Optometric Physician

A weekly e-journal by Art Epstein, OD, FAAO


Volume 20, Number 16

Monday, April 13, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: The CDC, CNN, AAO and the Truth?
######### Comparison of Lamina Cribrosa Morphology in Eyes with Ocular Hypertension and Normal-tension Glaucoma
######### Assessment of Firework-related Ocular Injury in the US
######### The M.A.STE.R.S Algorithm for Acute Visual Loss Management After Facial Filler Injection
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: The CDC, CNN, AAO and the Truth?

While the light at the end of the tunnel grows brighter, incompetence, poor planning, partisan politics, and outright dishonesty undoubtedly added to the tragedy of the COVID-19 outbreak in the US and throughout the world. Despite all of our modern medical miracles and scientific advances, COVID-19 brought humanity to its knees. Sadly, much of the worst of it didn’t have to happen.

By now, infection rates and community transmission patterns make it clear that COVID-19 is transmitted as an aerosolized airborne virus easily spread by asymptomatic patients during normal social interactions. Coughing and sneezing, and then touching contaminated surfaces may be sources of infection but simply being in close proximity to an infected person breathing normally bears significant risk. Viruses are not especially mobile, and while you could conceivably get a sufficient inoculum from touching a contaminated surface and then your face, it would seem far less likely than from breathing an infected person’s exhaled breath.

While I have nothing against the endlessly recommended frequent handwashing and using hand sanitizer and disinfectant wipes, it’s fairly clear at this point that more logical infection control strategy would have been to quickly identify and isolate the already infected, while mandating universal surgical or N95 mask wear. Wearing masks to prevent infection is not a new idea. Masks are commonly worn throughout Asia during infectious outbreaks. In the US, mask wearing was actually legally required in some areas during the 1918 flu outbreak. So while everyone should have been wearing masks when around other people, the problem was that we didn’t have enough masks to go around.

If you want to point fingers in this mess, start with the CDC and its director, Robert Redfield. Failing to develop or procure sufficient COVID test kits was grossly negligent. The need was clearly evident months before the first COVID case appeared in the US. Same with masks, which we still don’t have enough of. It’s hard not to wonder how much the lack of masks and effective testing contributed to the rapid spread and high death rates in places like New York City. As we look back at this tragic incompetence, I suspect we’ll see how these miscues contributed greatly to the forced shutdowns throughput the country and the long-term impact on the economy.

Finally, the American Academy of Ophthalmology didn’t miss the COVID outbreak as yet another opportunity to impugn contact lens safety, recommending that patients switch to eyeglasses for the duration of the outbreak. Picked up by CNN, Fox News, and a number of smaller media outlets needing just a bit more scary-sounding news, here is a direct quote from AAO spokesperson Dr. Tom Steinemann: "You rub your eyes, then rub your face, scratch your face, put your fingers in your mouth, put your fingers in your nose," he added. "Some people are not very hygienic and may have forgotten to first wash their hands." The AAO ignored a paper published in its own journal showing low risk of viral transmission through tears and a more recent paper in Contact Lens and Anterior Eye reporting no additional risk for patients following normal hygiene practices. Finally, the current guidance from CDC states:

  There is no evidence to suggest contact lens wearers are more at risk for acquiring COVID-19
  than eyeglass wearers. Contact lens wearers should continue to practice safe contact lens wear
  and care hygiene habits. Get answers to other questions about COVID-19 and contact lenses.

During a public health crisis, the need for clarity and credible direction is paramount. The Academy of Ophthalmology should be ashamed for using the COVID-19 outbreak to take a cheap shot at contact lenses and optometry.

Arthur B. Epstein, OD, FAAO
Chief Medical Editor


Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com.

The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Medical Information LLC (JMI), or any other entities or individuals.



Comparison of Lamina Cribrosa Morphology in Eyes with Ocular Hypertension and Normal-tension Glaucoma

To characterize differences in the lamina cribrosa (LC) morphology between healthy, ocular hypertension (OHT) and naive normal-tension glaucoma (NTG) eyes, 80 eyes of 80 participants were matched for age, sex and axial length, and underwent enhanced-depth-imaging volume scanning of the optic nerve head using spectral-domain optical coherence tomography. The lamina cribrosa curvature index (LCCI) and lamina cribrosa thickness (LCT) were measured in horizontal B-scan images spaced equidistantly across the vertical diameter of the optic disc.

