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

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Volume 18, Number 14

Monday, April 3, 2017

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Inside this issue: (click heading to view article)
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######### Off the Cuff: Strength in Numbers
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######### Diabetic Brain or Retina? Visual Psychophysical Performance in Diabetic Patients in Relation to GABA Levels in Occipital Cortex
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######### Nonmedical Out-of-pocket Patient and Companion Expenditures Associated with Glaucoma Care
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######### Effects of Chalazia on Corneal Astigmatism
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######### News & Notes
 

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Off the Cuff: Strength in Numbers

It’s hard not to see just how much things have changed in our country. Beyond the election, our president or even politics, the influence of “big money” has shifted power from Washington, D.C., to state capitols—influencing matters as diverse as second amendment rights and legalization of recreational marijuana use. Legislative influence and ballot initiatives make states easy targets. Today, faux, “astroturf” organizations and unwitting journalists manipulate public opinion with ease, while real agendas usually remain concealed from public view.

Case-in-point: 1-800 Contacts has been alarmingly successful at shifting the dialog from patient safety to false consumer advocacy. With money to burn, they went from state to state upping their demands along the way. From contact lens deregulation to online refraction, its false narrative continues to threaten both patient safety and professional authority.

Optometry of all professions should recognize the power of waging battles in state capitols. Over recent decades, our profession has literally been transformed state by state. And today, our future demands more expansive legislation that is both exclusive and broad rather than inclusive and limited. Yet, despite warmer relations with many progressive ophthalmologists, these battles will still need to be hard fought state by state.

Too many of us sit on the sidelines, hiding in the darkness of our exam rooms, staying disengaged and uninvolved. But letting colleagues do all the heavy lifting only leaves us divided and weak. In the end it hurts us all. With the tremendous vulnerability as well as opportunity existing in state legislatures today, supporting your state optometric organization is more critical now than it has ever been. If not now, you may not have another when.


Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com

 

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.

 

 

Diabetic Brain or Retina? Visual Psychophysical Performance in Diabetic Patients in Relation to GABA Levels in Occipital Cortex
 
 
Visual impairment is one of the most feared complications of type 2 diabetes mellitus, researchers wrote. They aimed to investigate the role of occipital cortex γ-aminobutyric acid (GABA) as a predictor of visual performance in type 2 diabetes. Eighteen type 2 diabetes patients were included in a longitudinal, prospective, one-year study, as well as 22 healthy age-matched controls. Researchers collected demographic data, HbA1C and used a novel set of visual psychophysical tests addressing color, achromatic luminance and speed discrimination in both groups. Psychophysical tests underwent dimension reduction with principle component analysis into three synthetic variables: speed, achromatic luminance and color discrimination.

A MEGA-PRESS magnetic resonance brain spectroscopy sequence was used to measure occipital GABA levels in the type 2 diabetes group. Retinopathy grading and retinal microaneurysms counting were performed in the type 2 diabetes group for single-armed correlations. Speed discrimination thresholds were significantly higher in the type 2 diabetes group in both visits; mean difference (95% confidence interval) was 0.86 (0.32-1.40) in the first visit and 0.74 (0.04-1.44) in the second visit. GABA from the occipital cortex predicted speed and achromatic luminance discrimination thresholds within the same visit in the type 2 diabetes group. GABA from the occipital cortex also predicted speed discrimination thresholds one year later in the type 2 diabetes group.

Researchers’ results suggested that speed discrimination was impaired in type 2 diabetes and that occipital cortical GABA is a novel predictor of visual psychophysical performance independently from retinopathy grade, metabolic control or disease duration in the early stages of the disease.


SOURCE: Sanches M, Abuhaiba SI, d'Almeida OC, et al. Diabetic brain or retina? Visual psychophysical performance in diabetic patients in relation to GABA levels in occipital cortex. Metab Brain Dis. 2017; Mar 30. [Epub ahead of print].


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Nonmedical Out-of-pocket Patient and Companion Expenditures Associated with Glaucoma Care
 
 
Nonmedical out-of-pocket costs to both patients and their companions for routine glaucoma care office visits have not been extensively studied in the United States. Researchers evaluated potential key predictors of patient expenditures that are critical to assessing the cost-effectiveness of glaucoma health care delivery. In total, 300 patients responded to the survey in three clinics in two clinical practice settings. Main outcome measures included both average visit and yearly expenditures.

Of the 300 patients, the majority were female (n=187, 62.3%) and African American (n=171, 57.0%). The median age was 66 years. The median [range; mean (SD)] expenditure per patient visit was $22.10 ($11.1, $42.9; $44.1 (72.8)). Patients with companions paid $38.77 more in average visit expenditure. The average visit expenditure for retired patients was $17.37 less when compared with non-retired patients. Patients living in a rural or suburban area paid $43.91 and $14.13 more per visit, respectively, compared with patients living in an urban area. Patients with noncommercial insurance paid $24.01 less in average visit expenditure. The median yearly patient expenditure was $96.70 [$44.6, $222.7; $210.4 (333.9)]. Patients with companions paid $192.37 more in yearly expenditure than those without companions, whereas retired patients paid $80.83 less in yearly expenditure than non-retirees. Patients with noncommercial insurance paid $109.34 less in yearly expenditure.

Researchers concluded that a small portion of the total cost of glaucoma care—non-medical, out-of-pocket costs—constitutes a substantial, non-covered medical expense to most patients in the United States. They found that patients who were employed, came with companions, lived in non-urban areas or were on Medicare had greater expenditures.

SOURCE: Schehlein EM, Im LT, Robin AL, et al. Nonmedical out-of-pocket patient and companion expenditures associated with glaucoma care. J Glaucoma. 2017;26(4):343-348.

