Optometric Physician

Vol. 22, #41   •   Monday, October 25, 2021


Off the Cuff: Professional Education Has Irreversibly Changed—It’s Time We Recognized This New Virtual Reality

I can think of very few positive things that have come from the COVID pandemic. However, one that stands out was the forced pivot from live in-person meetings and events to live virtual ones. While the Zoom world seemed to explode overnight, in reality, the pandemic only sped up changes that were already well underway.

For example, optometric education has been changing for quite some time. Many students no longer bother to attend live classes, instead relying on recordings and group notes. While educators with a more rigid traditionalist perspective might view this as troubling or try to turn a blind eye, today’s students expect flexibility and view live attendance as unnecessary and burdensome. As I see it, greater flexibility and greater utilization of advanced learning technology may yet be the salvation of our profession. More on this to come, but today I want to focus on continuing education.

Compared to optometric education, continuing practitioner education poses even greater challenges given the number of stakeholders involved and the conflation of financial, educational and regulatory objectives. The primary goal of continuing professional education is to assure that the practitioner is competent, knowledgeable and up to date. Ultimately, CE exists to protect the public. The reality is not that simple

Differing state CE requirements reflect one of the professions greatest weaknesses—the lack of uniform national licensure regulations. COPE was formed to minimize the resulting maze of different rules and regulations and, for the most part, it has done a decent job of it. However, COPE regulations and requirements have become increasingly outdated, are increasingly out of touch and are occasionally misguided.

At the start of the pandemic, the shutdown of live CE events prompted COPE to temporarily grant equivalence between virtual interactive distance learning and a live presentation. However, I understand that this will be discontinued at the end of 2021. I believe that this is a major step backward for the profession and a huge mistake.

Anyone with experience presenting live CE knows that physically being present is no guarantee that educational objectives are being met. Even top tier, super-popular speakers routinely see attendees playing games or texting on cell phones or occasionally even sleeping. The only thing being physically present generally assures is that someone is generating income from granting CE credits.

While virtual interactive distance learning can suffer from many of the same flaws as live CE, it also has many potential advantages. Leveraging existing technology, both attendance and attention can be better monitored and knowledge transfer more easily and directly assessed. Interactive distance learning is far more cost-effective. In 2020 when pivoting my Dry Eye Masterclass series from live to virtual interactive, we went from colleagues having to fly in from distant cities and stay overnight in hotels or drive for miles, to having them comfortably stay in their own homes and participate undistracted. Rather than reach only 100 attendees in a cramped and expensive hotel ballroom, the first virtual Masterclass had over 2,000 attendees. Instead of being swarmed by participants at the end of the presentation to get questions answered individually, I was able to respond sequentially online, with answers visible to all. Regarding concerns about sustained attention in a virtual environment, at the end of the CE portion of the presentation nearly 90% of attendees stayed for the uncredited Q&A session. The 2021 Dry Eye Masterclass programs remained well attended with similar results. Virtual interactive distance learning works.

While neither live in-person or virtual interactive distance learning are perfect, there is no reason why both cannot coexist as effective and equivalent means of ongoing practitioner education. I do understand that our national and state organizations gain a significant amount of income by providing CE and that, for those attending it may be a convenient and effective way to learn and gain CE credit. However, that does not justify forcing healthcare professionals to physically attend educational meetings when equivalent or better virtual alternatives are available. We need to find other less conflicted ways to support our professional organizations even if that means consolidating them to reduce redundancy and cost.

Understand that I am not calling for the end of live CE, but I think it is time we recognize that things have changed and that they are not going back to how they were. By embracing this new virtual reality, we can change our profession for the better and maybe even save it in the process.


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.


A Large Population Study Reveals a Novel Association Between Congenital Color Vision Deficiency and Environmental Factors

This is a retrospective study of the computerized database of the northern recruitment center of Israel of 53,895 consecutive male Jewish conscripts 16 to 19 years old, who completed the medical profiling process between 1988 and 2011, to assess the associations between the prevalence of congenital color vision deficiency (CVD) and genetics and environment, represented by place of origin (ethnic background) and place of birth, respectively. CVD was diagnosed using the 24-pseudo-isochromatic plate Ishihara test. Associations of CVD prevalence with sociodemographic variables, anthropometric indices, refractive errors, and mainly place of origin and place of birth were tested by both univariate analysis and multivariate regression models.

