Optometric Physician



Vol. 23, #15  •   Monday, April 25, 2022


Off the Cuff: It’s the Same Old Song With a Different Beat Down

Few would argue that the emergence of physician assistants dramatically improved access and quality of health care. Beginning in the late 1960s with education based on fast-track training for MDs during WWII, PAs now provide care in many countries around the globe. As is often the case, as the PA profession has grown, desire for increased independence and greater responsibility has quickly followed.

While I suspect that most ODs are unaware of the parallels between optometry and physician assistants, there are many and becoming increasingly more evident. Both professions are regulated by state law. As a result, practice scope can vary dramatically despite consistent education, skills and training. In most states PAs practice under direct supervision or a collaborative agreement with a physician, while in others, PAs are functionally independent. Our history is obviously different but how organized medicine views us is quite similar.

One thing for sure is that organized medicine likes to keep the PA leash held as short as possible while still benefiting from controlling a lower cost physician replacement. However, like most professions, the natural desire to better serve patient needs has prompted the American Academy of PAs (AAPA) to change the title “physician assistant” to “physician associate.”

Considering how broadly integrated PAs are and how dependent medicine has become on them, you can imagine how the proposed name change suggesting greater equality completely freaked the AMA out. In a special session, the AMA House of Delegates came out against the effort to rebrand the health professional title of “physician assistants” as “physician associates,” saying the move taken recently by the AAPA will “perplex patients seeking the benefit of physicians’ team leadership and superior training.” Immediate AMA past-President Susan Bailey, MD, summed up the AMA concern more concisely, saying the change “will undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice.”

Stumbling accidentally upon a web discussion between PAs and MDs about the proposed change, I immediately had a strong sense of déjà vu. Virtually all of the PAs were in favor of the title change to better reflect their role in healthcare, some MDs were supportive and comfortable with the change, while a significant number of clearly very insecure MDs scolded the PA profession for having the temerity of thinking that they had the intelligence, experience, knowledge or the ability to know what an MD knew after all of those long years of study and sacrifice memorizing things that many of them quickly forgot and never used in practice.

Don’t get me wrong. PAs, MDs and ODs are different. Our training is different and, as I have observed over the years, our personalities and the way we interact with patients are also different. With increases in medical knowledge, all professions have grown and expanded their ability to care for patients. What I have learned is that there is more than enough room for all of us and that a mutually supportive approach to interprofessional relations benefits us all, especially our patients. You go, physician associates. We feel your pain.



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 Jobson Medical Information LLC (JMI), or any other entities or individuals.




Exploring Contact Lens Opportunities for Patients Over 40

Contact lenses offer a good option for patients with presbyopia, especially with improved optical designs available in modern multifocal contact lenses. Due to the aging population there is a good opportunity to increase contact lens penetration by managing these patients better. However, multifocal contact lenses achieve low penetration in the market. A questionnaire was administered to people ages 40-plus years to investigate their perceptions of contact lenses for presbyopia. Only people with presbyopia who were existing contact lens wearers or willing to try contact lenses were included. Participants were recruited from the United Kingdom (UK), United States of America (USA), Netherlands, Germany, France, Spain and Italy.

Data from 1540 participants (57.9%, females; 42.1% males) was collected. Overall, 50.8% of the participants wore contact lenses, but contact lens wear was less common among older participants. Some data supported earlier studies; for example, 6.1% wore gas permeable lenses. However, only 25% of the contact lens wearers used multifocal contact lenses. The reasons the participants wanted to wear contact lenses were similar to younger patients such as sports or cosmesis. Reasons why participants had dropped out of contact lenses included discomfort and dry eye-related issues. Poor visual performance with contact lenses was a reason for dropout of contact lenses for the older participants.

Researchers wrote that the study highlighted some failings by eye care practitioners in the management of patients with presbyopia. For example, they wrote, it appeared that patients of this age group were seeking suggestions and recommendations from their eye care practitioners including upgrading contact lenses and dual wear options. The day-to-day problems encountered by the contact lens wearers in this study seemed to be issues that could be easily tackled by additional counseling and instruction from the eye care practitioners, the researchers added.

