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


Volume 18, Number 14

Monday, April 2, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: The FTC has it wrong – Please let them know!
######### Light Disturbance with Multifocal Contact Lens and Monovision for Presbyopia
######### Comparison of the Lubricity and Surface Roughness of Five Cosmetic Contact Lenses
######### Simplifying Target Intraocular Pressure for Different Stages of Primary Open-angle Glaucoma and Primary angle-closure Glaucoma
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: The FTC has it wrong – Please let them know!

As many of you know the Federal Trade Commission is considering significant changes to the already flawed Contact Lens Rule. Driven by 1-800, Costco and the misinformation campaign that I covered in last week’s issue, the proposed changes include a requirement that patients sign a document advising them that they are entitled to a copy of their contact lens prescription that would have to be kept on file for three years. This is in addition to actually giving them a copy of their prescription!

This senseless boondoggle would add significant time and cost to a contact lens examination and punish the overwhelming majority of eye care professionals who already comply with the rule. Why the FTC believes that additional rulemaking would prompt the scant few who choose to ignore existing federal law to suddenly become compliant makes little sense. What the new rule will certainly do is punish the innocent majority who already do comply. Far worse, it will do nothing to protect patients or consumer interests. It may also decrease competition, as some of us just give up on contact lenses entirely.

While enforcement of the existing rule would be more logical and effective, the FTC has shown little interest in prosecuting violators. Indeed, passive verification rules are flouted to the extent that intentional violation appears to be a part of the business plan of companies like Hubble, which routinely fill non-existent prescriptions with their own generic lenses. Other sellers intentionally game the system by calling at off-hours when offices are unable to respond in a timely fashion to decline expired or fabricated prescriptions.

There is common ground where the broad access and increased competition that the FTC seeks can coexist with the patient health and safety that we are sworn to protect. The proposed rule changes will not achieve this balance. Protecting consumer and patient interests would require that the FTC recognize and address the egregious abuses of online and big box retailers while increasing broad enforcement of all of its rules. The FTC should recognize that we are not the enemy of consumers, but allies who are equally committed to protecting our patients’ health and well-being.

Editor's Note: The FTC is accepting public comment regarding proposed changes to the contact lens rule here. I have covered some of the key points above, but feel free to add your own thoughts regarding the impact of the proposed changes—especially the requirement for a written acknowledgement of prescription release in addition to the actual prescription. Please make sure you address the need for greater enforcement of existing rules as a more reasonable strategy than adding burdensome and, ultimately, unnecessary rules. The deadline to get comments in is April 6. Please take a moment to make your voice heard.

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.


Light Disturbance with Multifocal Contact Lens and Monovision for Presbyopia
Dysphotopsia affects a significant number of patients, particularly after visual correction with multifocal optical designs. Evaluate light distortion (LD) in two modalities of contact lens (CL) wear: multifocal (MF) and monofocal (MV). This was a randomized, double-masked, crossover study involving 20 presbyopic patients. Patients were randomized first into either MF or MV for 15 days of use with a one-week washout period between each lens type. The LD was evaluated with the Light Distortion Analyzer (LDA, University of Minho) under monocular and binocular conditions. The light distortion index (LDI, %), among other parameters were analyzed. Subjective quality of vision was assessed with the Quality of Vision (QoV).

The LD showed an increase in all parameters in both CL modalities, and a significant increase for MV in the non-dominant eye. For the MF, there was also a significant increase in LDI and in BFCrad in the non-dominant eye. After 15 days of MF lens wear, there was a significant decrease in all LD parameters in the dominant eye. Binocularly, a significant improvement from 1 to 15 days was observed for LDI and BFCrad with MF. The QoV questionnaire showed no significant changes with neither CL.

Adaptation to light disturbances induced by MF CL was more effective compared with MV. Researchers wrote that practitioners might have greater success if they prepared patients for the adaptation required, to improve vision and reduce issues with light disturbance.

SOURCE: Fernandes P, Amorim-de-Sousa A, Queirós A, et al. Cont Lens Anterior Eye. Light disturbance with multifocal contact lens and monovision for presbyopia. 2018; Mar 22. [Epub ahead of print].


