Optometric Physician



Vol. 24, #17 •   Monday, April 24, 2023


Off the Cuff: Sophistry

I read a lot. I read mostly science fiction with a bent toward time and space travel, as well as in-depth historical works. Never thought about it before but just writing that I realize how polar opposite, those two genres are with the fantastical nature of the first and grounded reality of the latter. Huh? Anyway.... When I do read it’s mostly on a Kindle or the Kindle app on my phone. Because I’m always reading and after all my years of education, when I run across a word I’ve never seen or heard before, I’m always surprised. These words are typically not profession-related jargon or hard science concepts. They are typically slipped in as if conversational. I went to state schools more concerned about funding their sports programs than their academic ones. I’m not deluded into believing I went to some incredible literary institution. Go Bulldogs! Still, it’s surprising to find one of these words.

One of the features of reading on a Kindle that I really like is that when I run across one of these words, I can highlight it, and it pulls up a dictionary and Wikipedia definition. This began a relationship-long game for me trying to find words Epstein did not know. I’d be reading, and he’d be in his office working, and I’d say, “Arthur, what does (insert any random word here) mean?” Without hesitation or even stopping what he was doing, he would define it and typically use it in a sentence. This blew my mind every time. In 19 years of being together and 16 years of which I had the Kindle definition already in hand, I never stumped him. He also didn’t attend some Ivy league or literary college. He always credited his mother for his high SAT level vocabulary.

The other day I ran across the word “sophistry.” It’s defined as the clever use of fallacious arguments, especially to deceive or persuade. Ewww. I instantly conjured images of governments and/or politicians using sophistry to control the masses. Upon further research, Sophists were a group of men in ancient Greece who spoke very well and were more interested in winning an argument than being factually correct. They were typically very wealthy, making their money by teaching others how to make a weak case sound strong. This was especially powerful in a time before the written word. The well-spoken man was the most powerful.

I then searched to see if there was a positive side to sophistry. Interestingly, there is. Being aware of sophistry makes us better critical thinkers to avoid being deceived—to avoid believing the argument that sounds too good to be true. It inspires critical thinking and challenging assumptions behind an argument. This encourages the scientific mind to question and consider both the content of the statement as well the motivation and intent of the speaker. I wanted to say, “Arthur, what does sophistry mean?” I have no doubt he’d still be batting a thousand.

Shannon L. Steinhäuser, OD, MS, FAAO
Chief Medical Editor


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.


Evaluation of Hypertensive Disorder of Pregnancy and High Refractive Error in Offspring During Childhood and Adolescence

Growing evidence indicates that adverse prenatal or intrauterine environments might contribute to the development of high refractive error (RE) later in life. However, the association of maternal hypertensive disorder of pregnancy (HDP) with high RE in offspring during childhood and adolescence remains unknown. Investigators looked at the association between maternal HDP and overall and type-specific high REs in offspring in childhood and adolescence. This nationwide population-based cohort study included live-born individuals born in Denmark from 1978 to 2018, in the Danish national health registers. Follow-up started at the date of birth and ended at the date of RE diagnosis, 18th birthday, death, emigration, or December 31, 2018, whichever came first. Data analyses were conducted from November 12, 2021, through June 30, 2022. Maternal HDP (n=104 952), including preeclampsia or eclampsia (n=70 465) and hypertension (n=34 487). The main outcomes were the first occurrence of high RE (hyperopia, myopia, and astigmatism) in offspring. A Cox proportional hazards regression model was used to examine the association between maternal HDP and risk of high RE in offspring from birth until age 18 years, adjusting for multiple potential confounders.

This study included 2,537,421 live-born individuals, 51.30% of whom were male. During the follow-up of up to 18 years, 946 offspring of 104,952 mothers with HDP (0.90%) and 15 559 offspring of 2,432,469 mothers without HDP (0.64%) were diagnosed with high RE. The cumulative incidence of high RE was higher in the exposed cohort (1.12%; 95% CI, 1.05%-1.19%) than in the unexposed cohort (0.80%; 95% CI, 0.78%-0.81%) at 18 years of age (difference: 0.32%; 95% CI, 0.25%-0.40%). Offspring born to mothers with HDP had a 39% increased risk of overall high RE (hazard ratio [HR], 1.39; 95% CI, 1.31-1.49). Sibling-matched analysis revealed an increased risk of overall high RE in half siblings (HR, 1.21; 95% CI, 1.05-1.39) and full siblings (HR, 1.15; 95% CI, 0.99-1.34), but the difference was not significant for the latter. The elevated risks were observed for hypermetropia (HR, 1.41; 95% CI, 1.30-1.52), myopia (HR, 1.30; 95% CI, 1.10-1.53), and astigmatism (HR, 1.45; 95% CI, 1.22-1.71). The increased risk of high RE persisted among offspring aged 0 to 6 years (HR, 1.51, 95% CI, 1.38-1.65), 7 to 12 years (HR, 1.28; 95% CI, 1.11-1.47), and 13 to 18 years (HR, 1.16; 95% CI, 0.95-1.41), but the difference was not significant for the oldest group. When considering both timing of diagnosis and severity of maternal preeclampsia, the highest risk was observed in offspring prenatally exposed to early-onset and severe preeclampsia (HR, 2.59; 95% CI, 2.17-3.08).

