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


Volume 18, Number 17

Monday, April 23, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: When DREAMS Don’t Come True
######### Cataract Surgery in High Hyperopia
######### The Effects of Repeated Ozurdex Injections on Ocular Hypertension
######### The Use of Optical Coherence Tomography for the Detection of Early Diabetic Retinopathy
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: When DREAMS Don’t Come True

As many of you may already know, the long-awaited results of the DREAM study were released at the annual ASCRS meeting in Washington D.C. For those not familiar with the study, the DRy Eye Assessment and Management Study was a large NEI/NIH-funded multicenter assessment of the effectiveness of omega-3 supplements for the management of dry eye. The study’s conclusion, that omega-3 fatty acids from fish oil supplements were no better than placebo, came as a surprise to many of us, myself included.

As a very vocal and visible proponent of omega-3 supplementation for managing dry eye, I have been deluged with questions from colleagues about my take on the study and how the results would alter my clinical approach. Because of its importance to practitioners and patients alike, I will be covering the DREAM study in significant detail in the coming weeks. First, a bit of positive perspective.

While the results of the study will be scrupulously analyzed and likely debated for many months to come, numerous prior studies and a vast amount of clinical experience, including my own in a dedicated dry eye and ocular surface disease practice, support the benefits of omega-3 supplementation as an integral part of an effective and systematic dry eye and MGD management protocol. Despite its conclusions the DREAM study did confirm the benefits of omega-3 supplements in addition to smaller improvements seen with the olive oil control.

I have tremendous respect for study’s chair Penny Asbell and the DREAM team, and congratulate them on this important accomplishment. I’ve known Penny, a highly regarded corneal specialist and professor of ophthalmology at NYC’s Mt. Sinai Hospital, for many years. As with many important studies, the devil and real value of the DREAM study will be in the details, not in the headlines it generated. In a coming Off the Cuff, we’ll explore study design and real-world relevance.

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.


Cataract Surgery in High Hyperopia
Although cataract surgery is a well-established and standardized procedure, it can be demanding and associated with higher complication rates in high hyperopia, researchers wrote. As such, they presented clinical data for highly hyperopic patients who underwent cataract surgery over a 12-year period (2005 - 2016) and at a single center. Out of a total of 11, 434 cataract operations, 41 highly hyperopic eyes (SN60A≥ 31D) were included for analysis. Researchers compared the target spherical equivalent to the final postoperative spherical equivalent for five different formulas. They also reviewed the best-corrected distance visual acuity (BCDVA) before and after surgery and any complications.

LogMAR BCDVA increased significantly from a mean of 0.5 before to 0.37 after surgery (p=0.02). The main reasons for the reduced final BCDVA were glaucoma, Fuchs’ corneal endothelial dystrophy and age-related macular degeneration. One eye suffered a radial capsule tear and received a sulcus implanted intraocular lens (IOL). There was no statistically significant difference between formulas with respect to aberration of the final spherical equivalent.

Patients with high hyperopia often have ocular comorbidities. Researchers wrote that such eyes can be surgically challenging, resulting in reduced benefits from cataract surgery compared with normal eyes.

SOURCE: Waldmann NP, Gerber N, Hill W, et al. Cataract surgery in high hyperopia. Klin Monbl Augenheilkd. 2018;235(4):413-5.


The Effects of Repeated Ozurdex Injections on Ocular Hypertension
The purpose of this study was to correlate the degree of ocular hypertension with the number of Ozurdex injections. Intraocular pressure (IOP) fluctuations for a total of 183 injections were studied over a period of at least 12 months. The main indications for treatment were uveitis, diabetic macular edema and retinal vein occlusion.

Results of the study demonstrated that repeated Ozurdex injections did not increase the frequency of IOP spikes beyond 30mm Hg. For lower IOPs, however, a positive correlation existed. Furthermore, patients with primary open-angle glaucoma and uveitis had the highest IOP response to repeated injections. On average, patients with an IOP of ≥ 28.6mm Hg received pressure lowering medications, after which their IOP reached a stable level (16.7mm Hg) without the need for additional interventions.

Investigators found that multiple Ozurdex injections did not increase the frequency of IOP spikes beyond 30mm Hg, but advised that patients with a history of primary open-angle glaucoma still must be closely monitored.

SOURCE: Bahadorani S, Krambeer C, Wannamaker K, et al. The effects of repeated Ozurdex injections on ocular hypertension. Clin Ophthalmol. 2018;12:639-42.


