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| Vol. 24, #16 • Monday, April 17, 2023 |
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Off the Cuff: Instant Gratification
My residency was on the Gila River Indian Reservation in Sacaton, AZ. The patient population was very interesting. They were incredibly friendly people. I was told their tribe's name is actually not Pima but Akimel O’odham which means “the river people.” The story goes that because the tribe was so friendly, when the settlers came through, they would ask a bunch of questions. They would get the answer “pima” which translates to “I don’t know.”
The Pima Indians were historically an agriculture-based tribe and were genetically set up for times of feast-or-famine. Their bodies were perfectly attuned to store, which served them well for generations. In the early 1900s, though, the state of Arizona dammed up the Gila River for its own uses. The agricultural nature of the Pima Indians was undone. Food was now available year round. This made the population with their bodies built to store become morbidly obese with incredibly high numbers of diabetics and the associated complications. Things I would see there on a daily basis, I haven’t seen the likes of since. I did a case report on a 27-year-old double amputee who was already pseudophakic with severe fibrovascular proliferation requiring bilateral vitrectomy, stripping, and PRP.
Oddly, the optometry department shared a waiting room and restroom with the podiatry department. While trekking back to the restroom, I would walk by examination rooms filled with things I could never unsee: ulcerated feet, black toes, and multiple amputations. I typically had lunch with the podiatry residents as well as the interns from their department, our department, dentistry, pharmacy, physical therapy and psych. One day I asked one of the podiatry residents, “What was that? It looked like a glob of grape jelly on the bottom of his foot, and you guys were probing it with a swab.” He looked at me and said, “That’s nothing. There was someone on your side of the waiting room with a red ballooned up eye with yellow and green snot coming out of it. What was that?!”
It was at that moment I realized, we all have our thing. That’s when David, the psychologist, said something I’ll never forget. “Optometry really is the perfect profession. You get to make things better, heal things, and get to quantify it and see the results of what you do very quickly. It’s a profession of instant gratification. I almost never get to know if what I do makes an impact.” What a reality check to see how other professions saw mine. The tangible results of our care and patient management being immediate, seen, and appreciated, after all these years, still brings a professional satisfaction that not all medical professions are fortunate enough to experience.
Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com.
The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.
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Influence of The Body Positions Adopted for Resistance Training on Intraocular Pressure: A Comparison Between the Supine and Seated Positions
A variety of factors are known to mediate on the intraocular pressure (IOP) response to resistance training. However, the influence of body position adopted during resistance training on IOP remain unknown. The objective of this study was to determine the IOP response to the bench press exercise at three levels of intensity when performed in supine and seated positions.
Twenty-three physically active healthy young adults (10 men and 13 women) performed 6 sets of 10 repetitions against the 10-RM (repetition maximum) load during the bench press exercise against three levels of intensity (high intensity: 10-RM load; medium intensity: 50% of the 10-RM load; and control: no external load) and while adopting two different body positions (supine and seated). A rebound tonometer was employed to measure IOP in baseline conditions (after 60 seconds in the corresponding body position), after each of the 10 repetitions, and after 10 seconds of recovery. The body position adopted during the execution of the bench press exercise significantly affected the changes in IOP, with the seated position providing lower increases in IOP levels compared to the supine position. There was an association between IOP and exercise intensity, with greater IOP values in the more physically demanding conditions.
The researchers wrote that the use of seated positions, instead of supine positions, for the execution of resistance training should be prioritized for maintaining more stable IOP levels. This set of findings incorporates novel insights into the mediating factors on the IOP response to resistance training. Researchers added that, in future studies, the inclusion of glaucoma patients would allow to assess the generalizability of these findings.
SOURCE: Lara PM, Redondo B, Jerez-Mayorga D, et al. Influence of the body positions adopted for resistance training on intraocular pressure: a comparison between the supine and seated positions. Graefes Arch Clin Exp Ophthalmol. 2023 Feb 16. Epub ahead of print.
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Effects of Monocular Myopia on Visual Function and Binocular Balance
This study aimed to compare the binocular visual functions and balance among monocular myopic adolescents and adults, and binocular low myopic adolescents and explore whether monocular myopia requires glasses.
A total of 106 patients participated in this study. All patients were divided into three groups: the monocular myopia children group (Group 1=41 patients), the monocular myopia adult group (Group 2=26 patients) and the binocular low myopia children group (Group 3=39 patients). The refractive parameters, accommodation, stereopsis, and binocular balance were compared. The binocular refractive difference in Group 1, Group 2, and Group 3 was -1.37 ± 0.93, -1.94 ± 0.91, and -0.32 ± 0.27 D, respectively. Moreover, uncorrected visual acuity (UCVA), spherical equivalent (SE) and monocular accommodative amplitude (AA) between myopic and emmetropic eyes in Group 1 and Group 2 were significantly different. Researchers found a significant difference in the accommodative facility (AF) between myopic and emmetropic eyes in Group 2. Furthermore, significant differences were found in monocular AA, binocular AA and binocular AF between Group 1 and Group 2. The normal ratio of stereopsis according to the random dots test in Group 1 was higher than in Group 2. The normal ratio of dynamic stereopsis in Group 1 was lower than in Group 3. The normal signal-to-noise ratio of the binocular balance point in Group 1 was lower than Group 3.
The researchers concluded that, first, monocular myopia could lead to accommodative dysfunction and unbalanced input of binocular visual signals, resulting in myopia progression. Second, monocular myopia may also be accompanied by stereopsis dysfunction, and long-term uncorrected monocular myopia may worsen stereopsis acuity in adulthood. In addition, patients with monocular myopia could exhibit stereopsis dysfunction at an early stage. Therefore, the researchers wrote, children with monocular myopia should wear glasses to restore binocular balance and visual functions, thereby delaying myopia progression.