In this cohort study of the Danish population, maternal HDP, especially early-onset and severe preeclampsia, was associated with an increased risk of high RE in offspring during childhood and adolescence. These findings suggest that early and regular RE screening should be recommended for children of mothers with HDP.

SOURCE: Li M, Huang C, Yang W, et al. Evaluation of hypertensive disorder of pregnancy and high refractive error in offspring during childhood and adolescence. JAMA Netw Open. 2023 Apr 3;6(4):e238694.



Corneal Stromal Regeneration-Keratoconus Cell Therapy: A Review

Keratoconus is a corneal ectatic disease caused by stromal thinning leading to astigmatism and progressive loss of vision. Loss of keratocytes and excessive degradation of collagen fibers by matrix metalloproteinases are the molecular signatures of the disease. Despite several limitations, corneal collagen crosslinking and keratoplasty are the most widely used treatment options for keratoconus. In the pursuit of alternative treatment modalities, clinician scientists have explored cell therapy paradigms for treating the condition. Articles pertaining to keratoconus cell therapy with relevant keywords were used to search in PubMed, Researchgate, and Google Scholar. The articles were selected based on their relevance, reliability, publication year, associated published journal, and accessibility.

Various cellular abnormalities have been reported in keratoconus. Diverse cell types such as mesenchymal stromal cells, dental pulp cells, bone marrow stem cells, haematopoietic stem cells, adipose-derived stem cells apart from embryonic and induced pluripotent stem cells can be used for keratoconus cell therapy. The results obtained show that there is a potential for these cells from various sources as a viable treatment option.

Researchers wrote of the need for consensus with respect to the source of cells, mode of delivery, stage of disease, and duration of follow-up to establish a standard operating protocol. This may eventually expand cell therapy options for corneal ectatic diseases beyond keratoconus, they added.

SOURCE: Shetty R, Mahendran K, Joshi PD, et al. Corneal stromal regeneration-keratoconus cell therapy: a review. Graefes Arch Clin Exp Ophthalmol. 2023 Apr 19. [Epub ahead of print].


Prescription Trends for Preservative Free Glaucoma Medication in a Public Health System

This retrospective study evaluated data collected from the information systems "farm@web" and "Farmadrid" of glaucoma prescriptions in the Spanish National Health System to analyze the prescribing trends over a 7-years period, between 2013 and 2020, in a tertiary hospital (Hospital Clinico San Carlos, Madrid, Spain) and its health area.

Prostaglandin analogs were the most commonly used drugs in monotherapy during the study period (range: 36.82% to 47.07%). Fixed combinations of topical hypotensives had an upward trend since 2013 (range: 39.99% to 54.21%), becoming the most dispensed drugs in 2020 (48.99%). Preservative-free eye drops (lacking benzalkonium chloride, BAK) displaced preservative-containing topical treatments in all pharmacological groups. In 2013, BAK-preserved eye drops accounted for 91.1% of the total prescriptions; however, in 2020 they only accounted for 34.2% of total prescriptions.

The results of the present study highlighted the current trend of avoiding BAK-preserved eye drops for the treatment of glaucoma in the Spanish Health System.

SOURCE: Pérez-García P, Burgos-Blasco B, Morales-Fernández L, et al. Prescription trends for preservative free glaucoma medication in a public health system. Eur J Ophthalmol. 2023 Apr 17. [Epub ahead of print].




Industry News

Prevent Blindness Announces Recipients of the 2023 Jenny Pomeroy Award, Rising Visionary Award

View the recipients.

B+L to Present Data on NOV03, IOL Pipeline at ARVO 2023

Bausch + Lomb announced eight presentations at ARVO 2023, including results from the 12-month KALAHARI safety extension study of the investigational treatment NOV03 (perfluorohexyloctane), as well as the results of two studies on surgical intraocular lens pipeline programs. Learn more.

Visus to Present Data on Alpha-Crystallin Aggregation Inhibitors

Visus Therapeutics will present new scientific data at the ARVO 2023 on the company’s alpha-crystallin aggregation inhibitors, intended to restore elasticity and lens clarity, potentially reversing presbyopia and cataracts without the need for surgery. Read more.












Journal Reviews Editor:
Shannon L. Steinhäuser, OD, MS, FAAO

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