 

 

Effects of Chalazia on Corneal Astigmatism
 
 
A chalazion is a common eyelid disease that causes eye morbidity due to inflammation and cosmetic disfigurement. Corneal topographic changes are important factors in corneal refractive surgery, intraocular lens power calculations for cataract surgery and visual acuity assessments. However, the effects of chalazia on corneal astigmatism have not been thoroughly investigated. The changes in corneal astigmatism according to chalazion size and location are necessary for better outcomes of ocular surgery. The aim of this study was to evaluate changes in corneal astigmatism according to chalazion size and location. In this cross-sectional study, a total of 44 eyes from 33 patients were included in the chalazion group, and 70 eyes from 46 patients comprised the control group. Chalazia were classified according to location and size. An autokeratorefractometer (KR8100, Topcon) and a Galilei dual-Scheimpflug analyzer (Ziemer Group) were utilized to evaluate corneal changes.

Oblique astigmatism was greater in the chalazion group compared with the control group. Astigmatism by simulated keratometry (simK), steep K by simK, total root mean square, second order aberration, oblique astigmatism, and vertical astigmatism were significantly greater in the upper eyelid group. Astigmatism by simK, second order aberration, oblique astigmatism and vertical astigmatism were significantly greater in the large-sized chalazion group. Corneal wavefront aberration was the greatest in the upper eyelid chalazion group, whole area group, and large-sized chalazion group.

Large-sized chalazia in the whole upper eyelid should be treated in the early phase because they induced the greatest change in corneal topography. Chalazion should be treated before corneal topography is performed preoperatively and before the diagnosis of corneal diseases.

SOURCE: Jin KW, Shin YJ, Hyon JY. Effects of chalazia on corneal astigmatism: Large-sized chalazia in middle upper eyelids compress the cornea and induce the corneal astigmatism. BMC Ophthalmol. 2017;17(1):36


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News & Notes
 

Bausch + Lomb Introduces Ultra for Astigmatism Contact Lenses, Announces New U.S. Leadership
Bausch + Lomb launched Ultra for Astigmatism contact lenses—a monthly silicone hydrogel lens combining MoistureSeal technology and OpticAlign design, engineered for stability to promote a successful first fit. This latest offering advances the family of Ultra contact lens products, with the goal of providing astigmatic patients the all-day comfort and consistently clear vision already offered to spherical and presbyopic patients. The lenses feature MoistureSeal technology, which helps to maintain 95% of lens moisture for 16 hours through a unique two-phase polymerization process. The OpticAlign design was developed after extensive analysis and testing of numerous lens geometries to determine which performed best with the Ultra contact lens material. Read more.

In addition, the company announced changes to its management team to improve operational efficiencies and foster synergies to drive growth. Joseph “Joe” Gordon, senior vice president and general manager, U.S. Consumer Healthcare, will expand his role to include the U.S. Vision Care business. Tracy Valorie, senior vice president and general manager, U.S. Pharmaceuticals, will expand her role to include the U.S. Surgical business. John Ferris, most recently vice president of marketing for Bausch + Lomb’s OTC Vitamin portfolio, will serve as vice president and general manager for U.S. Vision Care. Chuck Hess, vice president and general manager for U.S. Surgical, will oversee the daily operations of the business. Read more.

EyePrintPRO Expands U.S. & Canadian Provider Network
EyePrint Prosthetics announced that eye care providers in 36 sites across the United States and Canada are now certified to fit the EyePrintPRO. The prosthetic scleral, designed to improve vision by creating a smooth refractive surface for the eye, is similar to a scleral lens as it is made of the same FDA-approved, oxygen-permeable materials. In addition, the fit vaults the cornea while landing on the sclera, but instead of using a series of standardized curvatures, proprietary Elevation Specific Technology software enables the exact match of unique irregularities to each individual eye. Because the prosthetic scleral cover shell is not constrained to typical fabrication, lenses can be made to match the exact contour of any eye—even in the most difficult of conditions where other options have failed. Read more.



American Optometric Foundation Announces New Name
The American Optometric Foundation has officially changed its name to the American Academy of Optometry Foundation (AAOF). The board of directors voted to change the name for the purpose of better aligning and branding the Academy’s foundation. Celebrating 70 years this year, the foundation’s mission is to develop and provide financial support for optometric research and education in vision and eye health to improve clinical patient care. Read more.

IKA Partners with Scleral Lens Education Society
The International Keratoconus Academy of Eye Care Professionals announced a partnership and collaboration with the Scleral Lens Education Society. Both organizations heavily support public education and professional development of corneal disease detection, advancing technology, and surgical and non-surgical management. The IKA and SLS—including international experts, educators and lecturers from private practice, academia, government and research—will cohesively work to further develop global best practices and clinical recommendations to provide eye care providers the necessary tools and the most up to date resources to maximize patient success.

Alcon Gets FDA Nod for Acrysof IQ Restor +2.5 Multifocal Toric IOL
Alcon received FDA approval for its AcrySof IQ Restor +2.5 Multifocal Toric intraocular lens with Activefocus optical design for patients undergoing cataract surgery who choose to address their astigmatism and presbyopia at the same time. The unique optical design of the lens is intended to deliver sharp, clear distance vision and a range of vision for patients who desire less dependence on glasses. The multifocal toric IOL’s central area is 100 percent dedicated to distance vision, and the lens is engineered for stability. Alcon plans to commercialize the lens in the United States beginning in mid-2017. Read more.

New Technologies and Treatments in Eye Care and OCCRS 2017 - San Diego, California
New Technologies and Treatments in Eye Care 2017 - Orlando, Florido


   
 
   

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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