Optometric Physician

A weekly e-journal
by Arthur B. Epstein, OD, FAAO

Volume 8, Number 33 Monday, August 18, 2008


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Off the Cuff: An Uncommon Thread


The American Academy of Ophthalmology Surgical Scope Fund is aimed at limiting all optometric scope expansion as well as controlling the public perception of optometry. Make no mistake, the fund isn't about protecting the public health or improving surgical care—it is about hobbling our independent profession.

"Optometrists are aggressively campaigning for YOUR job," the Arizona Ophthalmological Society warned, referring to then current OD legislative initiatives in neighboring New Mexico. They added, "the AAO Surgical Scope Fund helped educate the public through announcements that defined optometric education and their skill sets".

Millions of AAO dollars have been spent against optometry in Oklahoma, New Mexico and numerous other states, "educating" an unsuspecting public about what organized Ophthalmology thinks we are, what we know and what we should or shouldn't be allowed to do. As a pleasant aside, the AAO was lambasted by the New Mexico legislature for its scurrilous theatrics.

See what your colleagues are thinking on OptometricPhysician Blog.

Should we as a profession allow others to define us? I think not; however, each of our states largely fights alone when it comes to appropriately defining our profession and advancing needed legislation. The AOA has made significant advances in defending optometry in Washington, DC, but most of our key battles take place in state legislatures, rather than in Congress.

The AOA does have an "Affiliate Legal and Legislative Defense Fund," but bizarrely, it was created as a loan rather than a grant-based program. As a result, not one state has applied for the more than one million dollars sitting in the fund. Anyone who has worked on the state level understands why. State associations can barely afford local initiatives, let alone potentially crushing debt.

This year's House of Delegates passed a resolution to create a project team to review the now dead-in-the-water program. The four state associations that proposed this resolution should be lauded.

It's time our organizations approach our profession as a unified national entity just as MD organizations do. Taking control of our public persona is the first step to taking control of our destiny. AOA PR initiatives have been quite successful in increasing our standing in the public eye. However, state legislative battles require broader, more unified and much more aggressive national support.

I will be closely watching the steps the Legal and Legislative Defense Fund project team takes toward making this a reality. If the AOA is unable to implement what we need, including soliciting voluntary contributions to support State's efforts, perhaps we need to consider other alternatives.

In the end, we are all linked by a uncommon thread that crosses state boundaries and we need to support each other wherever we practice. Our profession's future depends on it.

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Arthur B. Epstein, OD, FAAO
Chief Medical Editor


Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com. Comments received may be published on OP-Blog at the discretion of the editor without attribution. Please indicate if you would like your thoughts attributed to you.

The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Publishing or any other entities or individuals.

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Tourette Syndrome and the Eye

Tourette syndrome is a stress-sensitive neurologic disorder characterized by involuntary vocal and motor tics. Both Tourette syndrome and the medical treatment for this condition can affect the eye.

In Case 1, a five-year-old boy was brought to an optometrist by his mother for excessive "flinching" of the eyes. The flinching was actually excessive blinking, and after consulting with the patient's pediatrician and a neurologist, Tourette syndrome was diagnosed. In Case 2, an adult male patient complained that, on occasion, he would forcibly blink out his soft contact lenses. He had previously received a diagnosis of Tourette syndrome, which is successfully managed with medication.

Eye signs in Tourette syndrome include excessive blinking, squinting, eye rolling, exaggerated eye opening and closing and problems with saccades. Because the eye can be involved in Tourette syndrome, optometrists should be aware of the different manifestations of the condition, which often go unrecognized.

SOURCE: Kovacich S. Tourette syndrome and the eye. Optom 2008;79(8):432-5.

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Bottle Cork and Cap Injury to the Eye: Review of 34 Cases

A retrospective review of the database of the Ophthalmology Institute of Modena from January 1999 to September 2007 was performed to describe a series of bottle cork and cap ocular injuries to report the visual impairment and clinical outcomes observed in 34 cases over eight years. All patients presented with closed-globe injury, and all were caused by bottles containing sparkling wine (white in 24 cases and red in 10 cases).

The incidence varied between two and six cases a year (average 3.89). Bottle cork and cap injuries represented 11 percent of all injuries admitted to one department in the period considered in the series. Nine patients recovered totally; 22 patients recovered partially; and three patients had a severe visual outcome (lower than Grade 3 according to trauma classification system, BCVA less than 0.2). Five patients needed a surgical procedure. The most frequent ocular lesion was hyphema; the worst was retinal detachment resulting from a giant retinal tear. Two patients suffered very severe visual impairment.

This is the largest series of bottle cork and cap ocular injuries published to date. This kind of injury is potentially sight-threatening and may lead to severe visual loss in a small percentage of cases. This study highlights the need for preventative measures such as warning labels or devices to regulate cork pressure.

SOURCE: Cavallini GM, Martini A, Campi L, Forlini M. Bottle cork and cap injury to the eye: A review of 34 cases. Graefes Arch Clin Exp Ophthalmol 2008; Aug 12 [Epub ahead of print].

