fovea, whereas the opposite perpendicularly oriented meridians were flat. Age, spherical equivalent, axial length (AL) and best-corrected visual acuity (BCVA) were collected. Height of the bulge, scleral and choroidal thicknesses, Bruch's membrane defects and presence of perforating scleral vessels were recorded.

Thirty-seven (75.5%) eyes were classified into the RSM group and 12 (24.5%) into the DSM group. Twenty-six (53.0%) eyes showed macular elevation only in the horizontal direction. Mean AL showed statistically significant differences (28.8 ± 2.7 vs. 30.5 ± 1.5 mm in the RMS vs. DSM group, respectively), and the presence of Bruch's membrane defects was more frequently seen in DSM (p<0.001). Mean age, spherical equivalent, BCVA, height of the inward convexity, retinal foveal thickness, foveal scleral thickness, subfoveal choroidal thickness and the presence of perforating scleral vessels did not show significant differences between groups.

This study showed the reliability of using 12 equal radial OCT scans as an objective method to define and differentiate DSM vs. RSM. Patients with RSM had shorter AL compared with those with DSM, and the presence of Bruch's membrane defects was more common in DSM. Researchers suggested these findings may contribute to identifying patients that have a higher risk of developing complications due to their myopia.

SOURCE: García-Zamora M, Flores-Moreno I, Ruiz-Medrano J, et al. Dome-shaped macula versus ridge-shaped macula eyes in high myopia based on the 12-line radial optical coherence tomography scan pattern. Differences in clinical features. Diagnostics (Basel). 2021; Oct 11;11(10):1864.


Dietary Ω-3 Polyunsaturated Fatty Acids are Protective for Myopia

Myopia is a leading cause of visual impairment and blindness worldwide. However, a safe and accessible approach for myopia control and prevention is currently unavailable, researchers wrote. They investigated the therapeutic effect of dietary supplements of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on myopia progression in animal models and on decreases in choroidal blood perfusion (ChBP) caused by near work, a risk factor for myopia in young adults.

The researchers demonstrated that daily gavage of ω-3 PUFAs (300 mg docosahexaenoic acid [DHA] plus 60 mg eicosapentaenoic acid [EPA]) significantly attenuated the development of form deprivation myopia in guinea pigs and mice, as well as of lens-induced myopia in guinea pigs. Peribulbar injections of DHA also inhibited myopia progression in form-deprived guinea pigs. The suppression of myopia in guinea pigs was accompanied by inhibition of the ChBP reduction-scleral hypoxia cascade. Additionally, treatment with DHA or EPA antagonized hypoxia-induced myofibroblast transdifferentiation in cultured human scleral fibroblasts. In human subjects, oral administration of ω-3 PUFAs partially alleviated the near-work-induced decreases in ChBP.

Evidence from these animal and human studies suggested ω-3 PUFAs are potential and readily available candidates for myopia control.

SOURCE: Pan M, Zhao F, Xie B, et al. Dietary ω-3 polyunsaturated fatty acids are protective for myopia. Proc Natl Acad Sci U S A. 2021 Oct 26;118(43):e2104689118.


Retrospective Evaluation of Corneal Foreign Bodies with Anterior Segment Optical Coherence Tomography

The medical records of patients with corneal foreign bodies were retrospectively analyzed to assess the anterior segment optical coherence tomography (AS-OCT) findings of various types of corneal foreign bodies. Patients who underwent anterior segment photography and Spectralis AS-OCT (Heidelberg Engineering GmbH, Germany) imaging were included.

The AS-OCT findings of 22 eyes of 20 patients with corneal foreign bodies were reviewed. The mean age was 34.9±14.98 years (range, 15 to 71) with a female/male ratio of 4/16. The mean best-corrected visual acuity at presentation was 0±0 LogMAR (range, 0 to 0). There were 18 metallic, 3 organic (chestnut burr) and 1 chemical clay foreign bodies. The metal materials demonstrated hyperreflectivity with a mirror effect. Chemical clay, which is an opaque material, had a hyperreflective appearance. Chestnut burr is an organic foreign body with a feather-like pattern and was not detected with AS-OCT.

