Optometric Physician
 


Vol. 22, #36   •   Monday, September 20, 2021

 

Off the Cuff: Right and Wrong


I don’t know if it’s just me or if most of you regularly question what you are doing clinically and why you are doing it. I think that always questioning what you think you know is an essential quality of an astute clinician. Despite this being what would seem a self-evident truth, I am amazed at how infrequently many of us question our thinking or the thinking of others.

An obvious example for me immersed in dry eye is artificial tears. Tears are not only the most commonly recommended dry eye treatment, they are also among the oldest. What is amazing is how little many of us actually know about them. While some clinicians stick with a favorite tear often for reasons unknown, I suspect most samples are absentmindedly handed out to patients looking for a freebie. No matter how much formulation science has advanced and products have improved, I don’t think prescribing habits have changed much, if at all, and probably for good reason. Does adding a lipid component to a tear actually help patients? Considering the critical role homeostasis plays in ocular surface maintenance, everything we do to the ocular surface environment affects everything else within that environment. Does adding a lipid to the tear film actually cause down regulation of meibomian gland lipid production and increased tear instability? Are we doing the exact opposite of what we’re trying to do?

Here is another clinical observation that fascinates me. We learn that the cornea has an order of magnitude more nerves than any other tissue in the body. Virtually all of us know that, but I’ve yet to hear someone ask why? It’s not like nature had a bunch of extra nerves hanging around and decided to give them to the cornea. It just can’t be that simple. Might it be more likely that all of those corneal nerves are receiving and conveying important data for maintaining ocular surface function? Considering the eye is so essential to survival and the ocular surface so critical to the eye’s function, that would be a logical explanation. The big question is: what is actually being measured and how is that information being used?

I spend a lot of time worrying about the influence so-called influencers have. The other day I saw a patient who traveled eight hours to see me. She described her treatment by two colleagues I know. Both treatment approaches were nearly identical and were consistent with what I have read on online forums. Both included on-eye IPL using laser grade shields and very limited facial IPL. Unfortunately, neither approach had any positive effect according to the patient. While I do see value for on-eye treatment for a chalazion or a vascularized lid margin, lid anatomy and the tarsal plate likely blocks most of the IPL energy from reaching the glands. IPL using a Toyos facial treatment pattern seems to convey energy more directly to the glands as it produces waves in a plane that traverses the dermis, even crossing closed lids. At least that’s how I see it.

Asking questions is the foundation of research and scientific exploration, but as our clinical world becomes more complex, questioning the simple, seemingly obvious things becomes even more important.





 


Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com


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.




 
 


 
 

Oral Isotretinoin Resulting in Recurrence of LASIK-treated Myopia: A Rare Side Effect


Isotretinoin is an analog of vitamin A, used to treat severe, recalcitrant nodular acne, psoriasis and disorders of keratinization. However, its benefits come with a broad range of serious side effects, including ocular adverse effects. Researchers reported and described a rare case of bilateral myopia in a female patient treated with oral isotretinoin for acne vulgaris.

A female patient, 29-year old, presented to the office for blurry vision. The patient was treated with oral isotretinoin for four weeks. She had a past medical history of myopia precisely corrected with laser-assisted in situ keratomileusis without any residual refractive error. After a thorough examination and laboratory workup, isotretinoin was thought to be the causative agent of her current complaint, so it was immediately stopped. The follow-up showed no further decrement of visual acuity in the patient. However, the vision loss acquired as an adverse effect of oral isotretinoin persisted.

SOURCE: Qureshi K, Tariq J, Chaudhry MS, et al. Oral isotretinoin resulting in recurrence of lasik-treated myopia: a rare side effect. Cureus. 2021;13(8):e16884.


 
 

 

 
 

Examining Risk Factors Related to Digital Learning and Social Isolation: Youth Visual Acuity in Covid-19 Pandemic


Around the globe, various self-quarantine, social distancing and school-closure policies were implemented during the coronavirus disease-19 (COVID-19) outbreak to reduce disease transmission. Many economies/territories were compelled to consider digital learning modalities. In particular, increased digital learning engagement with digital devices and mounting psychosocial stress due to social isolation are likely to pose adverse risks for youth visual health globally. This study examined the association between increased digital device use, psychosocial stress and myopia symptoms among Chinese youth during the COVID-19 pandemic. This is a retrospective, observational population study consisting of 3918 participants enrolled in primary, secondary and university in China. Participants were recruited through an online survey, which included self-reported information on daily digital device use, psychosocial stress level, condition of visual acuity and demographic information. Researchers utilized statistical tools including χ2 test, paired sample t test and multiple multivariate logistic regression.