The LCCIs in all seven planes were smaller in both OHT and healthy eyes than in NTG eyes, and did not differ significantly between the OHT and healthy eyes. The LCTs in all three planes were greatest in OHT eyes, followed by healthy and then NTG eyes. Overall, the larger LCCI was associated with smaller LCT.

The LC was thin and steeply curved in NTG eyes than in healthy and OHT eyes. In OHT eyes, the LC was thick, and its curvature was comparable to healthy eyes. The researchers said that longitudinal studies would be required to examine whether the straight and thickened LCs in OHT eyes precede the onset of OHT or are a protective response to elevated intraocular pressure.

SOURCE: Kim JA, Kim TW, Lee EJ, et al. Comparison of lamina cribrosa morphology in eyes with ocular hypertension and normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2020;61(4):4.

Assessment of Firework-related Ocular Injury in the US

Fireworks are popularly used for recreation but can lead to potentially blinding injuries. Studies quantifying the trend and national prevalence of firework-related ocular injuries are limited. To characterize firework-related ocular injuries treated in emergency departments (EDs) in the US from 1999 to 2017, this cross-sectional study used the National Electronic Injury Surveillance System, a stratified probability sample of more than 100 hospital-affiliated US EDs representing more than 5300 nationwide hospitals. Deidentified individuals in the National Electronic Injury Surveillance System database who experienced eye injury due to fireworks between Jan. 1, 1999, and Dec. 31, 2017, were included. Analysis began February 2019. Annual prevalence of firework-related ocular injury, firework type stratified by demographic information, diagnosis, event location/date and patient disposition were evaluated.

A total of 34,548 firework-related ocular injuries were seen in US EDs during the 19-year study period (estimated from 1,007 individuals in the National Electronic Injury Surveillance System database). Overall, 664 individuals (65.9%) were 18 years or younger, 724 (71.9%) were male and 512 (50.8%) were white. Twenty-eight patients (2.8%) sustained a ruptured globe, while 633 (62.9%) sustained ocular burn injuries, 118 (11.7%) had ocular foreign bodies, 97 (9.6%) had conjunctival irritation and 46 (4.6%) experienced other severe eye trauma. Of 1,007 individuals, 911 (90.5%) were treated and released without transfer, while 87 (8.7%) required admission or transfer to another hospital. The most common specified firework types included firecrackers (193 [19.2%]), bottle rockets (177 [17.6%]), sparklers (88 [8.7%]), roman candles (66 [6.6%]), and novelty devices (65 [6.5%]) (e.g., poppers and snappers). Bottle rockets disproportionately caused the most severe injuries, including ruptured globe (odds ratio, 5.82; 95% CI, 2.72 to 12.46; p<.001). A total of 411 cases (74.9%) occurred at home. Injuries most commonly occurred near the time of Independence Day and New Year's Day: 707 patients (70.2%) presented in July, 74 (7.4%) in June, 101 (10.0%) in January and 47 (4.7%) in December.

These findings supported that firework-related ocular injuries ranged from mild irritation to ruptured globe, and most occurred frequently in those who were young, male and white. Investigators wrote that focused preventive methods and regulations may be imperative in decreasing fireworks-related ocular morbidity, namely from bottle rockets and especially near national holidays.

SOURCE: Shiuey EJ, Kolomeyer AM, Kolomeyer NN. Assessment of firework-related ocular injury in the US. JAMA Ophthalmol. 2020; Apr 9. [Epub ahead of print].



The M.A.STE.R.S Algorithm for Acute Visual Loss Management After Facial Filler Injection

To propose an algorithm of treatment for sudden visual loss following filler injections and perform an English-written literature search for assignment of evidence level and grade recommendation. Algorithm of treatment includes ocular physical Maneuvers, hyAluronidase administration, intravenous STEroids, intraocular pressure Reduction, and Supplemental Oxygen (M.A.STE .R.S) based on previous acute management reports. Special consideration for algorithm buildup was made for ophthalmic diseases that share physiopathological features such as central retinal artery occlusion, systemic vasculitis affecting vision and acute glaucoma. Finally, a systematic cross-review of the reported cases with visual loss was done to identify the level of evidence and grant a recommendation grade.

