Optometrists Shouldn’t Butt Out

Encouraging smoking cessation is the OD’s job, and a new study shows it can work.
By Bill Kekevian, Senior Editor

Optometrists don’t simply care for patients’ eyes. As research reveals more ocular manifestations of systemic disease, and the profession’s scope of practice expands, optometrists are finding themselves making health recommendations, including advice on diet, exercise and tobacco cessation. But as ODs approach these new avenues of patient care, a question lingers: Will patients even listen to them on these issues? 

According to new evidence, the American Academy of Optometry says they will. The study, presented at the Academy’s meeting in Anaheim last month, looked at 193 patients who were counseled on smoking cessation. The research, conducted by Stanley W. Hatch, OD, found 14.4% of patients ceased tobacco use after counseling by an optometrist.1 By way of comparison, a 2012 study found the cessation rate of patients counseled by a primary care physician is 15%.2

“Other than age, smoking is the biggest risk factor for these conditions, and it can be changed,” Dr. Hatch says. Chances are, you know someone who has beaten smoking. Dr. Hatch suggests referring to those stories to help reach out to patients. However you approach it, Dr. Hatch wants to make it clear that it’s within the OD’s purview. “To the optometrist who feels discussing smoking cessation is outside the scope of practice: Is the management of cataract, macular degeneration, retinal vein and artery occlusion, and uveal melanoma outside their scope of practice? Absolutely not. If you quit smoking, you reduce your risk of blindness and death,” he says. 

In addition to degrading systemic health, studies show smoking directly affects ocular health and is associated with diseases such as macular degeneration.3,4 

Dr. Hatch suggests researching cessation programs and finding one you’re willing to share with patients. Then, relay this script: “Is there anything I can do to help? Research has shown that solo quitting is rarely successful, but those who participate in a smoking cessation program, see their primary care provider for medication and get counseling have much better success rates. Can I refer you to this local program?”

1. Hatch SW. Effect of tobacco cessation counseling in an eye care practice. Available at www.aaopt.org/sites/default/files/userfiles/2016/Education_Web.compressed.pdf. Accessed November 28, 2016.

2. Pierce J, Cummins S, White M, et al. Quitlines and nicotine replacement for smoking cessation: do we need to change policy? Annual Review of Public Health. 2012 April;33:341-56.

3. Asfar T, Lam B, Lee D. Smoking causes blindness: time for eye care professionals to join the fight against tobacco. Invest Ophthalmol Vis Sci. 2015;56:1120-1.

 4. Swanson MW. Smoking deception and age-related macular degeneration. Optom Vis Sci. 2014;91(8):865-71.

1-800-Contacts Making Headway with FTC?

After reviewing comments received in September 2015 about the costs, benefits and impact of the Contact Lens Rule, the FTC has proposed changes, including mandating eye care providers (ECPs) maintain a signed agreement of prescription dispensation for contact lens (CL) patients—for three years.1 

Brien Holden Humanitarian Award: Good Work and its Accolades

In honor of the memory and efforts of Professor Brien Holden, PhD, DSc, FAAO, the American Academy of Optometry recently announced the establishment of the Brien Holden Humanitarian Award. This new accolade aims to recognize an individual or organization whose humanitarian work in non-profit sectors strives to create or improve sustainable eye care systems in developing communities. 

Professor Holden, founder of the Brien Holden Vision Institute, was an internationally renowned scientist, humanitarian and professor at the School of Optometry and Vision Science at the University of New South Wales in Australia. His inspiring life of work was informed by a dream of universal access to vision care and a passion to provide sight for communities where disparities existed. 

“The awards given at the Academy of Optometry annual meeting represent our values and our history,” says Don Mutti, OD, PhD, incoming awards committee chair. “Each award honors an exceptional life while affirming our progress by celebrating the achievement of each new recipient. Dr. Holden devoted so much of himself to humanitarian work. This new award means the values of improving the vision of all are alive and well in our profession and the Academy.” Beginning in 2017, the award will be given annually. Nominations are due by April 1, 2017 to Helenv@aaoptom.org and should include two letters of nomination from Academy Fellows as well as the nominee’s CV.

Such a rule change comes as a hefty blow to optometrists fighting against the selling practices of online giants such as 1-800-Contacts. The FTC’s “Notice of Proposed Rulemaking (NPRM)” outlines the review process and the reasons behind the proposed changes.2 

Although the American Academy of Optometry provided a comment that included peer-reviewed research to support its claim that alternative supply chains for the sale of CLs is an identifiable risk factor for ocular morbidity in CL patients, the FTC concluded “they are not sufficient to reliably demonstrate that purchasing lenses online is a risk factor, or that online purchasers are at a higher risk of developing microbial keratitis or any other ocular complication.”2

Other organizations and ECPs also provided comments suggesting the Contact Lens Rule creates a mechanism for renewal of expired prescriptions, putting patients’ eye health at risk. The FTC claims these comments “did not include any empirical evidence showing that the passive verification mechanism has actually resulted in the renewal of expired prescriptions.”2 Additionally, “other examples of patient harm identified by commenters were either hypothetical or anecdotal.”2

Yet, the NPRM declares other evidence submitted by commenters is informative for the purposes of the rule change. The NPRM provides statistics from 1-800-Contact’s comment, pulled from surveys conducted on the company’s behalf. The surveys found only 35% of CL wearers reported receiving a copy of their prescription without asking for it, 28% received it after asking and 36% never received it at all.2 The NPRM claims that, even though these surveys cannot provide a definitive answer regarding automatic release compliance, they, along with “the high number of verifications, the ongoing pattern of consumer complaints and anecdotal reports, and the industry’s long history of failing to provide prescriptions” suggest compliance with the automatic prescription release provision needs improvement.2

With such evidence, it will be an uphill battle to keep these new rules from being enacted. The FTC is accepting public comments until January 30, 2017.