Comparison of the Lubricity and Surface Roughness of Five Cosmetic Contact Lenses
Cosmetic contact lenses are increasingly popular because of their eye-enhancing cosmetic benefits. The pigment particles used in these lenses can impact lens surface characteristics. This article examined the surface characteristics and the differences between the clear and the pigmented regions among five limbal ring design lenses. Scanning electron microscopy was used to determine the location and depth of the pigment particles from the lens surface. The coefficient of friction (CoF) was determined with a Basalt-MUST microtribometer at clear and pigmented regions on either the front or the back surface. Atomic force microscopy was used to determine the surface roughness of each lens in root-mean-square (RMS) units at clear and pigmented regions. A linear mixed model for repeated measures was used for the analysis of the CoF and RMS roughness to compare all lenses.

Four lens types had pigments exposed on the surface, and one lens type had pigment fully enclosed. The CoF differences between clear and pigmented regions were similar and not statistically significant for the lens type with pigments enclosed, whereas CoF differences for the other four lens types showed statistically significant differences.

Investigators noted that, of the lenses tested, cosmetic contact lenses with pigments enclosed in the lens matrix provided a more consistent surface between clear and pigmented regions compared with lenses that had exposed pigments.

SOURCE: Lau C, Tosatti S, Mundorf Met al. Comparison of the lubricity and surface roughness of 5 cosmetic contact lenses. Eye Contact Lens. 2018; Mar 19. [Epub ahead of print].




Simplifying Target Intraocular Pressure for Different Stages of Primary Open-angle Glaucoma and Primary angle-closure Glaucoma
Lowering intraocular pressure is currently the only therapeutic measure for glaucoma management. Many long-term, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline or to a specified level. This has lead to the concept of “target" IOP, a range of IOP for therapy that would stabilize the glaucoma and prevent further visual field loss without significantly affecting a patient's quality of life. A clinical staging of glaucoma by optic nerve head evaluation and perimetric parameters enables a patient's eye to be categorized as having mild, moderate or severe glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy.

In mild glaucoma, the initial target IOP range could be kept as 15mm Hg to 17mm Hg; for moderate glaucoma, 12mm Hg to 15mm Hg; and in the severe stage of glaucomatous damage, 10mm Hg to 12mm Hg. Factoring in baseline IOP, age, vascular perfusion parameters and change on perimetry or imaging during followup, this range may be reassessed over six months to a year. Target IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced.

Researchers advised that an appropriate use of medications/laser/surgery to achieve such a target IOP range in POAG or PACG could help to maintain visual fields and quality of life, preventing glaucoma blindness.

SOURCE: Sihota R, Angmo D, Ramaswamy D, et al. Simplifying "target" intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma. Indian J Ophthalmol. 2018;66(4):495-505.


News & Notes
Volk Expands Leadership Team
Volk Optical appointed Utkarsh Sharma, PhD, as vice president of product development and strategic marketing. Dr. Sharma brings extensive experience in product development, management and commercialization of ophthalmic imaging systems. Most recently, he served as director of Optovue’s advanced development team, leading the design and commercial launch of numerous ophthalmic diagnostic products. Prior to that, Dr. Sharma was a project team leader and scientist at Carl Zeiss Meditec, where he led the development of the first FDA-approved optical coherence tomography angiography technology. Read more.


Dr. Fine Named Keynote Speaker for 2018 Envision Conference
Envision announced that Ione Fine, PhD, a professor of psychology at the University of Washington in Seattle and an expert in brain plasticity and sight recovery technology, will deliver the keynote address at the thirteenth annual Envision Conference, to be held August 22 to 25 at the Hyatt Regency Wichita. She will speak at the conference’s plenary welcome session. The conference is the premier multidisciplinary gathering dedicated to advancing and disseminating knowledge about the causes, impact and rehabilitative opportunities tied to low vision. Read more.


Review of Optometry's New Technologies and Treatments in Eye Care in Nashville, April 6-8, 2018, at the Nashville Marriott at Vanderbilt University

Review of Optometry's New Technologies and Treatments in Eye Care



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



Optometric Physician™ (OP) newsletter is owned and published by Dr. Arthur Epstein. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add Optometricphysician@jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Optometric Physician.

E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

For information on advertising in this e-mail newsletter or other creative advertising opportunities with Optometric Physician, please click here for advertising information.