Optometric Physician



Vol. 25, #15 •   Monday, April 29, 2024


Off the Cuff: Changing From Change Healthcare

February 21, 2024, Change Healthcare, a large insurance claim clearinghouse owned by United Healthcare/Optum, the one I’ve used ever since opening my office and associated with Compulink, was cyber attacked and promptly shut down. I wrote about this when it initially happened. Since then more drama has unfolded. I read a news story recently that said United paid the Russian-based cybercriminals $22 million ransom in bitcoin to protect the data that was stolen. Even though this was paid, patient data was leaked to the dark web. Why? There were reportedly two cybergangs involved in the attack. ALPHV, also known as Black Cat, was the organization that United paid the ransom to but the second group, Ransom Hub, evidently didn’t get their cut and subsequently released screenshots of patient information with the threat of selling all of it in an attempt to extort a second ransom. I guess there really is no honor among thieves. United Healthcare has reported $872 million loss in the first quarter directly attributable to the attack and are estimating the total loss to be somewhere in the $1.3-1.6 billion range once it’s all said and done.

As for us we haven’t submitted a single medical claim file since before the February attack. Compulink offered temporary options of sending claim files to each individual insurance carrier as well as an alternate clearinghouse by Optum called Optum iEDI. It was clear these were all intended as temporary solutions until Change was up and running again. I chose to not pursue any temporary measures to avoid any unnecessary drama. After weeks and weeks of updates and further pushed out deadlines, I’ve been informed Optum iEDI is no longer an optional thing. I’m still not sure if it’s a stepping stone to ultimately getting Change back or if this is an entirely abandoned ship. This is even more unfortunate because Change also sent our patient statements as well as recall postcards. Maybe this will ultimately be a good thing in hindsight. I would’ve never undertaken moving clearinghouses, but now it seems to be an inevitable change from Change.

This was a major wake-up call. If a company the size of United Healthcare was able to be attacked, cyber criminals have become amazingly sophisticated and have the ability to exploit even the most robust and complex security measures. Educating our staff about risks and how to protect our systems and themselves seems wildly insufficient if not even futile. I have a rider on the business insurance for cyber attacks but would that even be sufficient in the event of a direct hit? I regularly receive postcards that my data was in this or that company’s data breach, and I can sign up for the identity protection service du jour. These are so common that I’ve accepted there is no truly protected identifiable data. It’s all out there somewhere. HIPAA rules seem almost quaint when these cybercriminals can just swoop in and put it all out there.

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.



The Effect of Yoga on IOP Using the iCare HOME2 Tonometer

Various yoga positions may have an unfavorable impact on intraocular pressure (IOP) and may therefore be seen as a potential risk factor for the progression of glaucoma. The new iCare HOME2 is a handheld self-tonometer for IOP measurements outside clinical settings. This is the first study to evaluate the immediate effect of common yoga postures on the IOP of healthy and glaucomatous eyes using the iCare HOME2 self-tonometer and to compare the time of IOP recovery in both groups. This single-center, prospective, observational study included 25 healthy and 25 glaucoma patients performing the following yoga positions: "legs up" (Viparita Karani), "bend over" (Uttanasana), "plough pose" (Halasana), and the "down face dog" (Adho Mukha Svanasana) for 90 seconds each, with a 2-minute break in between. IOP was measured with the iCare HOME2 before, during, and after each position.

IOP significantly increased in all eyes in all positions (p<0.05), showing no statistically significant difference between healthy or glaucomatous eyes (p>0.05). The mean rise in IOP in healthy subjects was 1.6 mmHg (SD 1.42; p=0.037), 14.4 mmHg (SD 4.48; p<0.001), 7.5 mmHg (SD 4.21; p<0.001), and 16.5 mmHg (SD 3.71; p<0.001), whereas in glaucoma patients, IOP rose by 2.8 mmHg (SD 2.8; p=0.017), 11.6 mmHg (SD 3.86; p<0.001), 6.0 mmHg (SD 2.24; p<0.001), and 15.1 mmHg (SD 4.44; p<0.001) during the above listed yoga positions, respectively. The highest increase in IOP was seen in the down face position, reaching mean IOP values above 31 mmHg in both study groups. IOP elevation was observed immediately after assuming the yoga position, with no significant change during the following 90 seconds of holding each pose (p>0.05). All IOP values returned to baseline level in all individuals, with no significant difference between healthy and glaucoma participants.

The data showed that common yoga positions can lead to an acute IOP elevation of up to 31 mmHg in healthy as well as glaucoma eyes, with higher IOP values during head-down positions. Given that IOP peaks are a major risk factor for glaucomatous optic neuropathy, researchers wrote that they generally advise glaucoma patients to carefully choose their yoga exercises. If and to what extent practicing yoga leads to glaucoma progression, however, remains unclear and warrants further research, they added.

SOURCE: Tania Darja Shajiei, Josephine Wachtl, Angelika Schuknecht, Lucas Bachmann, Christoph Kniestedt. The Effect of Yoga on Intraocular Pressure Using the "iCare HOME2" Tonometer. Klin Monbl Augenheilkd. 2024 Apr;241(4):347-354.



Are Artificial Intelligence Chatbots a Reliable Source of Information About Contact Lenses?