Each hour increase in digital device use was associated with 1.25 odds ratio OR (95% confidence interval (CI)=1.21-1.30; p< 0.001) increased risk of developing myopic symptoms, each additional hour of digital device use weighted by near-view and blue-light exposure was associated with OR=1.04 OR (95% CI=1.03 to 1.05; p<0.001) and OR=2.25 (95% CI=1.94 to 2.60; p<0.001) increased risk, respectively. Subjects reporting under stressful conditions were between OR=1.98 (95% CI=1.67 to 2.36; p<0.001) and OR=2.03 (95% CI=1.71 to 2.42; p<0.001) more likely to develop myopic symptoms, relative to those citing less stress.

The COVID-19 pandemic led to favorable conditions for myopigenic behavioral changes characterized by extended sedentary engagement with digital devices, which are significantly associated with higher risks of myopia incidence. Relatedly, psychosocial stress accompanying prolonged social isolation during the pandemic was a less noticeable, albeit significant, risk factor for myopia development.

SOURCE: Liu J, Chen Q, Dang J. Examining risk factors related to digital learning and social isolation: Youth visual acuity in COVID-19 pandemic. J Glob Health. 2021;11:05020.

 
 

Reported Patient Satisfaction and Spectacle Independence Following Bilateral Implantation of the PanOptix Trifocal Intraocular Lens


Eligible subjects interested in a trifocal intraocular lens (IOL) to potentially reduce dependence on spectacles for near, intermediate and distance vision were enrolled and followed for three months to assess the spectacle independence and satisfaction of subjects after bilateral implantation of the PanOptix trifocal IOL. Visual acuity and refractive data were collected one month and three months postoperatively, including the uncorrected and best distance-corrected binocular visual acuities at distance (4m), intermediate (60cm) and near (40cm). A patient satisfaction and spectacle independence questionnaire were administered at the three-month visit.

A total of 30 subjects successfully completed the study. Eighty-five percent of eyes (51/60) had a refraction within 0.50D of plano with ≤0.50D of refractive cylinder. One subject (3%) reported needing glasses for distance work, three (10%) reported needing glasses for intermediate work and four (13%) reported needing glasses for near work. Ninety percent or more of all subjects reported never wearing glasses or wearing them only a little at all working distances. Ninety percent or more were able to function without glasses at all three working distances all or most of the time. More than ninety percent of subjects reported being "completely" or "mostly" satisfied with their vision without glasses or contact lenses at all three distances and overall.

Investigators wrote that a high percentage of patients are likely to achieve spectacle independence for distance, intermediate and near vision with this trifocal IOL.

SOURCE: Blehm C, Potvin R. Reported patient satisfaction and spectacle independence following bilateral implantation of the PanOptix Trifocal Intraocular Lens. Clin Ophthalmol. 2021;15:2907-12.

 

 

 
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Industry News


Essilor Launches Vision-S 700 Refraction Station


Essilor Instruments introduced the Vision-S 700 refraction station, offering three-minute refractions and concentrating a complete refraction experience into an immersive station. Consisting of a stand-alone, ultra-compact tabletop subjective refraction unit, the refraction station incorporates the patented Digital Infinite Refraction method and liquid lens module. In addition to its spacesaving feature, immersive imaging technology simulates real-life conditions for the patient. Read more.

 

 
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TearRestore Offers Warm Compress Treatment


A new company, TearRestore, is simplifying warm compress treatment through offering a convenient and consistently effective option for patients. The proprietary product utilizes specially designed reusable heat packs to target the meibomian glands while not hindering the user’s vision throughout treatment. The result is a consistently therapeutic treatment that allows the user to continue their daily routine. Learn more.


X-Cel and ABB to Host Joint Educational Opportunity

 


Practices interested in improving their overnight ortho-k outcomes for myopia management can join X-Cel Specialty Contacts and ABB Optical Group on September 29, at 8:30 p.m. Eastern, with guest speaker Andrew Biondo, OD, FSLS, to discover how REMLens can benefit patients and practice. Register here.


Neurolens Names Bertrand Chief Executive Officer

 


Neurolens announced that its board of directors appointed Pierre Bertrand as chief executive officer, effective immediately. Current Chief Executive Officer and founder Davis Corley will transition to executive chairman of the Neurolens board of directors. Read more.

 



 

 
 

 



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