A
weekly e-journal by Art Epstein, OD, FAAO
Off the Cuff: Our Growing Leadership Vacuum
I am sure that this editorial will ruffle some feathers, but what I am writing needs to be read. This is just the first in a series of what I consider to be reality checks. Consider this: Interest in becoming an optometrist has been on a steady decline for quite a while. While some optometry programs would have you believe that they have substantial waiting lists for admission, friends in academia and the data speak a different story. For many programs, there are barely enough candidates—despite relaxed admission standards—to fill existing seats. Dentistry, which decades ago, saw commercialism growing and a fate similar to what happened to pharmacists looming, shuttered schools to reduce practitioner numbers and bolster their profession’s stability. Optometry’s answer? Open more schools even in areas that clearly do not need more schools or more optometrists. I stumbled upon this social media ad by ASCO a few weeks ago:
|
||||||
Effect of Topical Prostaglandins on the Biomechanics and Shape of The Cornea | ||||
This study investigated the effect of topical prostaglandin (PG) eye drops on the biomechanics and shape of the cornea. Consecutive patients with primary open-angle glaucoma who had been treated with the same anti-glaucoma PG (114 eyes, 57 patients) or β-blocker (36 eyes, 18 patients) eye drops in one eye alone for more than three months at Inouye Eye Hospital or Miyata Eye Hospital. The biomechanical properties of the cornea were measured using a Corvis ST device (Oculus, Wetzlar, Germany). Corneal tomography was measured with a Casia 1 or 2 (Tomey Corp.,). The biomechanical parameters and tomographic features of the cornea were compared between PG-treated eyes, β-blocker-treated eyes, and contralateral eyes using a mixed-effect model adjusted for intraocular pressure and corneal thickness; and a linear model adjusted for age, sex, intraocular pressure and corneal thickness.
The PG-treated eyes had a significantly smaller applanation 1 time, the highest concavity radius and a larger deformation amplitude than the contralateral eyes. Also, the PG-treated eyes had a significantly smaller applanation 1 time and applanation 2 velocity, but a larger peak distance than the β-blocker-treated eyes. There were no significant differences in any of the Casia parameters between the PG-treated eyes and the contralateral eyes. The results of this study suggested that topical PG made biochemical changes to the cornea but did not alter its shape. |
||||
SOURCE: Amano S, Nejima R, Inoue K, et al. Effect of topical prostaglandins on the biomechanics and shape of the cornea. Graefes Arch Clin Exp Ophthalmol. 2019; Aug 10. [Epub ahead of print]. |
The Effect of Multiple Vitrectomies and its Indications on Intraocular Pressure | ||||
This study assessed the relationship between different indications for trans pars plana vitrectomies (PPVs) and intraocular pressure (IOP), and the effect of multiple PPVs on the IOP. Researchers also examined whether there were differences in the number of IOP-lowering medications or surgeries before and after PPV. A retrospective study including all patients that underwent at least one PPV in the period from 2001 to 2014 at a clinic. Medical records of all patients were reviewed, and clinically relevant data were entered in a database. Generalized estimating equation models for repeated measurements were used to examine the effect of the number of PPVs on the IOP and the risk of undergoing glaucoma surgery, for each of the indications for PPV.
