Optometric Physician

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


Volume 20, Number 18

Monday, April 20, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: The Power and Perils of Leadership
######### The Evidence of SARS-CoV-2 Infection on the Ocular Surface
######### Machine Learning Applied to Retinal Image Processing or Glaucoma Detection: Review and Perspective
######### A Meta-analysis to Study the Effect of Pan Retinal Photocoagulation on Retinal Nerve Fiber Layer Thickness in Diabetic Retinopathy Patients
######### News & Notes

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Off the Cuff: The Power and Perils of Leadership

Although many COVID-19 prognosticators have been cheering on an earlier-than-expected end to the outbreak, the reality is the epidemic will not suddenly and totally disappear. At least not likely for 12 to 18 months. As a result, resuming practice will not be like flipping a light switch to turn on “business as usual.” Even with pent-up demand, as the depth of the tragedy sinks in, patients will increasingly put off routine care. Competition for those patients will increase dramatically. Getting back to normal will be like navigating an obstacle course. With that in mind, I thought a brief discussion of the importance of leadership would be helpful, as leadership is likely to become the difference between survival and success, or failure. The timing for this discussion is actually perfect, as we currently have great examples of how good leadership can transform an entire space and how a poor leader can wreak havoc on a once-successful company.

Picking a top leader example was easy. John Legere, former CEO of T-Mobile inherited a cell phone company that was a distant third out of four national carriers. T-Mobile was a rudderless ship known for spotty connections and miserable customer service. During his tenure, Legere systematically reinvented not only T-Mobile, but redefined the entire cell phone industry—taking the lead first on value, then innovation, then culture and finally, customer service. We switched from our once-beloved but increasingly arrogant and expensive Verizon and never looked back. We currently pay about 25% of our old Verizon bill even with an extra line and a smartwatch added. Perhaps more importantly, while I’ve never met Legere, his bigger-than-life personality makes me like him. Every single T-Mobile employee I’ve interacted with since he took over has had only positive things to say about him and the company he ran. Now that T-Mobile has just merged with Sprint, he stepped down as CEO.

Sadly, finding an example of poor leadership was just as easy. Doug Parker, current CEO of American Airlines, is a case study in lackluster leadership. With a long history in the airline industry from heading regional carrier America West to a hostile takeover of bankrupt US Air to finally doing the same to venerable but bankrupt American, Parker is a skilled opportunist. He also appears totally disconnected from his customers and employees. From alienating the airline’s most loyal and profitable frequent flier, championing miserably uncomfortable cabin and hellishly small lavatory makeovers, to angering employees and labor unions at every turn, Parker has flown AA into the ground. In the travel maelstrom created by the coronavirus outbreak, his poor leadership leaves American the least-likely-to-survive airline. A last-minute video to frequent fliers released yesterday was the first attempt to correct the course, but may be too little too late.

The coming weeks and months will be very difficult. With significant challenges yet to come, leadership will be key to your practice’s survival. The examples I shared show just how much of a difference leadership skill can make. Keep in mind that a successful practice serves patients and meets their needs. Successful leaders have a vision and a sense of direction and won’t deviate from the path to success. We all need to be that leader!

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.



The Evidence of SARS-CoV-2 Infection on the Ocular Surface

This cross-sectional study looked at patients who received a COVID-19 diagnosis between Dec. 30, 2019, and Feb. 7, 2020, at Tongji Hospital. A total of 102 patients (48 males [47%] and 54 females [53%]) with clinical symptoms, Rt, and chest computed tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years.

Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) were confirmed to have COVID-19 by laboratory diagnosis with a SARS-CoV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis were identified from 72 patients with a laboratory confirmed COVID-19. Of those two patients, SARS-CoV-2 RNA fragments were found in ocular discharges by SARS-CoV-2 RT-PCR in only one patient.

Our findings suspect the incidence of SARS-CoV-2 infection through the ocular surface is extremely low, while the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. To lower the SARS-CoV-2 nosocomial infection, all health care professionals should wear protective goggles. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-CoV-2.

