Optometric Physician



Vol. 24, #14 •   Monday, April 3, 2023


Off the Cuff: When Patient Education Misses the Mark

A few weeks ago I was flying home from the SECO meeting in Atlanta. We had some impressive delays due to tornadoes and thunderstorms in the area, but eventually the flight was cleared to head to Phoenix. (Thank you to my fellow delayed passengers Drs. Melissa Barnett and Doug Devries for the company.) Once seated, the lady sitting next to me began telling me about how she was flying to Phoenix to help her daughter, who had recently graduated college, find an apartment. She told me about her son, her husband, where they lived, what she did, what her husband does, etc. for hours. Oddly, she never told me her name.

Once she found out I was an eye doctor, she was telling me how she had cataract surgery even though I already knew from the pupil sparkling off her IOL. She had gotten the Panoptix multifocal IOL but she was seeing halos and glare, and thought something was wrong. Her surgeon had recommended an YAG capsulotomy, but she was going to get a second opinion before she did that. I asked why. She said, “He explained the cataract was like an M&M. He said he opened the front of the candy shell and took out the chocolate. Now he says he wants to laser a hole in the back of the shell. Why would I let him do that when he already took out the best part of the M&M?” I had never heard the M&M reference before. I understood her surgeon's analogy, but I also understood her confusion with the removal of the “best part.” After telling her the cataract surgery process, optical properties of multifocal IOLs, and what a posterior capsular opacity was without confectioners’ references, she said she finally understood and would get the YAG when she got home.

I pride myself on my patient education. To hear this obviously intelligent woman be told her crystalline lens was like an M&M and be left in total confusion, feeling quite smug, I was blaming the surgeon and his seemingly lacking patient education skills. But yesterday, I got my own smugness put in check. A long-time glaucoma and keratoconus patient that I had seen for years called saying I never told her she had glaucoma. She was freaking out. She was seen at another office because she was unable to get an early appointment at our office. I looked at her record, and she was clearly diagnosed with low tension glaucoma and educated multiple times. I had reviewed multiple tests with her. We had modified medications a few times. My best guess is that she confused low tension glaucoma with not actually having glaucoma since her pressures weren’t high. Who knows?

That interaction yesterday made me think of my seat mate's cataract surgeon. Maybe his education was spot-on but this patient didn’t or couldn’t hear it because of the idea of surgery…on her eyeballs, all the lens options being thrown at her, laser versus manual surgery, financial aspects, the idea of not having to wear glasses overriding it all. I know with Dr. Epstein’s doctors visits in the six months before his passing and even with my own visits, when the news is unexpected and/or overwhelming, all the patient education in the world won’t connect when all the thoughts are churning in your head while you simultaneously acknowledge the doctor is still talking, and you’re obviously missing something important. Sometimes patient education can miss the mark when patients are unable to process or even hear the intended message, regardless of our best efforts.

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 Relationship Between the Distribution of Facial Erythema and Skin Type in Rosacea Patients

Individuals with rosacea have different facial erythema distribution patterns; however, whether they are related to the skin type is unclear. This study enrolled 201 Chinese patients, including 195 females and six males, diagnosed with rosacea. Facial images were taken using the VISIA® Complexion Analysis System (technology that evaluates skin type, facial features, sun damage, and pigmentation in the skin), and red-area images were further analyzed. The erythema distribution pattern of rosacea was divided into peace signs, wing shapes, and neither of the two patterns, according to the distribution location. Skin types were divided according to the Fitzpatrick skin type, and oily-dry skin subtypes were determined according to the Baumann skin-type scale.

There were 130 and 44 cases of typical peace signs and typical wing shapes, respectively. The remaining 27 cases were of neither type. Among the 76 patients with peace-sign patterns, the majority (58.5%) had oily combination skin. Among the patients with a typical wing shape, 43 (97.7%) had dry combination skin. Among the 27 patients with no peace-sign or wing-shape pattern, 17 (63.0%) had dry combination skin. The peace sign pattern was more common in individuals with darker skin tones.

The authors suggested that the differences in the immune microenvironment, Demodex habitation, and altered lipid content may explain the presence of the peace-sign pattern in the oily combination skin population. Wing-type patterns were associated with the lateral parts of the cheeks and could be caused by abnormal vessel dilations of the anatomic branches of the zygomatic-facial and facial arteries, which indicates that the main pathogenesis for this type of rosacea may be neurovascular.

SOURCE: Tao M, Li M, Zhang Y, et al. The relationship between the distribution of facial erythema and skin type in rosacea patients: a cross-sectional analysis. Arch Dermatol Res. 2023 Mar 20. [Epub ahead of print].



