Optometric Physician



Vol. 23, #32  •   Monday, August 22, 2022


Off the Cuff: Telemedicine in Eyecare

During the pandemic lockdowns, our office stayed open. We rescheduled all routine exams; continued renewing contact lenses, eyeglasses, and medication prescriptions to hold our patients over during those uncertain times; and added more patient-centric options. The only patients we saw were emergencies. Even though Phoenix is the fifth largest city in the country, still today our clinic is nearly the only after-hours emergency provider around. Because so many offices were closed, we were seeing emergency patients from all over the state.

Early on we had a patient from Yuma call with blurry vision in one eye and a nagging headache. He did a telemedicine visit with his primary care physician, who thought it was a sinus infection and prescribed oral antibiotics. When that didn't work, the patient was then prescribed oral steroids. When those also didn't work, he found us. I requested retinal photos and OCTs which quickly confirmed the optic neuritis I suspected and ordered an MRI to be performed in Phoenix which further confirmed the patient’s new onset multiple sclerosis.

I absolutely understand the necessity and utility of telemedicine especially during the pandemic, but this technological “advancement” in healthcare misses the mark in medical eye care. Imaging equipment, like our ultra-widefield retinal camera and OCT, has become core to what we do on a daily basis in both primary and specialty care. We rely on state-of-the-art technology and cannot ignore the role that that technology has had in evolving optometry into the truly medical profession it has become today.

Note about Epstein:
the surgery he had on Wednesday went as planned and at the time of this writing, he is still in ICU recovering very well. The surgical team and nursing staff at Banner University Medical Center in Phoenix has been just exceptional, and Arthur is receiving amazing care. I'm very grateful to all of our friends who have reached out and checked in on us. I can't thank you enough.


Shannon L. Steinhäuser, OD, MS, FAAO
Co-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.





Rhegmatogenous Retinal Detachment Following Initiation of Pilocarpine Hydrochloride Ophthalmic Solution 1.25% for Treatment of Presbyopia

Retinal detachment has previously been reported in association with topical miotic use for treatment of glaucoma. Pilocarpine hydrochloride 1.25% was recently FDA approved for treatment of presbyopia, with no reports of associated retinal detachments in the clinical trial data.

Researchers described two novel cases of unilateral retinal detachment occurring within 10 days of initiation of pilocarpine 1.25% for treatment of presbyopia. The patients were pseudophakic men in their 60s or 70s with pre-existing retinal detachment risk factors such as high myopia, lattice degeneration, and prior retinal detachment. Both affected eyes were treated with pars plana vitrectomy and gas endotamponade with an uncomplicated post-operative course.

Researchers wrote that retinal detachment may be associated with pilocarpine 1.25% use. They added that caution should be used when considering prescribing this medication in patients with pre-existing retinal pathology.

SOURCE: Eton EA, Zhao PY, Johnson MW, et al. Rhegmatogenous retinal detachment following initiation of pilocarpine hydrochloride ophthalmic solution 1.25% for treatment of presbyopia. Retin Cases Brief Rep. 2022; Aug 12. [Epub ahead of print].





Prosthetic Replacement of the Ocular Surface Ecosystem for Terrien Marginal Degeneration: A Case Series

This is a retrospective case series of patients with advanced Terrien marginal degeneration (TMD) who were assessed and fit with customized Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) lenses to assess outcomes of the PROSE treatment in patients with advanced TMD. Data were collected on PROSE fitting details including visual acuity (VA) before and after PROSE, slit-lamp findings, and corneal tomography scans.

Six eyes in four patients were included. All patients attempted at least one other contact lens (CL) modality before PROSE. Some patients had corneal comorbidities such as pseudopterygium and pseudo-bleb that contributed to intolerance to previous lenses and warranted extra considerations in the fitting process. With PROSE, VA improved in all six eyes. Patients with structural corneal comorbidities achieved improved vision, comfort, and lens tolerance with PROSE. Two eyes had non-corneal ocular comorbidities that limited PROSE efficacy. Another eye discontinued PROSE wear because of limbal stem-cell disease progression necessitating a limbal stem-cell transplant.

Investigators reported that PROSE treatment can be an effective option to improve vision and comfort for patients with advanced TMD who are intolerant to first-line therapeutic CL modalities, even in the presence of other corneal comorbidities.

SOURCE: Wong BM, Trinh T, Garg A, et al. Prosthetic replacement of the ocular surface ecosystem for Terrien marginal degeneration: a case series. Eye Contact Lens. 2022; Aug 16. [Epub ahead of print].




Effectiveness of Commonly Used Contact Lens Disinfectants Against SARS-CoV-2

These researchers assessed the effect of commonly used contact lens disinfectants against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The efficacy of five disinfectant solutions against SARS-CoV-2 was tested in the presence and absence of contact lenses (CLs). Three types of unused CLs (hard gas permeable, soft hydrogel, and soft silicone hydrogel) and worn silicone hydrogel CLs were tested. Contact lenses were infected with SARS-CoV-2 and disinfected at various times, with and without rubbing and rinsing, as per manufacturer's instructions. Reverse-transcriptase polymerase chain reaction (RT-PCR) and viability polymerase chain reaction (PCR) were applied to detect SARS-CoV-2 RNA and viral infectivity of SARS-CoV-2, respectively.

In the presence of SARS-CoV-2-infected CLs, no SARS-CoV-2 RNA could be detected when disinfectant solutions were used according to the manufacturer's instructions. When SARS-Co-V2-infected CLs were disinfected without the rub-and-rinse step, SARS-CoV-2 RNA was detected at almost each time interval, with each disinfecting solution tested for both new and worn CLs. In the absence of CLs, viable SARS-CoV-2 was detected with all disinfectant solutions except Menicon Progent at all time points.

Researchers found that disinfectant solutions effectively disinfect CLs from SARS-CoV-2 if manufacturer's instructions are followed. The rub-and-rinse regimen is mainly responsible for disinfection. The viability of PCR may be useful to indicate potential infectiousness.

SOURCE: Veugen J, Nuijts R, van den Biggelaar F, et al. Effectiveness of commonly used contact lens disinfectants against SARS-CoV-2. Eye & Contact Lens: Science & Clinical Practice. 2022; Aug 15. [Epub ahead of print].