Today's Spotlight

Managing Microbial Keratitis

Infectious keratitis is a prevalent source of vision loss. While data from the 1990s report incidence as 30,000 cases per year in the United States, a newer study suggests this number has more than doubled. A small but significant percentage of these eyes go on to require corneal transplantation; between 2% and 6% will require an urgent transplant and an even higher percentage will require surgery to ameliorate resultant scars. A smaller number, perhaps as high 1.8% of ulcers seen at academic centers, go on to require enucleation or evisceration.

Because of the potential for severe vision loss, microbial ulcer management requires critical thinking at nearly all junctures, as well as careful and thoughtful follow-up. Based on the severity of infection upon diagnosis, the degree of virulence of the particular microbe and patient-specific features, corneal infections can sometimes progress despite aggressive and appropriate intervention. The good news, however, is that when these infections are identified and treated early, the odds of a favorable outcome are much greater.

Today's Spotlight

Managing Corneal GP Complications

The advent of soft disposable contact lenses permanently altered the contact lens landscape, resulting in the decline of corneal gas permeable (GP) lens fitting. GP lenses are increasingly relegated to patients with complex prescriptions or high vision demands, and specialty designs such as custom soft toric, hybrid and scleral lenses are now widely available and steadily growing in popularity. Consequently, corneal GP lenses are often overlooked as a first choice. 

Thanks to today’s technology, complications related to contact lens overwear and poor lens-to-cornea alignment can be identified early on to help avoid permanent corneal damage. It is important to be aware of common GP lens complications and understand how to troubleshoot in order to maintain good corneal health and lasting comfort.

Today's Spotlight

Let’s Make It Less Complex

Specialty contact lens designs help us restore significant visual function in patients with difficult prescriptions and corneal conditions. As these designs have flourished, so too have available options for these individuals. Several lens manufacturers aim to provide designs that improve predictability and efficiency in the fitting process. 

Scleral lenses in particular have seen a number of advancements over the past several years. These lenses are intended to clear the cornea and are separated from it by a nonpreserved saline solution. As our knowledge of scleral lens fitting improves, the process has become easier. Here, we discuss the factors that have simplified scleral lens fitting for today’s practitioners.

Today's Spotlight

When Dry Eye Compromises Corneal Integrity

Dry eye disease (DED) affects all parts of the lacrimal functional unit—including the cornea, conjunctiva, meibomian glands, lacrimal glands and the interconnecting innervation. As clinicians, we tend to detect dry eye by listening to patient complaints for DED-related symptoms and closely examining the cornea. This isn’t a misguided approach, considering the cornea is crucial to vision and is often the first structure compromised by DED. 

This article delves into DED’s impact on the cornea, including what we know about the pathophysiology of the condition, the initiating insult and methods of progression. 

Today's Spotlight

The Role of Toric Peripheries

Q: I just started fitting scleral lenses but haven’t yet ordered any toric peripheral curve lenses. My lab consultant mentioned that a majority of the orders she gets are for toric peripheries. Most of my patients seem happy and I rarely see much difference in lens edge appearance, but am I missing the point by not ordering toric peripheral curve lenses?

Click below for the answer.
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Look Inside The Current Issue

November 15, 2017


A Red Eye: Scleritis or Episcleritis?

Differentiating between the two is crucial to ensure you initiate the right treatment.

Glaucoma Therapy: Don’t Forget the Ocular Surface

Following the mantra “do no harm” can be a challenge when prescribing topical glaucoma medications. These tips can help minimize damage.

Graft-vs.-host Disease: How, Why and What Next

Dry eye is rampant in this population, and other complications abound.

The Conjunctiva in Crisis: Ocular Irritation Unmasked

When conjunctival calamities strike, here’s how to identify the cause and come up with a plan.

The Origins and Management of Contact Lens Discomfort

Understanding how this irritating nuisance develops is the first step toward fighting its deleterious effects.

When Dry Eye Compromises Corneal Integrity

Your patients’ blurry vision, keratitis and infections could be caused by ocular surface disease.


A Second Helping

Idiopathic intracranial hypertension sometimes returns. When it does, here’s what to do.

Could Eyelids Be the Key to DED?

A new theory finds the two linked by a familiar foe: bacterial biofilm.

Go Deep on Corneal Abrasions

Understanding the physiology of rupture and repair will improve your management decisions.

It’s All About the Benjamins

Let’s discuss the most important word in all of medicine—and it’s not “patient,” unfortunately.

Jaundice and the Eyes

Optometrists may be the first to notice icterus, a harbinger of systemic concerns.

News Review

OD Regulations | Eye Dominance | Drug Patents | Diabetic Retinopathy

Next Time, Order Well Done

A young man returned from an overseas trip with more than just memories.

Product Review

Pharmaceuticals | Diagnostic Technology | Patient-use Devices | Scleral Lenses

Red Alert

A routine conjunctivitis case could portend serious systemic illness.

Red Eyes Mean Optometry

Patients still head to their primary care provider for this when they should be giving their OD a call. What we find could be far more troubling.

Steer Clear of the Coding Rut

Every patient’s office visit is different and, often, so is the coding.

Stemming the Tide

Cycloablation lowers IOP at its source: the ciliary body. Once considered a last resort, it may be warranted earlier.

Sugar Rush

November is Diabetic Eye Disease Awareness Month. So put away that leftover Halloween candy already!

The Role of Toric Peripheries

They provide one last refinement to the fit, improving comfort and vision.


Practice Pearls

Expert clinician Paul Karpecki, OD, provides practical insights and management strategies for a wide array of ocular conditions.

RCCL e-News

A quick read of the best pearls from the current issue of Review of Cornea & Contact Lenses, with links to full articles.

Optometric Retina Society E-Newsletter

Keep up to date on the latest research and clinical findings in retinal disease care with this quarterly publication from the ORS.

Optometric Physician E-Journal

A weekly e-journal edited by Art Epstein, OD, featuring incisive commentary, timely research summaries and late-breaking news.

Additional Publications


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Review of Cornea & Contact Lenses

Nov/Dec 2017

Women in Optometry

Women in Optometry - November 2017
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