Conjunctival Sac Microbiome in Anophthalmic Patients: Flora Diversity and the Impact of Ocular Prosthesis Materials

The purpose of this study was to explore the changes of bacterial flora in anophthalmic patients wearing ocular prostheses (OP) and the microbiome diversity in conditions of different OP materials. A cross-sectional clinical study was conducted involving 19 OP patients and 23 healthy subjects. Samples were collected from the upper, lower palpebral, caruncle, and fornix conjunctiva, and 16S rRNA sequencing was applied to identify the bacterial flora in the samples. The eye comfort of each OP patient was determined by a questionnaire. In addition, demographic information of each participant was also collected.

The diversity and richness of ocular flora in OP patients were significantly higher than that in healthy subjects. The results of flora species analysis also indicated that in OP patients, pathogenic microorganisms such as Escherichia Shigella and Fusobacterium increased significantly, while the resident flora of Lactobacillus and Lactococcus decreased significantly. Within the self-comparison of OP patients, compared with Polymethyl Methacrylate (PMMA), prosthetic material of glass will lead to the increased colonization of opportunistic pathogens such as Alcaligenes, Dermabacter and Spirochaetes, while gender and age have no significant impact on ocular flora.

The researchers reported, the ocular flora of OP patients was significantly different from that of healthy patients. They added that abundant colonization of pathogenic microorganisms may have an important potential relationship with eye discomfort and eye diseases of OP patients. PMMA, as an artificial eye material, demonstrated potential advantages in reducing the colonization of opportunistic pathogens.

SOURCE: Zhao H, Chen Y, Zheng Y, et al. Conjunctival sac microbiome in anophthalmic patients: Flora diversity and the impact of ocular prosthesis materials. Front Cell Infect Microbiol. 2023;13:1117673.

Should Ocular Demodex Be Checked and Treated in Refractory Keratitis Patients Without Blepharitis?

This study aimed to evaluate the correlation between Demodex infestation and keratitis, and to assess demodicosis using a simple approach. A modified slit lamp illumination (at 40× magnification) was used to observe Demodex tails in 40 patients with refractory keratitis, and 80 healthy controls. Bacterial smear and culture of the conjunctival sac and corneal lesion were performed in all patients with keratitis. Tea tree oil ointment (TTOO) was added as a Demodex killing agent for lid scrubs to the treatment when Demodex infestation was confirmed.

Demodex tails were found in all patients compared to 42/80 of the controls. Seventeen patients presented blepharitis, while 23 were free of scales and inflammation at the lid margin. The demodicosis was mild, moderate, and severe in 8, 19, and 13 patients, respectively, compared to mild in 42 controls. The keratitis was mild, moderate, and severe in 13, 19, and 8 patients, respectively. The severity of Demodex infestation was not correlated to the severity of keratitis. The growth of Staphylococcus was revealed in nine patients who did not react to antibiotic eye drops prior to the TTOO treatment. Patients' signs and symptoms were resolved after the lid scrub with TTOO.

The authors summarize that ocular Demodex needs to be checked and treated in refractory keratitis patients with or without blepharitis. A slit-lamp illumination under high magnification favors the judgment of the severity of Demodex infestation.

SOURCE: Gao YY, Wang T, Jiang YT, et al. Should ocular Demodex be checked and treated in refractory keratitis patients without blepharitis? Int J Ophthalmol. 2023;16(2):201-7.




Industry News

Avenova Launches Eye Health Oral Supplement

Avenova introduced MaquiBright extract of superfruit Maqui Berry eye health support oral supplements. Together with concentrated, unrefined omega-3 oil, the supplement is designed to offer essential nutrients and free radical fighters to support healthy tear production and overall eye health. Learn more.

Vuity Gets Increased-dosing Nod

The FDA recently approved a twice-daily dosing option of AbbVie's presbyopia drop Vuity (pilocarpine HCl ophthalmic solution) 1.25%. According to the new labeling, a second dose (one additional drop in each eye) may be administered three to six hours after the first dose. The company says this can extend the effect of Vuity up to nine hours. Read more.

NORA Issues Call for Posters

The Neuro Optometric Rehabilitation Association (NORA) is now accepting abstracts for consideration for its 2023 General Conference, October 5 to 8, in Portland, Ore. Learn more.

ISVA Appoints Board Officers

The International Sports Vision Association announced the appointment of new executive and advisory board members. View the members.

Prevent Blindness Designates April as Women’s Eye Health and Safety Month

Learn more.














Journal Reviews Editor:
Katherine M. Mastrota, MS, OD, EMBA, FAAO

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