Artificial Intelligence (AI) chatbots are able to explain complex concepts using plain language. The aim of this study was to assess the accuracy of three AI chatbots answering common questions related to contact lens (CL) wear. Three open access AI chatbots were compared: Perplexity, Open Assistant and ChatGPT 3.5. Ten general CL questions were asked to all AI chatbots on the same day in two different countries, with the questions asked in Spanish from Spain and in English from the U.K. Two independent optometrists with experience working in each country assessed the accuracy of the answers provided. Also, the AI chatbots' responses were assessed if their outputs showed any bias towards (or against) any eye care professional (ECP).

The answers obtained by the same AI chatbots were different in Spain and the U.K. Also, statistically significant differences were found between the AI chatbots for accuracy. In the U.K., ChatGPT 3.5 was the most and Open Assistant least accurate (p<0.01). In Spain, Perplexity and ChatGPT were statistically more accurate than Open Assistant (p < 0.01). All the AI chatbots presented bias, except ChatGPT 3.5 in Spain.

Researchers wrote that AI chatbots do not always consider local CL legislation, and their accuracy seems to be dependent on the language used to interact with them. Hence, at this time, they noted, although some AI chatbots might be a good source of information for general CL related questions, they cannot replace an ECP.

SOURCE: Nery García-Porta, Megan Vaughan, Sofia Rendo-González, et al. Are artificial intelligence chatbots a reliable source of information about contact lenses? Cont Lens Anterior Eye. 2024 Apr;47(2):102130.

Effect of Intravitreal Aflibercept on Corneal Endothelial CellsMyopia

To determine the effect of repeated intravitreal injections of aflibercept on the corneal endothelium in patients with diabetic macular edema (DME) and macular edema due to retinal vein occlusion (RVO), a prospective study was conducted between January 2021 and November 2023, and a total of 87 treatment-naive eyes with DME and RVO were evaluated. The exclusion criteria were surgery or laser intervention during the follow-up period, contact lens wear, cataract surgery in the last 6 months, dystrophy, or other corneal condition that may cause endothelial damage. In addition to routine examinations on the day of application, researchers also measured the corneal endothelium using specular microscopy on the 1st, 4th and 8th day of injection. Researchers evaluated 4 parameters: endothelial cell density (CD), hexagonality (HEX), coefficient of variability (CV) and central corneal thickness (CCT). First of all, they evaluated the entire cohort of eyes, and then divided it according to 2 criteria; the diagnosis into DME/RVO and according to the lens status into phakic/pseudophakic eyes.

A total of 87 eyes of 68 patients were evaluated. The average age of the patients at the time of diagnosis was 66.8 ±9.3 years. Within the cohort, 51 (59%) eyes were phakic and 36 (41%) pseudophakic. A total of 61 (70%) eyes with a diagnosis of DME were treated, 26 (30%) with RVO. During the follow-up, there were no significant changes in the average values of CD, HEX, CV, or CCT due to aflibercept treatment, either in the whole group or in subgroups according to diagnosis or lens condition.

The results of this study suggest that intravitreal administration of aflibercept in patients with DME and RVO did not have an impact on corneal endothelial parameters, including CCT, HEX, CD and CV. These parameters were measured using endothelial microscopy during an 8-injection observation period.

SOURCE: Zuzana Šulavíková, Zuzana Šustykevičová, Marek Káčerik, Vladimír Krásnik. Effect of Intravitreal Aflibercept on Corneal Endothelial Cells. Cesk Slov Oftalmol. 2024;80(Ahead of print):1001-1006.




Industry News

B+L Announces Study Findings on Daily Nutritional Supplement for Dry Eyes Met Primary Endpoints

Bausch + Lomb announced that a clinical study evaluating the efficacy and safety of a novel daily nutritional supplement formulated to address the symptoms of dry eyes met both of its primary endpoints: change in tear production and participant reports of dry eye symptoms. The study was published in Frontiers in Ophthalmology. Bausch + Lomb expects to launch in the US the supplement, which features a proprietary blend of ingredients including lutein, zeaxanthin isomers, curcumin and vitamin D3, under the brand name Blink™ NutriTears® early in the third quarter of 2024. Read more.


• Excision BioTherapeutics will present positive data from its herpes simplex virus-1 keratitis program, EBT-104, and an overview of a next-generation AAV delivery vector, at the American Society of Gene & Cell Therapy annual meeting (May 7-11 in Baltimore).

• Anu Gore, PhD, joined Bausch + Lomb in the new role of vice president, Formulation Sciences and Product Development. Dr. Gore brings more than 24 years of biopharmaceutical product development and eyecare leadership, most recently from AbbVie and Allergan.

• The Glaucoma Foundation presented its inaugural Chairman's Spotlight Award to writer, performer and producer David Letterman. Read more.

• Glaukos was honored with a Stevie® Award for Marketing Campaign of the Year for its Keratoconus Consumer Awareness Campaign. The award from the American Business Association recognized consumer awareness focus of the campaign, centered around a website and supported by social media and materials describing KC signs and symptoms, risks, and possible rapid progression. Visit the website.

• Prevent Blindness declared May the first Inherited Retinal Disease Genetic Testing Awareness Month. Learn more.

• Topcon announced Ali Tafreshi was named CEO and president of Topcon Healthcare. With more than 20 years of experience in the eyecare industry, Tafreshi most recently served as the company’s chief officer of Strategy, Innovation, and Clinical Development, where he was responsible for the strategy to drive digital health solutions using Harmony. Learn more.







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

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