Optometric Physician

Vol. 22, #39   •   Monday, October 11, 2021


Off the Cuff: Practice Politics

Dear friend, mentor and role model Jack Runninger wrote a column entitled Lessons Learned for decades. As a master communicator, Jack actually wrote the book “You'll Do Great If You Communicate." When I was still wet behind the ears as a writer, Jack shared some sage advice, “never write about politics, sex or religion,” he said. I learned very quickly and confirmed numerous times over the past 20 plus years that he was right—especially about politics. Even when Democrats and Republicans spoke to each other, politics could be a hot potato with incendiary potential.

In practice, with a patient in the chair, I learned that Jack’s counsel of avoiding contentious topics remained wise. For most of my career, I avoided or deflected topics involving sex, religion or politics. Today, as I suspect many of you are finding, that is becoming increasingly difficult, as our cultural landscape seems to be spinning increasingly out of control.

In the US, no matter who you are, where you live, or how right or left you lean, these are unprecedented times. COVID, the political divide, vaccines, the border, immigration, the economy, the budget, Afghanistan, you name it, everyone has something to be upset and stressed about. Whether we like it or not, like the damn COVID virus itself, our patients can’t help but bring this tsunami of uncertainty, and occasionally anger, into our offices and our exam chairs.

So how do we deal with these incredibly powerful social currents, especially when many of us also have strong feelings about these issues? I’ll share how I try to handle it. First, I always listen to the patient. If they bring up something that we are clearly on the same page on, I will acknowledge their feelings and occasionally but very briefly commiserate with them. My goal is to solidify our personal relationship while quickly diverting back to the matter at hand—the problem they came in to see me for. If the topic is one where we have diametrically opposite viewpoints, I will acknowledge their comment, bite my tongue, and immediately channel the conversation back to the clinical realm without sharing my personal perspective. Lately, I’ve had an extremely sore tongue.


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.



Sensory Integration Abilities for Balance in Glaucoma: A Preliminary Study

The goal of this study was to quantify the association between sensory integration abilities relevant for standing balance and disease stage in glaucoma. The disease stage was assessed using both functional (visual field deficit) and structural (retinal nerve fiber layer thickness) deficits in the better and worse eye. Balance was assessed using an adapted version of the well-established Sensory Organization Test (SOT). Eleven subjects diagnosed with mild to moderate glaucoma stood for three minutes in six sensory-challenging postural conditions. Balance was assessed using sway magnitude and sway speed, computed based on center-of-pressure data. Mixed linear regression analyses were used to investigate the associations between glaucoma severity and balance measures.

Findings revealed that the visual field deficit severity in the better eye was associated with increased standing sway speed. This finding was confirmed in eyes open and closed conditions. Balance was not affected by the extent of the visual field deficit in the worse eye. Similarly, structural damage in either eye was not associated with the balance measures.

In summary, this study found that postural control performance was associated with visual field deficit severity. The fact that this was found during eyes closed as well suggests that reduced postural control in glaucoma is not entirely attributed to impaired peripheral visual inputs. Researchers suggested that a larger study would be needed to further investigate potential interactions between visual changes and central processing changes contributing to reduced balance function and increased incidence of falls in adults with glaucoma.

SOURCE: O'Connell C, Redfern M, Chan KC, et al. Sensory integration abilities for balance in glaucoma, a preliminary study. Sci Rep. 2021 Oct 4;11(1):19691.


Prevalence and Risk Factors of Dry Eye Disease Among University Students in Bangkok, Thailand

A cross-sectional study using an electronic survey was conducted in two Rajabhat universities in Bangkok, Thailand, to investigate the prevalence of dry eye disease (DED) and its associated risk factors among Thai university students. The woman's health study questionnaire was used to determine students with DED. The prevalence of DED along with 95% confidence interval (CI) were calculated. Logistic regression model was used to identify the associated risk factors.

A total of 4111 university students joined and completed the survey questionnaires. Mean age was 18.8 ±1.1 years with female predominance (2874 students, 69.91%). Clinically diagnosed DED was reported in 136 students (3.31%), while severe symptoms of eye dryness and irritation were reported in 227 students (5.52%). The prevalence of DED among Thai university students was 8.15% (95% CI, 7.33% to 9.02%). History of contact lens use and high screen time (>8 hours per day) were reported in 868 students (21.11%) and 2101 students (51.11%), respectively. Male gender, contact lens use and high screen time were significantly associated with higher risk of DED with the adjusted ORs (95% CI) of 1.39 (1.09, 1.77), 2.49 (1.96, 3.17), and 1.43 (1.14, 1.80), respectively.

Investigators found that DED was not rare among Thai university students. Contact lens use and high screen time were two significant modifiable risk factors of DED in the students studied. Investigators suggested that the findings could raise awareness of DED in a younger population and provide valuable information for public health promotion in university students.

