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 careit is about hobbling our
"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.
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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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.
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].
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.
NEWS & NOTES
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.