“If the FTC rule changes become finalized and implemented, I see an adverse potential to disrupt the patient-physician relationship, which places the patient at risk for vision loss,” says Greg Caldwell, OD, diplomate of the American Board of Optometry. “These rule changes will also create additional administrative burdens, especially for small businesses. I encourage colleagues to help the AOA and state associations fight back and educate the FTC about why its proposal is rooted in inaccurate information about our role as physicians committed to the health and well-being of our patients.”

1. Federal Trade Commission. FTC Seeks Comment on Proposed Changes to Contact Lens Rule. News Release. November 10, 2016. Available at www.ftc.gov/news-events/press-releases/2016/11/ftc-seeks-comment-proposed-changes-contact-lens-rule. Accessed November 18, 2016.

2. Federal Trade Commission. Notice of Proposed Rulemaking. Available at www.ftc.gov/system/files/documents/federal_register_notices/2016/11/contact_lens_rule_nprm111416.pdf. Accessed November 18, 2016.


Thyroid Eye Disease Discovery

new study, recently published in The American Journal of Pathology, took a closer look at the underlying molecular pathways that lead to scarring in thyroid eye disease (TED) and found that activating the aryl hydrocarbon receptor (AHR) pathway by its ligands blocks collagen production and myofibroblast proliferation. 

“Thyroid eye disease is the most common extra-thyroidal manifestation of Graves’ disease, an automimmune disorder, and is characterized by myofibroblast accumulation, tissue remodeling and scarring within the orbit,” says Joseph Pizzimenti, OD. “Unfortunately, current therapies do not target or prevent the excessive tissue remodeling caused by myofibroblast formation and activation.”1,2 

But now, investigators from the Flaum Eye Institute of the School of Medicine and Dentistry of the University of Rochester believe AHRs may be the key to controlling or preventing tissue remodeling or destruction associated with TED. The researchers compared human orbital fibroblasts from TED patient tissue with tissue from patients without TED, and found the TED orbital fibroblasts expressed higher levels of AHRs than non-TED orbital fibroblasts. They also discovered the AHR ligands turned on AHR-dependent genes, blocking the transforming growth factor (TGF)-β -driven conversion of orbital fibroblasts to scar-forming myofibroblasts.

“TGF-β is a cytokine that induces myofibroblast formation,” Dr. Pizzimenti explains. “Because the TGF-β signaling pathway is influenced by AHR signaling pathways, AHR agonists may have the potential to prevent myofibroblast formation in patients with TED, resulting in a therapeutic benefit.”1,2 

“The study looks ahead to AHR and AHR ligands as future ‘anti-scarring’ therapeutic options for eye diseases and possibly also for other scarring conditions,” Dr. Pizzimenti says. “In severe cases of TED, treatment should be customized for each patient in close collaboration with the endocrinologist.”

But as promising as these study findings may be, the journey from lab to approval can be a long one, Dr. Pizzimenti cautions. 

1. Woeller CF, Roztocil E, Hammond CL, et al. The aryl hydrocarbon receptor and its ligands inhibit myofibroblast formation and activation. Am J Pathol. November 11, 2016. [Epub ahead of print].

2. Pelino CJ, Pizzimenti JJ. Axis of activity. Rev Optom. 2014;151(1):67-9.



Study: Most Diabetes Patients Skip Eye Exams

Nearly 60% of Americans with diabetes skip their regular eye exams, according to a study presented at the American Academy of Ophthalmology meeting in October. Researchers reviewed approximately 2,000 patients with diabetes over a four-year stretch. They found that 58% of patients with diabetes did not obtain regular follow-up exams. Subsets within that group show even more troubling numbers, as patients with diabetes who are also smokers were more likely than nonsmokers to neglect eye exams. Patients with less severe diabetes and no resultant eye problems were also skipping out on eye exams. However, patients who have already developed diabetic retinopathy were 30% more likely to follow up, according to the research. 

Nonadherence to eye care in people with diabetes. Presented at the 120th annual meeting of the American Academy of Ophthalmology, October 14-18, 2016; Chicago.

In the news

A recently published phase II study suggests treating wet age-related macular degeneration (AMD) with a platelet-derived growth factor (PDGF) antagonist in combination with ranibizumab could provide significant improvement in visual outcomes. Researchers noted a 62% relative benefit from baseline in study participants treated with 1.5mg anti-PDGF Fovista (pegpleranib, Ophthotech) in combination with Lucentis (ranibizumab 0.5mg, Roche) compared with monotherapy.

Jaffe GJ, Ciulla TA, Ciardella AP, et al. Dual antagonism of PDGF and VEGF in neovascular age-related macular degeneration. Ophthalmol. October 28, 2016. [Epub ahead of print].

A new study shows an
iPad game is more effective than patching for amblyopia treatment. Half of the pediatric study participants were asked to play the game 10 hours total over two weeks, and the other half were assigned patching therapy. When BCVA was measured at two weeks, 39% of those who used the iPad game reached 20/32 or better compared with 7% in the patching group. 

Li SL, Reynaud A, Hess RF, et al. Binocular iPad game vs patching for treatment of amblyopia in children. JAMA Ophthalmol. November 10, 2016. [Epub ahead of print].

A new study compared laser iridotomy (LI) and lens extraction with intraocular lens (IOL) implantation for the treatment of glaucoma. By looking at the outcomes of 211 patients who received LI and 208 who received lens extraction with IOL implantation, researchers found clear lens extraction was more effective regarding patients’ vision and eye pressure levels at three years post-procedure. 

Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. The Lancet. 2016;388:1389-97.