SOURCE: Supiyaphun C, Jongkhajornpong P, Rattanasiri S, et al. Prevalence and risk factors of dry eye disease among University Students in Bangkok, Thailand. PLoS One. 2021 Oct 1;16(10):e0258217.


Virtual Reality-based and Conventional Visual Field Examination Comparison in Healthy and Glaucoma Patients

Researchers clinically evaluated the noninferiority of a custom virtual reality (VR) perimetry system when compared to a clinically and routinely used perimeter on both healthy subjects and glaucoma patients. They use a custom-designed VR perimetry system tailored for visual field testing. The system uses Oculus Quest VR headset (Facebook Technologies, LLC, Bern, Switzerland) that includes a clicker for participant response feedback. A prospective, single-center study was conducted at the Department of Ophthalmology of the Bern University Hospital (Bern, Switzerland) for 12 months. Of the 114 participants recruited, 70 subjects (36 healthy and 34 glaucoma patients with early to moderate visual field loss) were included in the study. Participants underwent perimetry tests on an Octopus 900 (Haag-Streit, Köniz, Switzerland) as well as on the custom VR perimeter. In both cases, standard dynamic strategy (DS) was used in conjunction with the G testing pattern. Collected visual fields (VFs) from both devices were then analyzed and compared.

High mean defect (MD) correlations between the two systems (Spearman, ρ≥0.75) were obtained. The VR system was found to slightly underestimate VF defects in glaucoma subjects (1.4 dB). No significant bias was found with respect to eccentricity or subject age. On average, a similar number of stimuli presentations per VF was necessary when measuring glaucoma patients and healthy subjects.

This study demonstrated that a clinically used perimeter and the proposed VR perimetry system had comparable performances with respect to a number of perimetry parameters in healthy and glaucoma patients with early to moderate visual field loss.

SOURCE: Stapelfeldt J, Kucur SS, Huber N, et al. Virtual reality-based and conventional visual field examination comparison in healthy and glaucoma patients. Transl Vis Sci Technol. 2021 Oct 4;10(12):10.




Industry News

AAO/AAOF Announce Resident Travel Fellowship Recipients

The American Academy of Optometry and its Foundation named the recipients of this year’s Resident Travel Fellowships, which enable residents to attend Academy 2021 Boston, November 3 to 6. View the Allergan Resident Travel Fellowships.



Essilor Introduces Vision-S 700 Refraction Station

Essilor introduced the Vision-S 700 Refraction Station to increase the speed and efficiency of refraction. The device offers smart tests and algorithms, a wider field of vision, customizable options and a compact design, among other features. Learn more.

Menicon Launches Miru 1day UpSide SiHy Daily Disposable Lenses


Menicon America launched the Miru 1day UpSide, a silicone hydrogel daily disposable lens that utilizes SmartTouch technology in its packaging. Miru 1day UpSide incorporates MeniSilk Air and NanoGloss Pro technologies to create an optimal balance of material and surface properties with a goal of delivering a lens optimized for eye health—providing high oxygen, an ultra-low modulus and a smooth, low-friction surface. A SmartTouch package provides ease of handling and reduces the patient’s risk of inner lens contamination. Miru 1day UpSide is available in sphere, and Menicon has plans to add a multifocal in the first half of 2022. Read more.

New TearRestore HylaWipe Furthers Dry Eye Treatment


The new TearRestore HylaWipe offers a baseline treatment for dry eye syndrome that includes skin care compounds. The active cleanser is a mild concentration of tea tree leaf oil, which has been shown to effectively treat blepharitis and hinder the growth of Demodex, along with hyaluronic acid and green tea extract to soothe the skin and boost the skin’s moisture content, making the HylaWipe ideal for dry/sensitive eyes. Visit the site.

iCare Gets FDA 510(k) Nod for Eidon Ultra-widefield Lens Module


The Eidon Ultra-Widefield Lens module from iCare USA, which received FDA 510(k) approval for distribution in the US, is the newest accessory for the Eidon family of retinal imaging modalities, and enables capture of 120-degree images of the retina in a single shot or up to 200 degrees, with its expanded Mosaic function. Its image quality enables the detection of small details and signs of pathologies from the center to the periphery. The module can be retrofitted to most Eidon fundus imaging systems, enabling the acquisition of ultra-widefield infrared, autofluorescence and fluorescein angiography images with an up to 200-degree panoramic view. Learn more.

Marco, HOYA Announce Collaborative Program


Marco Ophthalmic is collaborating with HOYA Vision Care to provide customized offers that are tailored to the needs to independent eye care practitioners. Through the program, eye care providers will receive complete complimentary consultations, program discounts, and support from Marco and HOYA Vision Care. Learn more.




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