A search through PubMed and Medscape databases for English-written scientific papers using the terms “facial filler,” “retinal artery occlusion,” “management, treatment,” “complications” and “adverse events” turned up a total of 46 papers (190 cases), which were then analyzed. A high variability on management for treatment of sudden visual loss after facial filler injections was observed. This was attributed partially to the great diversity of medical specialists performing cosmetic facial procedures such as dermatologists, plastic surgeons, esthetic doctors and ophthalmologists, and the lack of high evidence level studies.

The proposed algorithm provides an initial guideline based on prior literature reports and physiopathology involving facial filler injection complications. Analysis identified 22 successfully treated cases with vision recovery (11.57%). Ocular physical maneuvers had the best evidence-based level and grade recommendation (A) for the management of acute vision loss secondary to facial filler injections.

SOURCE: Graue G, Ochoa Araujo DA, Plata Palazuelos C, et al. The M.A.STE.R.S algorithm for acute visual loss management after facial filler injection. J Cosmet Dermatol. 2020; Apr 8. [Epub ahead of print].

News & Notes
AAO & ASCO Virtual Clinical Training to Keep Optometry Students on Graduation Track
With COVID-19 leaving students unable to see patients in person, the American Academy of Optometry established a virtual clinical training program to help the nation’s 1,800 fourth-year prospective doctors of optometry accumulate the 350 clinical observation hours needed to graduate. The new program, the Student Online Clinical Case Education Program (SOCCEP), will provide several weeks of live streamed and/or recorded experiences, each about 30-minutes in length. During each session, a faculty member or industry presenter will deliver a specific case study. Students will then have an opportunity to ask questions before the session concludes with the lecturer delivering a patient outcome. Learn more.

Icare USA Completes Merger with CenterVue
Handheld tonometer maker Icare USA completed its merger with CenterVue, a maker of highly automated ophthalmic imaging devices, after the acquisition of CenterVue by the Finnish Revenio Group in April 2019. The merged company is known as Icare USA. In March 2020, the two corporations were consolidated under a single management team. Read more.

ProperOptics.com Features Virtual Try-On
GSRx has reminded practitioners that ProperOptics.com, the lens supplier’s e-commerce site that supports its independent practice partners, includes a virtual try-on feature. ProperOptics.com provides independent practices with an online presence to capture more optical sales in their local market. Practices make the same profit as they would from an in-office sale of Proper Optics complete eyewear, minus a $5.00 processing fee. By uploading a photo, consumers visiting the site will be able to try on 160-plus Proper Optics frames. The feature is easy to use and is compatible with most smartphones. Learn more.

SightGlass Reports Positive Interim Data from Trial of Novel Eyeglasses for Myopia Management in Children
SightGlass Vision announced that data from the Control of Myopia Using Peripheral Diffusion Lenses: Efficacy and Safety Study (CYPRESS) clinical trial showed that both test arms demonstrated a reduction in myopia progression as assessed by the co-primary outcome measures of axial length and cycloplegic spherical equivalent refraction change at 12 months. The topline results are part of a 12-month interim analysis of the company's trial evaluating its novel eyeglasses designed to slow the progression of myopia in children. CYPRESS is a prospective, multicenter, subject- and observer-masked, randomized, controlled clinical study in 256 children ages six-to-10 years old across 14 trial sites in the United States and Canada. Read more.

BlephEx Announces Appeal Victory in Patent Litigation with Myco
BlephEx, creator of the BlephEx device and eyelid cleaning procedure, announced a victory before the Court of Appeals for the Federal Circuit in its ongoing patent litigation with Myco Industries. The appeal arose after the Federal District Court for the Eastern District of Michigan granted Myco’s motion for a preliminary injunction to enjoin BlephEx from making allegations of patent infringement and threatening litigation against Myco’s potential customers. After briefing and oral argument, the Court of Appeals reversed, vacated and remanded the district court’s order, stating “we find that the court abused its discretion by entering that preliminary injunction.” Read more.


Optometric Physician™ Editorial Board

Chief Medical Editor
Arthur B. Epstein, OD, FAAO

Journal Reviews
Shannon Steinhäuser, OD, FAAO

Contributing Editors
• Katherine M. Mastrota, MS, OD, FAAO
• Barry A. Weissman, OD, PhD, FAAO (Dip CL)

Editorial Board
• William Jones, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO



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