The Use of Optical Coherence Tomography for the Detection of Early Diabetic Retinopathy
Diabetic retinopathy (DR) is one of the leading causes of vision loss globally, with a severe burden on all societies due to its high treatment and rehabilitation costs, authors wrote. They added that early diagnosis of DR might provide preventive steps (including retinal laser therapy, and tight carbohydrate, blood pressure and cholesterol control) that could in turn help to avoid progression of the pathology with the resultant vision loss.

Optical coherence tomography (OCT) enables the in vivo structural imaging of the retina, providing both qualitative (structure) and quantitative (thickness) information. In past decades, extensive OCT research has been done in the field of DR. In the current review, the authors focused on studies that aimed to detect the earliest retinal changes before DR could be diagnosed funduscopically.

Authors concluded that spectral-domain OCT—the latest, widely available imaging technology—offers fast and reliable retinal imaging, which, together with recent developments in image processing and artificial intelligence, holds promise for development of a quick and efficient, state-of-the-art screening tool for DR.

SOURCE: Somfai GM, Gerding H, DeBuc DC. The use of optical coherence tomography for the detection of early diabetic retinopathy. Klin Monbl Augenheilkd. 2018;235(4):377-84.

News & Notes
Academy 2018 San Antonio Education Program Announced
The American Academy of Optometry announced highlights of Academy 2018, to be held Nov. 7 to 10, 2018, at the Henry B. González Convention Center in San Antonio. This year’s Plenary Session, Today’s Research, Tomorrow’s Practice: The Future of Health Care Delivery, will discuss trends and concepts that will shape your future practice, while the Monroe J. Hirsch Research Symposium, Vision Restoration for Retinal Degenerative Disease, will discuss how vision restoration in patients with retinal degenerative disease is within reach. Registration and housing open on May 21, 2018. Read more. Acuvue Oasys With Transitions has received FDA 510(k) clearance and is indicated for the attenuation of bright light. The two-week reusable, spherical contact lens will be marketed by Johnson & Johnson Vision Care and commercially available in first half of 2019. Read more.

Alcon Adds Gemstone Collection to Air Optix Colors Lens Portfolio, Introduces 2-Count Packs to Invite Patients to “Play with Color”
Alcon introduced its new Air Optix Colors Gemstone Collection of color contact lenses, with three new colors—Amethyst, True Sapphire and Turquoise—to enhance any eye color. Now offering a total of 12 colors, Air Optix Colors lenses appeal to a wide range of patients and offer new revenue potential for practices. At the same time, Alcon launched a two-count pack for all Air Optix Colors, enabling eye care professionals to introduce more patients to color contact lenses, with or without vision correction. This smaller-size pack gives patients the ability to try out eye color for part-time wear and evaluate multiple colors. To support practices in rolling out the collection, Alcon will provide updated social and online media assets on the Alcon Vision Care Marketing Portal. In addition, patients can virtually try on the colors before coming to the office through the Air Optix Colors Color Studio.

B+L Gets 510(K) Nod for Boston Scleral Lens Case, Recycles Nearly 2.5 Million Contact Lenses
Bausch + Lomb announced that the company’s Specialty Vision Products business received FDA 510(K) clearance for the Boston scleral lens case, a storage case developed specifically for scleral lenses designed to hold lenses up to 23.5 millimeters in diameter and up to 10 millimeters in sagittal depth. The case is indicated for use with Boston original conditioning solution, Boston Advance formula conditioning solution and Boston Simplus multi-action solution. Patients can purchase the lens case from the Specialty Vision Products Web Store, along with other products, such as ScleralFil preservative free saline solution and Boston contact lens solutions. Read more.
In addition, the company announced that its One By One Recycling Program recycled nearly 2.5 million used contact lenses, blister packs and top foil since launch, saving more than 14,000 pounds of waste. The program works by providing participating practices with large recycling bins to collect used contact lenses, blister packs and top foil. Once the bins are full, a free shipping label can be printed from www.BauschRecycles.com, and the used materials can be mailed to TerraCycle for recycling. For every qualifying shipment of two pounds or more, a $1-per-pound donation is made to Optometry Giving Sight. Read more.

Paragon Hosts Orthokeratology KOLs from China
Paragon Vision Sciences recently hosted a group of 18 key opinion leaders and researchers from China. This program, in partnership with Essilor China, included a full day of lectures and presentations. Participants from the U.S. and China shared clinical expertise and practice management information in the areas of fitting and patient management of CRT and specialty contact lenses. Paragon Vision Sciences received China Food and Drug Administration approval and commercial availability of its corneal reshaping/ orthokeratology brand, Paragon CRT Contact Lenses, in January 2017. Paragon was recently acquired by CooperVision and is now part of its new Specialty Eyecare Division.

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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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