SOURCE: Xiang A, Du K, Fu Q, et al. Do monocular myopia children need to wear glasses? Effects of monocular myopia on visual function and binocular balance. Front Neurosci. 2023;17:1135991.
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Schwann Cells Are Key Regulators of Corneal Epithelial Renewal
Corneal sensory nerves protect the cornea from injury. They are also thought to stimulate limbal stem cells (LSCs) to produce transparent epithelial cells constantly, enabling vision. In other organs, Schwann cells (SCs) associated with tissue-innervating axon terminals mediate tissue regeneration. This study defined the critical role of the corneal axon-ensheathing SCs in homeostatic and regenerative corneal epithelial cell renewal.
SC localization in the cornea was determined by in situ hybridization and immunohistochemistry with SC markers. In vivo SC visualization and/or ablation were performed in mice with inducible corneal SC-specific expression of tdTomato and/or Diphtheria toxin, respectively. The relative locations of SCs and LSCs were observed with immunohistochemical analysis of harvested genetically SC-prelabeled mouse corneas with LSC-specific antibodies. The correlation between cornea-innervating axons and the appearance of SCs was ascertained using corneal denervation in rats. To determine the limbal niche cellular composition and gene expression changes associated with innervation-dependent epithelial renewal, single-cell RNA sequencing (scRNA-seq) of dissociated healthy, de-epithelized, and denervated cornea limbi was performed. The authors observed limbal enrichment of corneal axon-associated myelinating and non-myelinating SCs. Induced local genetic ablation of SCs, although leaving corneal sensory innervation intact, markedly inhibited corneal epithelial renewal. scRNA-seq analysis highlighted the transcriptional heterogenicity of cells populating the limbal niche, and identified transcriptional changes associated with corneal innervation and during wound healing that model potential regulatory paracrine interactions between SCs and LSCs.
The investigators concluded that limbal Schwann cells are required for innervation-dependent corneal epithelial renewal.
SOURCE: Mirmoeini K, Tajdaran K, Zhang J, et al. Schwann cells are key regulators of corneal epithelial renewal. Invest Ophthalmol Vis Sci. 2023;64(4):7.
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Industry News
Review of Presbyopia and the Aging Eye Launches to Focus on ‘Generation 45+’
The Jobson Optical Group is excited to announce the launch of Review of Presbyopia and The Aging Eye, a digital content platform focusing on providing eye care professionals with cutting-edge educational articles and multimedia on new technologies and care protocols for the age 45+ generation. The publication’s mission is straightforward: To re-engineer the presbyopic patient journey.
Jack Schaeffer, OD, FAAO, has been named Chief Clinical Editor. A leading proponent of continuing professional education, Dr. Schaeffer, who recently sold his 18-location practice, has written extensively for numerous publications and lectured internationally. He currently sits on several industry boards and advisory panels. John Sailer will be editor in chief.
Dr. Schaeffer has assembled the leading authorities in their respective fields as topic channel editors, known as the EYE TEAM:
• Optical: Dr. Kirk Smick
• Contact Lenses: Drs. Jack Schaeffer, Mark Schaeffer, Brooke Kaplan, David Schaeffer
• Dry Eye: Drs. Melissa Barnett, Jackie Garlich
• Pharma: Dr. Ian Ben Gaddie
• Glaucoma: Dr. Murray Fingeret
• Refractive Surgery: Drs. Eric Schmidt, Marc Bloomenstein
• Retina: Dr. Mark Dunbar
• Aesthetics: Dr. Selina McGee
• Ocular Nutrition: Dr. Julie Poteet
“Review of Presbyopia and the Aging Eye is about optometry’s future,” says Dr. Schaeffer. “It is about learning how to accept this new ‘Generation 45+’ as a specialty in your practice, and how to incorporate all the pharmaceuticals, techniques, past, present, and future to create that practice that will survive into the 22nd century.”
Dr. Schaeffer also expects Review of Presbyopia and the Aging Eye to help doctors build their fee-for-service business. “In the average optometry practice, 85% of the patients come with vision care insurance that pays one-third of their normal fees, and the reimbursement has not changed in 20 years,” he says.
“There certainly are viable treatment options for the +45 patient right now, but the future holds even greater promise as companies plan a proliferation of new and improved product and technology introductions to address the growing market need,” says Al Greco, publisher and vice president, new business. “These developments present a significant opportunity for ECPs to raise the bar in the outcomes they achieve, and the patient satisfaction levels they deliver. Education is the key to success, and Review of Presbyopia and The Aging Eye is designed to meet those educational needs as a one-stop-destination for all topics related to the 45+ eye.” Explore the website.
Announcements
• J&J Vision named Lori Tierney president, Americas; Jacqueline Henderson president, EMEA; and Christoph Vonwiller, president, Asia Pacific. Read more.
• Visus Therapeutics announced Jehan Tamboowalla joined the company as senior vice president of business development and marketing. Read more.
Haag-Streit Launches Fifth Imaging Competition
Haag-Streit launched Slit Lamp Imaging Competition 2023. Learn more.
Olleyes Receives Poster Award
Olleyes announced that poster “Virtual Reality Game-Based Automated Perimetry Performance in Healthy Children” presented by a group of Duke Eye Center researchers at the American Association for Pediatric Ophthalmology and Strabismus in March, which demonstrated the benefits of the VisuALL Virtual Reality Platform, took first place prize for best poster at the event. Learn about the company.
Lumata Health, Prevent Blindness Partner
Lumata Health and Prevent Blindness are partnering to deliver more resources to Americans with vision loss. Read more.
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Journal Reviews Editor:
Katherine M. Mastrota, MS, OD, EMBA, FAAO
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