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Blood Levels of Vitamin C, Carotenoids and Retinol Inversely Associated with Cataract

This cross-sectional study evaluated participants aged 50 years and older to examine the association of blood antioxidants with cataract. Participants were interviewed for putative risk factors (tobacco, alcohol, biomass fuel use, sunlight exposure and socioeconomic status) and underwent lens photography and blood sampling. Lens photographs (nuclear, cortical and posterior subcapsular) were graded according to the Lens Opacities Classification System (LOCS II). Cataract was defined as LOCS II Grade 2 or greater for any opacity, or ungradable because of dense opacification or history of cataract surgery. People without cataract were defined as LOCS II less than Grade 2 on all three types of opacity with absence of previous surgery.

Of 1,443 people, 94 percent were interviewed, 87 percent attended an eye examination and 78 percent gave a blood sample; 1,112 (77 percent) were included in the analyses. Compared with levels in Western populations, antioxidants were low, especially vitamin C, which was inversely associated with cataract. Odds ratios (OR) for the highest (15 micromol/L or greater) compared with the lowest (6.3 micromol/L or lower) tertile were 0.64. Tertiles of zeaxanthin, alpha-carotene and retinol were associated with decreased odds of cataract. In analysis of continuous data, significant inverse associations were found for vitamin C, zeaxanthin, lutein, lycopene, alpha- and beta-carotene and beta-cryptoxanthin, but not for alpha- or gamma-tocopherol.

SOURCE: Dherani M, Murthy GV, Gupta SK, et al. Blood levels of vitamin C, carotenoids and retinol are inversely associated with cataract in a North Indian population. Invest Ophthalmol Vis Sci 2008;49(8):3328-35.

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MONTHLY CONTACT LENS WEARERS REPORT DECREASE IN COMFORT AT MONTH'S END. Wearers of monthly-replacement contact lenses tend to notice a decline in lens performance and comfort in weeks three and four of wear, a new survey reveals. The survey, conducted among 434 monthly lens wearers in France and sponsored by Johnson & Johnson Vision Care, Inc. (subjects were unaware of the sponsor's identity), included representation of 20 different brands of lenses. More than 70 percent of monthly silicone hydrogel wearers and 68 percent of hydrogel wearers reported a decrease in wearing comfort as the month progressed, and 95 percent of those respondents said they become aware of the discomfort in weeks three and four. Monthly silicone hydrogel wearers who experienced discomfort tended to notice it earlier in the lens cycle than hydrogel wearers. The survey also asked about lens wearers' perceptions of the eyecare professional's role in communicating the benefits of contact lens innovations. Eighty-one percent said they expect their doctor to recommend an upgrade on comfort grounds; three-quarters of respondents would consider seeing their eyecare professional more often if he or she proactively proposed more comfortable lenses. Ninety-one percent of those surveyed also said that they are more satisfied when their eyecare professional shows them lenses that are better for their ocular health and that offer more comfort. The results suggest that eyecare practitioners question monthly-replacement contact lens wearers specifically on comfort performance.


PHASE II TRIAL OF RNAi THERAPY FOR DME BEGINS. Quark Pharmaceuticals and its partner, Pfizer Inc., have initiated patient dosing in a Phase II trial evaluating PF-4523655 (RTP801i-14) in patients with diabetic macular edema (DME). PF-4523655 is a novel siRNA drug candidate being codeveloped by Quark and Pfizer that may potentially be efficacious when used as monotherapy and in combination with existing VEGF-based therapies. The compound was designed to inhibit Quark's proprietary target RTP801, a gene involved in abnormal ocular blood vessel development and leakage. The Phase II trial is a prospective, randomized, dose-ranging study to evaluate the safety and efficacy of PF-4523655 vs. laser therapy in 160 DME patients at multiple centers worldwide. Results from a Phase I/II trial showed that the compound was safe and well-tolerated in patients with wet AMD who had failed to respond to currently approved therapies. Quark and Pfizer are considering an additional Phase II study of PF-4523655 in patients with wet AMD. Under terms of the agreement, Pfizer holds exclusive development rights to siRNA-mediated therapies that inhibit RTP801 for ophthalmic and non-ophthalmic indications; Quark is eligible for development and sales-based milestone payments.


GLAUCOMA FOUNDATION ESTABLISHES NEW AWARD. The Glaucoma Foundation has created a new annual award for Innovation and Excellence in Glaucoma to recognize the contributions of individuals who have played a significant and unique role in promoting the medicine and science of glaucoma. The first Glaucoma Foundation Award for Innovation and Excellence in Glaucoma will be presented to Robert Ritch, MD, on December 3, 2008, at the 22nd Black and White Ball, the foundation's yearly benefit gala. Dr. Ritch is the founder of the Glaucoma Foundation; he holds the Shelley and Steven Einhorn Distinguished Chair in Ophthalmology and is surgeon director and chief of glaucoma services at the New York Eye and Ear Infirmary. He also serves as a professor of clinical ophthalmology at the New York Medical College, Valhalla, NY. Dr. Ritch is currently TGF's medical director and chairman of its scientific advisory board. He was recently awarded the Lifetime Achievement Honor Award and the Leadership in Education in Ophthalmology Award from the AAO.

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Optometric PhysicianTM Editorial Board

Chief Medical Editor
Arthur B. Epstein, OD, FAAO

Therese DeAngelis

Art/Production Director

Joe Morris

Journal Reviews
Shannon Steinhäuser, OD, FAAO

Editorial Board

• William Jones, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Ron Melton, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO
• Randall Thomas, OD, MPH, FAAO


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