SOURCE: Zhang X, Chen X, Chen L, et al. The evidence of SARS-CoV-2 infection on the ocular surface. Ocul Surf. 2020; Apr 11. [Epub ahead of print].

Machine Learning Applied to Retinal Image Processing or Glaucoma Detection: Review and Perspective

This is a systematic review on the main algorithms using machine learning (ML) in retinal image processing for glaucoma diagnosis and detection. ML has proven to be a significant tool for the development of computer-aided technology. Furthermore, secondary research has been widely conducted over the years for ophthalmologists. Such aspects indicate the importance of ML in the context of retinal image processing. The publications that were chosen to compose this review were gathered from Scopus, PubMed, IEEE Xplore and ScienceDirect databases. Then, the papers published between 2014 and 2019 were selected. Research that used the segmented optic disc method was excluded. Moreover, only the methods that applied the classification process were considered. The systematic analysis was performed in such studies and, thereupon, the results were summarized.

Based on architectures used for ML in retinal image processing, some studies applied feature extraction and dimensionality reduction to detect and isolate important parts of the analyzed image. Differently, other works utilized a deep convolutional network. Based on the evaluated research, the main difference between the architectures was the number of images demanded for processing and the high computational cost required to use deep learning techniques.

All of the analyzed publications indicated it was possible to develop an automated system for glaucoma diagnosis. Researchers wrote that the disease’s severity and its high occurrence rates have justified the research that has been carried out. Recent computational techniques, such as deep learning, have been shown to be promising technologies in fundus imaging. However, such techniques require an extensive database and high computational cost, and studies have shown that the data augmentation and transfer learning techniques have been applied as an alternative way to optimize and reduce network training.

SOURCE: Barros DMS, Moura JCC, Freire CR, et al. Machine learning applied to retinal image processing for glaucoma detection: review and perspective. Biomed Eng Online. 2020;19(1):20.



A Meta-analysis to Study the Effect of Pan Retinal Photocoagulation on Retinal Nerve Fiber Layer Thickness in Diabetic Retinopathy Patients

Diabetic retinopathy is a microvascular disease associated with changes in peripapillary retinal nerve fiber layer thickness, with the changes being more pronounced in proliferative diabetic retinopathy (PDR) patients undergoing laser photocoagulation. Investigators aimed to assess changes in peripapillary retinal nerve fiber layer thickness in proliferative diabetic retinopathy patients using optical coherence tomography (OCT). A database search was conducted from June 2018 through October 2018, and included PubMed, Medline, Ovid and Google Scholar. A meta-analysis of weighted mean difference and standard deviation was conducted.

A total of 10 studies containing 377 eyes of PDR patients were selected. The analysis of the included studies revealed no significant effect of PRP on average retinal nerve fiber layer thickness using OCT.

Investigators wrote that their meta-analysis revealed no significant effect of PRP on RNFL thickness and that the impact of PRP could vary. They added that the measurement of peripapillary RNFL thickness may yield erroneous and unpredictable results in this subgroup of patients, further confounding the evaluation of nerve fiber layer damage and its progression.

SOURCE: Wadhwani M, Bhartiya S, Upadhaya A, et al. A meta-analysis to study the effect of pan retinal photocoagulation on retinal nerve fiber layer thickness in diabetic retinopathy patients. Rom J Ophthalmol. 2020;64(1):8-14.

News & Notes
TearClear Appoints Dempsey As CEO
TearClear announced the appointment of Robert J. Dempsey as chief executive officer. Dempsey, who served as former global head of ophthalmology at Shire, which was acquired by Takeda, was responsible for one of the top 10 largest biopharmaceutical mergers of 2019—the divestiture of Takeda’s lead ophthalmic drug, Xiidra, a transaction of up to $5.3 billion. The announcement comes as TearClear is approaching the initial close of up to $25 million as part of a Series B financing led by Visionary Ventures, Bluestem Capital and Flying L Partners. Read more.

Editors Note: Warm congratulations to my good friend Bob Dempsey for his appointment to this role. I’ve known Bob Dempsey for years and expect great things from TearClear under his leadership. Bob is a true visionary and a perfect example of a great leader!

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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