SOURCE: Naroo SA, Nagra M, Retallic N. Exploring contact lens opportunities for patients above the age of 40 years. Cont Lens Anterior Eye. 2022 Apr 16:101599.


Prevalence of Corneal Topographic Patterns in Ectatic Corneal Diseases

This paper highlighted various topographic patterns and their prevalence in a large spectrum of ectatic corneal diseases (ECDs). Knowledge of these patterns can help clinicians make quicker diagnoses and select appropriate contact lens design. Keratoconus, pellucid marginal degeneration, keratoglobus, and post-refractive surgery progressive corneal ectasia are considered ECDs. This cross-sectional retrospective study reviewed records of 632 consecutive patients with clinical ECDs at their first presentation to determine various corneal topography patterns and their prevalence in patients with ECDs who visited tertiary eye hospitals of western India. The right eye was considered for pattern analysis. In cases with suspected or forme fruste ectasia in the right eye, the fellow eye was considered. A sagittal map with standard scale of Atlas 9000 topographer was used for pattern analysis. They were classified into 18 categories and grouped under five groups. The prevalence of these patterns was calculated and assessed with 95% confidence interval (CI).

The mean age of patients was 23.6 ± 8.2 years. The highest prevalence was: asymmetric patterns 39.6% (95% CI: 35.7 to 43.5) [asymmetric bowtie (AB) with steepest radial axis index (SRAX) 18.8%; AB with inferior steep (IS) 16%; AB with superior steep (SS), 3.2%; symmetric bowtie (SB) with SRAX 1.6%]; and central or paracentral patterns, 28.6% (95% CI: 25.1-32.3) [IS, 12.2%; heart, 7.4 %; oval, 4.1%; SB, 2.4%; round, 1.6%; and irregular, 0.9%] followed by advanced patterns, 17.3 % (95% CI:14.4 to 20.4) [non-measurable, 5.4;, globus, 4.9%; and indiscriminate, 7%]. The peripheral patterns were 11.7% (95% CI: 9.3 to 14.4) [claw, 6.3%; junctional, 3.2%; butterfly, 1.9%; and SS, 0.3%]. Rare patterns were 2.8% (95% CI: 1.7 to 4.5) [superior (junctional, claw and heart), ABSS with SRAX and ABSRAX located temporally].

Asymmetric and central or paracentral were the most common patterns in this study. The higher prevalence of advanced patterns indicated the need for earlier diagnosis of ECDs in this population, investigators wrote. The peripheral patterns also had significant prevalence.

SOURCE: Shah Z, Singh S, Shilpy N, et al. Prevalence of corneal topographic patterns in ectatic corneal diseases. Optom Vis Sci. 2022 Apr 22. [Epub ahead of print].



The Safety Profile of FDA-Approved Epithelium-Off Corneal Cross-Linking in a US Community-Based Healthcare System

Researchers evaluated the occurrence of early postoperative complications following FDA-approved epithelium-off corneal cross-linking in the United States. This multicenter, retrospective cohort study identified patients who underwent epithelium-off (epi-off) corneal cross-linking (CXL) for keratoconus and post-refractive keratectasia within the Kaiser Permanente Northern California healthcare system between 2016 and 2018. Postoperative complications including delayed epithelial healing, infection, and loss of visual acuity were recorded.

The study included 878 eyes of 654 patients. The mean age was 27±9.4 years (range, 7 to 71). Five hundred ninety-nine patients (91.6%) had keratoconus while 55 had post-refractive corneal ectasia (8.4%). Forty-seven eyes had prolonged follow-up because of the occurrence of complications in the early postoperative period. The respective rates of delayed epithelial healing and keratitis were 3.9% (95% CI: 2.7 to 5.3%), and 1.5% (95%: CI, 0.8 to 2.5%). Four approaches for management of delayed epithelial healing were compared; epithelium healing duration was the longest in the repeat bandage contact lens (BCL) group (23.8 days) and the shortest in the antibiotic ointment group (14.3 days), with statistically significant differences (p<0.05) in the healing time between these two groups.