Of 1,072 PPVs, 447 eyes fulfilled the inclusion criteria. The IOP increased with 3mm Hg after a PPV with indication of retinal detachment, but remained stable after PPV for epiretinal membrane, macular hole and vitreous hemorrhage. At the end of the follow-up period, the number of IOP-lowering medications was significantly higher compared with baseline, except in the macular hole group. Also, the number of eyes that underwent glaucoma surgery was significantly higher compared with the fellow (non-operated) eyes. There was a significant association between the number of PPVs and the final IOP for the indication of retinal detachment, and between the number of PPVs and glaucoma surgery (odds ratio [95% confidence interval]: 2.60 [1.62-4.15]). Researchers found that the IOP rose significantly after PPV with indication of retinal detachment. This association was not found for other indications for PPV. Also, the risk of IOP-lowering surgeries was higher after PPV, but not different between the PPV indications. Researchers suggested that IOP should be monitored carefully after PPV, since there might be a higher risk of secondary glaucoma. |
||||
SOURCE: Kovacic H, Wolfs RCW, Kılıç E, et al. The effect of multiple vitrectomies and its indications on intraocular pressure. BMC Ophthalmol. 2019;19(1):175. |
Accuracy of Computer-assisted Vertical Cup-to-disk Ratio Grading for Glaucoma Screening | ||||
Glaucoma screening can be performed by assessing the vertical-cup-to-disk ratio (VCDR) of the optic nerve head from fundus photography, but VCDR grading is inherently subjective. This study investigated whether computer software could improve the accuracy and repeatability of VCDR assessment. In this cross-sectional diagnostic accuracy study, five ophthalmologists independently assessed the VCDR from a set of 200 optic disk images, with the median grade used as the reference standard for subsequent analyses. Eight non-ophthalmologists graded each image by two different methods: by visual inspection and with assistance from a custom-made publicly available software program. Agreement with the reference standard grade was assessed for each method by calculating the intraclass correlation coefficient (ICC), and the sensitivity and specificity determined relative to a median ophthalmologist grade of ≥0.7. VCDR grades ranged from 0.1 to 0.9 for visual assessment and from 0.1 to 1.0 for software-assisted grading, with a median grade of 0.4 for each. Agreement between each of the eight graders and the reference standard was higher for visual inspection (median ICC, 0.65; interquartile range, 0.57 to 0.82) than for software-assisted grading (median ICC, 0.59; IQR, 0.44 to 0.71, Wilcoxon signed-rank test). Visual inspection and software assistance had similar sensitivity and specificity for detecting glaucomatous cupping. Investigators wrote that the computer software used in this study did not improve the reproducibility or validity of VCDR grading from fundus photographs compared with simple visual inspection. More clinical experience was correlated with higher agreement with the ophthalmologist VCDR reference standard. |
||||
SOURCE: Snyder BM, Nam SM, Khunsongkiet P, et al. Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. PLoS One. 2019;14(8):e0220362. |
News & Notes | |||||||||||||||
MyopiaCare Welcomes New Members Pascal Blaser, founder of MyopiaCare, an online educational platform for myopia specialists and parents, welcomed the following new team members. • Ross Grant BSc (Hons), MSc, FCOptom, PDipM, joined as chief business development officer. Grant trained as an optometrist at Aston University, Birmingham, UK, and has more than 40 years experience in clinical practice, academia, research, marketing and general management. • Thomas Aller, OD, FBCLA, joined as a clinical advisor. Dr. Aller has been researching for the past 27 years the use of bifocal contacts for the control of myopia. After receiving the world’s earliest patent for a method of myopia progression control, he collaborated for 10 years with Brien Holden and the Vision CRC on their anti-myopia program. Dr. Aller is currently conducting clinical trials on myopia management with an EDOF multifocal contact lens as well as an anti-hyperopia multifocal lens design. • Oliver Woo, Optometrist UNSW, FIAOMC, joined as a clinical consultant. A University of New South Wales Australia graduate, Dr. Woo’s special interests are pediatric optometry, myopia prevention and control contact lens fitting with orthokeratology and specialty contact lenses. In 2007, Dr. Woo became the first Australian fellow of International Academy of Orthokeratology and Myopic Control, and opened an orthokeratology and myopic control clinic in 2010. • Giancarlo Montani, Optometrist FIACLE, FBCLA, joined as a clinical advisor. He is professor of clinical contact lens application at the University of Salento, Lecce, Italy. In 2007, Professor Montani co-founded the Centre for Contact Lens Research of the University of Salento. MyopiaCare, founded in 2015, is an online platform developed to educate parents and support eye care specialists in their fight against myopia. |
|||||||||||||||
|
Optometric Physician™ (OP) newsletter is owned and published by Dr. Arthur Epstein. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073. HOW TO ADVERTISE |