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


Volume 18, Number 33

Monday, August 14, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: A Big Day of Firsts
######### Effects of Acute Peripheral/Central Visual Field Loss on Standing Balance
######### Pilot Study of a Novel Classroom Designed to Prevent Myopia By Increasing Children's Exposure to Outdoor Light
######### Activated Retinal Pigment Epithelium, an Optical Coherence Tomography Biomarker for Progression in Age-related Macular Degeneration
######### News & Notes

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Off the Cuff: A Big Day of Firsts

Today is a special day. For Optometric Physician it’s a day of many “firsts.” This is the first time that I’ve run a “best of” Off The Cuff—something I don’t expect to do again. This is the first time I’ve written about the same person on four separate occasions. It’s not the first time I’ve recognized a colleague for their contributions to the profession or their kindness as a person, but it is the first time I’ve written an editorial to wish someone a happy birthday.

For the grumpy among you, I know this is a powerful platform and trust that I don’t take that lightly. But today is Uncle Frank Fontana’s 95th birthday, and that makes it a very special day indeed.

Of the pieces I’ve written about Frank, I think “Uncle Frank Day” best captures how those of us lucky enough to know him best and love him the most feel about him. Still practicing and still attending meetings, Frank is an essential part of our family and our profession’s history. He is the uncle we think about the most. The father whose voice still guides us through life’s twists and turns, and a constant reminder that we can remain active and valuable as long as we want to.

Happy 95th birthday Uncle Frank —Your Nephew Artie

Uncle Frank Day (originally published March 14, 2016)

If I could have one wish, I would make today Uncle Frank Day. It would be a national holiday that we would celebrate every year. Uncle Frank Day would remind us of the value of friendship, the importance of caring and the rewards of dedication. Those are just some of the things I learned from Uncle Frank. For those of you who don’t know Frank Fontana, let me tell you about my Uncle Frank.

Long before many of you were born, before anyone even thought of the words “key opinion leader,” Uncle Frank was a KOL—perhaps the very first. As a volunteer for our profession, Frank was tireless. As a consultant, mere mention of his name would open doors. Frank had, and still has, many friends in high places. He paved paths that many of our most respected colleagues still walk today.

Frank served in Europe during WWII. He began practicing optometry in 1950 after completing his education under the GI Bill. I relish some of the war stories he’s shared with me over the years—some more than once. As a pioneer in contact lenses, Frank spent a good part of his career on the podium educating others. I had the good fortune of speaking with him several years ago in Chicago. It was a highlight of my career. I like to think I’ve followed in Frank’s footsteps. Frank co-founded the AOA Contact Lens Section in 1981, and I served as chair of the Contact Lens and Cornea Section 25 years later. I had the honor of being sworn in by Frank.

If you’re wondering why everyone calls him Uncle Frank, as it turns out, we're all part of Frank’s family. Each of us is a niece or a nephew, or we might as well be. I’m not kidding. Frank is the only person I’ve ever met who carries pictures of other people’s kids in his wallet.

Over the years, Frank (and Frankie, Jr., who looks after his dad) has become family to many of us. The man holds a most special place in our profession and in our hearts. I thought it fitting to take a moment and share a little about my dear friend with you. After all, it’s Uncle Frank Day!



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


Effects of Acute Peripheral/Central Visual Field Loss on Standing Balance
Vision impairments such as age-related macular degeneration (AMD) and glaucoma are among the top risk factors for geriatric falls and fall-related injuries. AMD and glaucoma lead to loss of the central and peripheral visual fields, respectively. This study utilized a custom contact lens model to occlude the peripheral or central visual fields in healthy adults, offering a novel within-subject approach to improve our understanding of the etiology of balance impairments that may lead to an increased fall risk in patients with visual field loss.

Two dynamic posturography tests, including an adapted version of the Sensory Organization Test and a virtual reality environment with the visual scene moving sinusoidally, were used to evaluate standing balance. Balance stability was quantified by displacement and time-normalized path length of the center of pressure. Nine young and eleven older healthy adults wore visual field occluding contact lenses during posturography assessments to compare the effects of acute central and peripheral visual field occlusion.

Researchers found that visual field occlusion had greater impact on older adults than young adults, specifically when proprioceptive cues are unreliable. Furthermore, they added that the results suggested that both central and peripheral visions were important in postural control; however, peripheral vision might be more sensitive to movement in the environment.

SOURCE: O'Connell C, Mahboobin A, Drexler S, et al. Effects of acute peripheral/central visual field loss on standing balance. Exp Brain Res. 2017; Aug 1. [Epub ahead of print].

Pilot Study of a Novel Classroom Designed to Prevent Myopia By Increasing Children's Exposure to Outdoor Light
This study sought to assess light characteristics and user acceptability of a prototype Bright Classroom (BC), designed to prevent children's myopia by exposing them to light conditions resembling the outdoors. Conditions were measured throughout the school year in the glass-constructed BC, a traditional classroom (TC) and outdoors. Teachers and children completed user questionnaires and children rated reading comfort at different light intensities. A total of 230 children (mean age 10.2 years, 57.4% boys) and 13 teachers (36.8 years, 15.4% men) completed questionnaires.

The median (Inter Quartile Range) light intensity in the BC (2,540 [1,330 to 4,060] lux) was greater than the TC (477 [245 to738] lux), though less than outdoors (19,500 [8,960 to 36,000] lux). A prominent spectral peak at 490nm to 560nm was present in the BC and outdoors, but less so in the TC. Teachers and children gave higher overall ratings to the BC than TC, and light intensity in the BC in summer and on sunny days (>5,000 lux) was at the upper limit of children's comfort for reading.

