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

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Volume 18, Number 16

Monday, April 17, 2017

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Inside this issue: (click heading to view article)
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######### Off the Cuff: Crony Crapitalism…Fake News Attacks on Optometry Grow
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######### Scleral Lens Prescription and Management Practices: The SCOPE Study
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######### Subclassification of Primary Angle Closure Using Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopic Parameters
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######### The Relationship Between Anisometropia, Amblyopia and Strabismus
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######### News & Notes
 

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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.

Take a moment to search Google under these key words: “crony capitalism optometry.” What you see is only a small fraction of what is shaping up to be an all out anti-optometry propaganda onslaught. Even more distressing is that legitimate media outlets on both sides of the political divide are carrying these stories. And at the top of that Google search? An op-ed piece titled: “The American Optometric Association is blinding patients to innovation.”

Clearly 1-800 and their newfound ally, Opternative, are behind much of this. A lot of money is being spent in an attempt to influence public opinion. Make no mistake: While we are concerned about patient well-being, their goal is total deregulation of contact lenses and eye examinations. Yes, I also said eye examinations. Today it’s refraction; tomorrow, it will be routine eye exams.

This is only the beginning. If we continue to sit on our hands doing essentially nothing, public sentiment will be turned against us. Once that happens—right or wrong—coming back will be difficult. In the end, our patients and our profession will suffer.

Several years ago, the AOA instituted a PR initiative that was wildly successful. The program took the lead in protecting patients during a serious public health crisis. It also drastically enhanced the image of optometry. I was proud to have been part of it.

A quick search of current news suggests that that initiative has faded into the past. It’s time the AOA brought it back and made it a top priority. In a world increasingly influenced by fake news, we cannot afford to be sitting ducks.  

 


Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com

 

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.

 



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.


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.

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.

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.



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News & Notes
 

Academy Announces 2017 ARVO Student Travel Fellowships
The American Academy of Optometry announced the recipients of the 2017 Student Travel Fellowship Awards, supported by Johnson and Johnson Vision, paving the way for six students to present their research at the Association for Research in Vision and Ophthalmology annual meeting in May. The 2017 recipients and their respective schools include: • Bright Ashimatey, OD, Indiana University
• Billie Beckwith-Cohen, DVM, MBA, FAAO, University of California Berkeley
• Gareth Hastings, MPhil, BOptom, University of Houston
• Jakaria Mostafo, University of Houston
• Cornelia Peterson, DVM, The Ohio State University
• (Supported by the Academy) Yifei Wu, BScOptom, Indiana University
Read more


 

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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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