Researchers determined that AS-OCT was a valuable noninvasive tool to define the characteristics of foreign bodies, as well as decide the proper treatment method and monitor patients with corneal foreign bodies.

SOURCE: Akbaş E, Barut Selver Ö, Palamar M. retrospective evaluation of corneal foreign bodies with anterior segment optical coherence tomography. Turk J Ophthalmol. 2021 Oct 26;51(5):265-28.




Industry News

B+L Presents Scientific Data on Products and ARMOR

Bausch + Lomb announced that seven scientific posters involving the company's products, as well as data from the company's Antibiotic Resistance Monitoring in Ocular MicRoorganisms (ARMOR) surveillance study, would be presented during the annual meetings of the American Academy of Optometry in Boston (Nov. 3 to 6) and American Academy of Ophthalmology in New Orleans (Nov. 12 to 15). The company also planned to host several promotional education events. In addition to data from the company's ARMOR study, the presentations include analyses on Xipere (triamcinolone acetonide injectable suspension) for suprachoroidal use, which received FDA approval in October, and Bausch + Lomb Infuse Multifocal contact lenses. Read more.



FDA Approves Vuity (pilocarpine HCI ophthalmic solution) 1.25%, First Drop to Treat Presbyopia

Allergan announced the FDA approved Vuity (pilocarpine HCl ophthalmic solution) 1.25% for the treatment of presbyopia in adults as the first FDA-approved eye drop to treat this common and progressive eye condition. The daily prescription eye drop works in as early as 15 minutes and lasts up to six hours, as measured on day 30, to improve near and intermediate vision without impacting distance vision. Vuity is an optimized formulation of pilocarpine delivered with pHast technology, enabling the drop to rapidly adjust to the physiologic pH of the tear film. It uses the eye's ability to reduce pupil size, improving near vision without affecting distance vision. Read more.

Prevent Blindness Names Essilor’s Rick Gadd Person of Vision Award Recipient


Prevent Blindness announced that the 2022 Person of Vision Award will be presented to Rick Gadd, president of Essilor North America. The award presentation event will take place March 31, 2022, at 583 Park Avenue, New York, NY, in conjunction with Vision Expo East. All proceeds from the event will go to support the sight-saving programs of Prevent Blindness. The Prevent Blindness Person of Vision Award recognizes an individual, corporation and/or organization whose inspired outlook champions healthy vision and its importance for a healthy life. Gadd was selected as the recipient of the Person of Vision Award for his impactful leadership and dedication to providing quality eye care products and services to the those across the country. Learn more.

Heru Releases Wearable Platform with 6 Vision Diagnostic Modalities that Support 5 CPT Codes


Heru is expanding the capabilities of re:Vive by Heru, the company’s wearable gamified diagnostic solution, to include three new testing modalities: Color Vision CPT 92283, Contrast Sensitivity and Dark Adaptation CPT 92284. The new multimodal cloud-based platform replaces several legacy devices, enabling six popular vision exams to be performed with a space-saving wearable at a low cost of entry. Read more.

J&J Vision to Present Findings from New Myopia Research at Academy


Johnson & Johnson Vision announced that new myopia data outcomes would be presented at the American Academy of Optometry annual meeting in Boston, November 3-6. View the presentations.




Coburn Introduces Lynn Nichols as Digital Marketing and Trade Show Specialist


Coburn Technologies welcomed Lynn Nichols to its marketing team as Digital Marketing and Trade Show Specialist. Nichols was previously marketing communications manager at American Optical and headed up marketing operations for ophthalmic industry publications now owned by PentaVision. Most recently, she served as marketing director for the Springfield Symphony Orchestra in Massachusetts.

Visus Appoints Dr. Guyer as Board Chairman and Welcomes Danse as Head of Business Development


Visus Therapeutics announced the appointment of ophthalmology and industry expert David Guyer, MD, as the chairman of the board, and life sciences veteran Ted Danse as the head of business development. Read more.





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