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weekly e-journal by Art Epstein, OD, FAAO
Off the Cuff: Crony Crapitalism…Fake News Attacks on Optometry Grow
By now you’ve probably heard enough about “fake news.” If it were not so serious an issue and the public so susceptible to its influence, the ease at which fake news propagates through traditional media would actually be humorous. Right now, fake news is becoming a very serious problem for optometry. We are increasingly under attack by media flacks and hired-gun “political think tanks” purposefully using blatant fake news against us.
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Scleral Lens Prescription and Management Practices: The SCOPE Study | ||||
The SCOPE (Scleral Lenses in Current Ophthalmic Practice: an Evaluation) study group designed and administered an online survey regarding current scleral lens prescription and management practices to assess current scleral lens prescription and management practices. The survey was open from January 15, 2015, to March 31, 2015, and generated 723 responses from individuals who had fit at least five patients with scleral lenses. Respondents (n=663) prescribed scleral lenses that ranged from 15mm to 17mm in diameter (65%), smaller than 15mm (18%) and larger than 18mm (17%). More than 50 lens designs were identified. Average daily wearing time of 11.8 hours was consistent across 651 respondents, and 475/651 (73%) recommended midday removal on some, most or all days. Most respondents recommended nonpreserved saline to fill the bowl of the lens before application (single-use vials, 392/653 [60%]; bottled products, 372/653 [57%]). A hydrogen peroxide-based disinfection system was the most commonly recommended care product (397/651 [61%]). A reasonable degree of consensus exists regarding some aspects of scleral lens prescription and management (average lens diameter, daily wearing time and use of nonpreserved products for lens application). Further study is needed to develop evidence-based guidelines for scleral lens prescription and management. |
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SOURCE: Harthan J, Nau CB, Barr J, et al. Scleral lens prescription and management practices: The SCOPE study. Eye Contact Lens. 2017; Apr 6. [Epub ahead of print]. |
Subclassification of Primary Angle Closure Using Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopic Parameters | ||||
A total of 73 eyes of 73 patients with primary angle closure (PAC) that had undergone laser peripheral iridotomy (LPI) were imaged using anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) under the same lighting conditions. Anterior chamber depth, anterior chamber width, iris cross-sectional area, peripheral iris thickness, iris curvature, lens vault (LV) and angle opening distance 500μm from the scleral spur (SS) were determined using the AS-OCT image. Trabecular-ciliary process angle (TCA), trabecular-ciliary process distance (TCPD) and ciliary body (CB) thickness 1mm posterior to the SS were estimated on the UBM image using ImageJ software. Iris insertion, iris angulation, iris convexity, presence of ciliary sulcus, irido-angle contact and CB orientation assessed on the UBM image were included. Partitioning around the medoids algorithm was used for cluster analysis based on the parameters obtained using AS-OCT and UBM. Axial length and pupil diameter were incorporated into statistical models. Clinical and anatomic characteristics were compared between the clusters, as classified using the partitioning around medoids algorithm method. Cluster analysis revealed that two-group clustering produced the best results. The two clusters, which were defined in terms of parameters obtained using AS-OCT and UBM, showed differences in iris curvature (0.16mm ± 0.08mm vs. 0.11mm ± 0.04mm), TCA (91.0° ± 13.4° vs. 63.7° ± 6.2°), TCPD (0.99mm ± 0.22mm vs. 0.78mm ±0.16mm), CB orientation (neutral/anterior, 35/13 vs. 0/25) and iris insertion (basal/middle/apical, 37/9/2 vs. 12/11/2). Pre-LPI intraocular pressure (IOP) (18.8 ± 5.4 vs. 16.2 ± 4.5mm Hg; p=0.037) and percentage of IOP reduction after LPI (22.3% ± 17.9% vs. 8.3% ± 19.5%) showed a significant difference between the two clusters. The most distinct difference between the two subgroups in the cluster analysis was TCA, suggesting that the position of the CB is important in subclassifying PAC. By using UBM, clinicians may obtain more clues about the mechanisms of PAC; in turn, they may learn to predict the IOP-lowering effects of LPI. |
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SOURCE: Kwon J, Sung KR, Han S, et al. Subclassification of primary angle closure using anterior segment optical coherence tomography and ultrasound biomicroscopic parameters. Ophthalmology. 2017:S0161-6420(16)31364-1. |
The Relationship Between Anisometropia, Amblyopia and Strabismus | ||||
Researchers investigated the potential causal relationships between anisometropia, amblyopia and strabismus, specifically to determine whether either amblyopia or strabismus interfered with emmetropization. They analyzed data from non-human primates that were relevant to the co-existence of anisometropia, amblyopia and strabismus in children. Researchers relied on interocular comparisons of spatial vision and refractive development in animals reared with: monocular form deprivation; anisometropia optically imposed by either contact lenses or spectacle lenses; organic amblyopia produced by laser ablation of the fovea; and strabismus that was either optically imposed with prisms or produced by surgical or pharmacological manipulation of the extraocular muscles. Hyperopic anisometropia imposed early in life produced amblyopia in a dose-dependent manner. However, when potential methodological confounds were taken into account, no support was found for the hypothesis that the presence of amblyopia interfered with emmetropization or promoted hyperopia, or that the degree of image degradation determined the direction of eye growth. However, strong evidence existed that amblyopic eyes were able to detect the presence of a refractive error and altered ocular growth to eliminate the ametropia. On the other hand, early onset strabismus, both optically and surgically imposed, disrupted the emmetropization process producing anisometropia. In surgical strabismus, the deviating eyes were typically more hyperopic than their fellow fixating eyes. The results showed that early hyperopic anisometropia was a significant risk factor for amblyopia. Researchers wrote that early esotropia could trigger the onset of both anisometropia and amblyopia; however, amblyopia, in isolation, did not pose a significant risk for the development of hyperopia or anisometropia. |
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SOURCE: Smith EL 3rd, Hung LF, Arumugam B, et al. Observations on the relationship between anisometropia, amblyopia and strabismus. Vision Res. 2017:S0042-6989(17)30049-4. |
News & Notes | |||||||||
Academy Announces 2017 ARVO Student Travel Fellowships
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