Elevated BMI (obesity) and blood pressure (hypertension), as well as myopia, were all positively associated with congenital CVD. The composition of the study population provided a unique opportunity to investigate the relationship between ethnicity and environment. The prevalence of CVD significantly differed among subpopulations of different ethnic backgrounds as well as among those who were born in different geographical locations. Additionally, differences in the prevalence of CVD (1.2-1 to 6%) were observed among conscripts from the same origin, who were born in Israel, compared to those who were born elsewhere. Both place of origin (p<0.01) and place of birth (p<0.05) were associated with the prevalence of CVD in a multivariable regression model.

This study affirmed previously established associations of CVD with certain variables and revealed a possible novel association of CVD with environmental factors.

SOURCE: Machluf Y, Allon G, Sebbag A, et al. A large population study reveals a novel association between congenital color vision deficiency and environmental factors. Graefes Arch Clin Exp Ophthalmol. 2021; Oct 20. [Epub ahead of print].


Topical Medication Adherence and Visual Field Progression in Open-angle Glaucoma: Analysis of a Large US Healthcare System

Modelling of visual field and pharmacy data (Kaiser Permanente, 2001 to 2014) from open-angle/pseudoexfoliation glaucoma patients in clinical practice indicated a significant inverse association between the level of medication adherence and rate of visual field progression. Retrospective analysis of combined visual field and pharmacy data from Kaiser Permanente Southern California's HealthConnect electronic health record database quantified the effect of nonadherence to topical hypotensive medication on glaucomatous visual field progression in clinical practice. Patients with a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma (2001 to 2011) and ≥3 subsequent visual field tests of the same Swedish Interactive Threshold Algorithm type were followed up from first medication fill to final visual field test. Medication adherence (proportion of days covered) was estimated from pharmacy refill data. A conditional growth model was used to estimate the effect of adherence level in modifying the progression of mean deviation over time after adjusting for potential confounders, including age, sex, race/ethnicity, baseline glaucoma severity and comorbidity.

In total, 6,343 eligible patients were included in the study and followed for (mean) 5.8 years; average treatment adherence during follow-up was 73%. After controlling for confounders and the interaction between time and baseline disease severity, the model indicated that mean deviation progression was significantly (p=0.006) reduced by 0.006 dB per year for each 10% (absolute) increase in adherence. Model estimates of time to glaucoma progression (mean deviation change -3 dB from baseline) were 8.3 and 9.3 years for patients with adherence levels of 20% and 80%, respectively.

Researchers wrote that improving patient adherence to topical glaucoma medication may result in slower deterioration in visual function over time.

SOURCE: Shu YH, Wu J, Luong T, et al. Topical medication adherence and visual field progression in open-angle glaucoma: analysis of a large us healthcare system. J Glaucoma. 2021; Oct 19. [Epub ahead of print].


Combined Automated Screening for Age-Related Macular Degeneration and Diabetic Retinopathy in Primary Care Settings

Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are among the leading causes of blindness in the United States and other developed countries. Early detection is the key to prevention and effective treatment. Investigators built an artificial intelligence-based screening system that utilizes a cloud-based platform for combined large-scale screening through primary care settings for early diagnosis of these diseases. iHealthScreen Inc., an independent medical software company, developed automated AMD and DR screening systems utilizing a telemedicine platform based on deep machine learning techniques. For both diseases, investigators prospectively imaged both eyes of 340 unselected non-dilated subjects over 50 years of age. For DR specifically, 152 diabetic patients at New York Eye and Ear faculty retina practices, ophthalmic and primary care clinics in New York City were examined with color fundus cameras. Following the initial review of the images, 308 images with other confounding conditions like high myopia and vascular occlusion, and poor quality were excluded, leaving 676 eligible images for AMD and DR evaluation. Three ophthalmologists evaluated each of the images, and after adjudication, the patients were determined referrable or non-referable for AMD DR. Concerning AMD, 172 were labeled referable (intermediate or late) and 504 were non-referable (no or early). Concurrently, regarding DR, 33 were referable (moderate or worse), and 643 were non-referable (none or mild). All images were uploaded to iHealthScreen's telemedicine platform and analyzed by the automated systems for both diseases. The system performances were tested on a per eye basis with sensitivity, specificity, accuracy and kappa scores with respect to the professional graders.