Investigators concluded that light intensity in the BC exceeded TC and was at the practical upper limit for routine use. They added that children and teachers preferred the BC.

SOURCE: Zhou Z, Chen T, Wang M, et al. Pilot study of a novel classroom designed to prevent myopia by increasing children's exposure to outdoor light. PLoS One. 2017;12(7):e0181772.



Activated Retinal Pigment Epithelium, an Optical Coherence Tomography Biomarker for Progression in Age-related Macular Degeneration
The Project MACULA online resource for age-related macular degeneration (AMD) histopathology was surveyed systematically to form a catalog of 15 phenotypes of retinal pigment epithelium (RPE) and RPE-derived cells, as well as layer thicknesses in advanced disease. This was done to summarize and contextualize recent histology and RPE outcomes in advanced AMD as a way to show RPE activation and migration as important precursors to atrophy, manifesting as intraretinal hyperreflective foci on spectral-domain optical coherence tomography (SDOCT). Phenotypes were also sought in correlations with clinical longitudinal eye-tracked SD-OCT and with ex vivo imaging and histopathology correlations in geographic atrophy (GA) and pigment epithelium detachments (PED).

The morphology catalog suggested two main pathways of RPE outcomes: basolateral shedding of intracellular organelles (apparent apoptosis in situ) and activation with anterior migration. Investigators wrote that acquired vitelliform lesions might represent a third pathway. Migrated cells were packed with RPE organelles and confirmed as hyperreflective on SD-OCT. RPE layer thickening due to cellular dysmorphia and thick basal laminar deposit was observed near the border of GA. Drusenoid PED showed a life cycle of slow growth and rapid collapse preceded by RPE layer disruption and anterior migration.

Researchers wrote that RPE activation and migration were an important precursor to atrophy that could be observed at the cellular level in vivo via validated SD-OCT. Collapse of large drusen and drusenoid PED appeared to occur when RPE death and migration prevented continued production of druse components. Data implicated excessive diffusion distance from choriocapillaris in RPE death as well as a potential benefit for targeting drusen in GA.

SOURCE: Curcio CA, Zanzottera EC, Ach T, et al. Activated retinal pigment epithelium, an optical coherence tomography biomarker for progression in age-related macular degeneration. Invest Ophthalmol Vis Sci. 2017;58(6):BIO211-26.

News & Notes
Bausch + Lomb Receives 510(K) Clearance for Boston XO & XO2 Materials
Bausch + Lomb received 510(k) FDA clearance for the therapeutic use of its Boston XO and Boston XO2 materials in treating several ocular surface diseases. The gas permeable materials are used in a broad spectrum of custom specialty lenses including the Zenlens scleral lens from Alden Optical, a part of the Bausch + Lomb Specialty Vision Products business. They also are indicated for daily wear to correct refractive ametropia and manage irregular corneal conditions. The expanded indication enables scleral lenses manufactured with the gas permeable materials to be used for treatment of certain ocular surface conditions, including dry eye disease and limbal stem cell deficiencies, skin disorders with ocular surface manifestations, neurotrophic keratitis, and corneal exposure that may benefit from an expanded tear reservoir and the saline-hydrated environment inherent in a scleral lens design. Read more.


visuSolution Announces Commercial Expansion to U.S.
visuSolution, a German manufacturer of ophthalmic measurement instruments and electronic reading aids, plans to expand its commercial operations into the United States. visuSolution CEO Maik Zwick said in a press release the expansion is perfectly aligned with the company’s mission of bringing optimal sight to as many people as possible. The company’s products are focused on digital video centration and low vision, and include visuReal (Premium, Portable and Pro) and visuPlus (Active and FlexiCam), which are compatible with iOS devices. Read more.


Daily Contact Lenses Surpass Monthlies in U.S. Sales
Point-of-sale data from GfK Optics, a provider of market and consumer information, shows strong momentum for daily contact lenses, driving overall growth in the U.S. soft contact lens market. But the number of new contact lens wearers remains flat overall. In January 2017, for the first time, monthly sales of daily contact lenses surpassed those of monthly lenses in dollar volume, reaching 38.1% market share—up from 31.5% in January 2016, according to the report. New products and innovation continue to drive daily lens sales surges; in 2016, 42% of growth in the daily category was from product launches in the prior year. GfK data also showed that the average price of a single daily lens has increased by more than 10 cents since 2012, driven in part by the growing prevalence of higher-cost multifocal, toric and silicon hydrogel lenses within the modality. Daily multifocal lenses grew 45.4% in 2016 over the prior year, with more than three quarters (77.9%) of growth driven by products launched in 2015. Read more.

Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia

The American Academy of Optometry and American Academy of Ophthalmology are teaming up to offer tips on how to safely photograph an eclipse. On Aug. 21, the first total eclipse of the sun will happen in the United States since 1979. Today, however, millions of individuals have access to smartphones and digital cameras to photograph the eclipse, so eye care professionals caution first-time viewers who may be unaware of the damage they could potentially do to their eyes. The most important safety tip the release mentions is to never look directly at the sun. Viewing the sun directly, even for brief periods, can cause permanent damage to the retina and result in blindness. Specially designed solar eclipse glasses are essential, and cameras need to be equipped with specially designed solar filters, the release said. Read more.


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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