The concern for early clinical complications after epi-off CXL often led to delayed CXL intervention and further keratoconus progression with increased economic burdens. A large retrospective review of 878 eyes found that the FDA-approved epi-off CXL protocol appeared to be safe with low occurrence rates of early postoperative complications. Researchers recommended the preferred management for delayed epithelial healing is using antibiotic ophthalmic ointment.

SOURCE: Ang MJ, Darbinian JA, Hoskins EN, et al. The Safety Profile of FDA-Approved Epithelium-Off Corneal Cross-Linking in a US Community-Based Healthcare System. Clin Ophthalmol. 2022; Apr 11;16:1117-25.






Industry News

J&J Vision Introduces TearScience Activator for MGD Treatment

Johnson & Johnson Vision announced availability of the next-generation TearScience Activator Clear. Building on the foundation of the LipiFlow Thermal Pulsation System, an automated treatment for meibomian gland dysfunction, TearScience Activator design features a single-piece eye cup and translucent design enabling more efficient and accurate positioning in the eye for more consistent delivery of heat and pressure across the entire lid. The device uses redesigned manufacturing process and fewer raw materials than its predecessor. Learn more.






Orasis Announces Positive Phase III Topline Results of CSF-1

Orasis Pharmaceuticals announced Phase III NEAR-1 and NEAR-2 clinical trials, which evaluated the efficacy and safety of its novel eye drop candidate, CSF-1, met primary and key secondary endpoints. Read more.

Eaglet Eye Relaunches Educational Program

Eaglet Eye is relaunching a three-part virtual educational program, the “Eaglet Eye Scleral Lens Series,” hosted by Dr. Tom Arnold. The program focuses on Profilometry-based scleral lens fitting and aims to help practitioners get more comfortable with scleral lens fitting. Learn more and register.

Euclid Vision Announces Acquisition of Visionary Optics

Euclid Vision, a global provider of advanced orthokeratology and proactive myopia management initiatives, acquired Visionary Optics, a specialty scleral contact lens designer. Read more.

Théa Introduces iVIZIA OTC Products in United States

Théa Pharma announced availability of the iVIZIA line of over-the-counter eye care products in the United States, including lubricating eye drops, lubricating eye gel and three options for daily hygiene of sensitive eyelids. iVIZIA eye drops offer preservative-free extended relief and ocular surface protection to patients with any type of dry eye, including those who wear contact lenses. Learn more.

B+L Recycles More Than 48 Million Units of Product

Bausch + Lomb announced its One by One and Biotrue Eye Care Recycling programs recycled a total of 48,235,850 million units, or 290,145 pounds, of used contact lenses, eye care and lens care materials. Both programs are made possible through a collaboration with TerraCycle, a leader in the collection and repurposing of hard-to-recycle post-consumer waste. Read more.

IDOC Launches Service to Help Practices Source Benefits

IDOC launched its newest HR service, IDOC Benefits & Beyond, a marketplace-based solution to help independent optometrists find and provide quality benefits for their staff. IDOC partnered with Alera Group, a national insurance firm with related expertise, to roll out the offering. Learn more.

Weave a Leader in G2 Spring 2022 Report

Weave, a customer communication platform for small business, was named a leader in the G2 Spring 2022 Reports in all four categories, including optometry software, patient relationship management and patient engagement software and dental practice management. Learn more.

Prevent Blindness Offers UV Awareness Month Resources

Prevent Blindness is offering a dedicated webpage for Ultraviolet Awareness Month in May along with other resources. Learn more.


















Journal Reviews Editor:
Shannon Steinhauser, OD, MS, FAAO

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