In identifying referable DR, the system achieved a sensitivity of 97.0% and a specificity of 96.3%, and a kappa score of 0.70 on the prospective dataset. For AMD, the sensitivity was 86.6%, the specificity was 92.1%, with a kappa score of 0.76.

The AMD and DR screening tools achieved excellent performance operating together to identify two retinal diseases prospectively in mixed datasets, demonstrating the feasibility of such tools in the early diagnosis of eye diseases. Investigators wrote that the early screening tools would help create an even more comprehensive system capable of being trained on other retinal pathologies, a goal within reach for public health deployment.

SOURCE: Bhuiyan A, Govindaiah A, Alauddin S, et al. Combined automated screening for age-related macular degeneration and diabetic retinopathy in primary care settings. Ann Eye Sci. 2021; Jun;6:12.




Industry News

AAOF Announces Korb-Exford Dry Eye Career Development Grant Recipient

The American Academy of Optometry Foundation announced Jillian F. Ziemanski, OD, PhD, FAAO, is this year’s recipient of the Korb-Exford Dry Eye Career Development Grant. Dr. Ziemanski is an assistant professor at the University of Alabama at Birmingham School of Optometry, Department of Optometry and Vision Sciences. Her proposal, Cytokine Priming of the Complement System at the Ocular Surface: Application to Primary Sj√∂gren’s Syndrome, was selected from a pool of competitive submissions. This $25,000 grant will help Dr. Ziemanski advance eyecare and improve outcomes for people with dry eye disease.



AAOF Announces Beta Sigma Kappa Research Fellowship Recipient

The American Academy of Optometry Foundation, in collaboration with the Beta Sigma Kappa International Optometric Honor Society, announced Kevin Willeford, OD, MS, PhD, FAAO, is the 2021 recipient of the Beta Sigma Kappa (BSK) Research Fellowship. Dr. Willeford is an associate professor at the Nova Southeastern University College of Optometry. The fellowship will fund his project, “Do non-strabismic individuals use slow fusional vergence to stabilize binocular alignment across gaze positions?”

Oyster Point Gets FDA Nod for Tyrvaya


Oyster Point Pharma received FDA approval for Tyrvaya (varenicline solution) Nasal Spray 0.03 mg for the treatment of the signs and symptoms of dry eye disease. Tyrvaya is believed to bind to cholinergic receptors to activate the trigeminal parasympathetic pathway resulting in increased production of basal tear film as a treatment for dry eye disease. Read more.

CLX System and MaximEyes.com Simplify Contact Lens Ordering


First Insight has simplified contact lens online ordering, patient reorders and centralizing patient data with the cloud-based CLX System and MaximEyes.com, the company’s new unified EHR and practice management software for eye care practices. Learn more.

Registration is Open for IDOC’s The Connection 2022


Returning to a live, in-person format for 2022, IDOC’s annual national conference, The Connection, is scheduled for February 24 to 26 in Orlando. The three-day event will offer attendees a first-hand look at the full spectrum of IDOC’s new practice management services. Register here.

Registration Open for 6th Annual ISVA Conference


Registration is open for Elevating Athletic Performance, the 6th Annual International Sports Vision Association conference, scheduled for February 10 to 12, 2022 at the Embassy Suites by Hilton Orlando Lake Buena Vista South in Kissimmee, FL. The conference will offer up to 17 COPE-approved CE credits. Learn more and register.

Senate FY2022 Appropriations Bill Doubles Funding for CDC’s Vision and Eye Health Program


As a result of continued Prevent Blindness advocacy efforts, the Senate Appropriations legislation includes a total of $6 million for vision and eye health programs at the Centers for Disease Control and Prevention. This includes funding the Vision Health Initiative (VHI) at $2 million in FY2022—a $1 million increase over FY2021—and continued funding of $4 million for the Glaucoma project. If the legislation is enacted into law, the VHI’s funding level would be at its highest since FY2010. Read more.









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