Optometric Physician

Vol. 22, #32   •   Monday, August 23, 2021


Off the Cuff: Why the Show Can’t Go On

We don’t hear much about the “new normal” anymore. I suspect it’s because the realization that there is no normal is starting to sink in. Unfortunately, understanding what this actually means is far from universal and people still pack planes, sail on cruises, attend crowded meetings and act as if it’s just another late summer day in 2019. It’s not. COVID will ensure that things are unlikely to ever be the same again—at least not for a very long time. This isn’t good or bad, it just is. I believe that we will look back at 2020 as an inflection point in human existence separating the pre-COVID and post-COVID era. It’s time we realized the essential truth of this.

Viruses, by their very nature, mutate. COVID appears inclined to do so with surprising rapidity. We will see new variants with fluctuating transmissibility and unpredictable lethality ebb and flow like a gruesome red tide for years and possibly decades to come. Even if we vaccinated every single person in the US tomorrow and every one of us wore masks, the low vaccination rates in other countries, global travel and declining vaccine effectiveness over time make it nearly impossible to completely eradicate COVID or stop its unstoppable mutation.

This week, we made a very difficult and frankly costly decision—one that I think has ramifications for the profession going forward. I have attended every Vision Expo West going back almost as far as I can remember. Every year since we opened our practice, we took the entire staff to Expo for the education. We covered their rooms, meals, CE, and we have an annual staff dinner. This year we cancelled the trip. My rationale was straightforward and is something everyone should consider. Las Vegas is a high transmission area, and despite all of the assurances of safety measures being taken by the hotels and the convention center, no one goes to Las Vegas to be safe. Based on my own experience, quite the contrary. Based on recent firsthand reports from friends, it’s business as usual in Vegas, only it’s not really usual.

In Arizona we had the Pfizer-BioNTech vaccine. Recent data out of Israel, a country with one of the highest vaccination rates in the world, is that Pfizer efficacy against the Delta variant has dropped to below 40%. While there is some evidence that it is still protective against severe disease, there is also evidence that even that is waning. This from the magazine Science: As of 15 August, 514 Israelis were hospitalized with severe or critical COVID-19, a 31% increase from just four days earlier. Of the 514, 59% were fully vaccinated. Of the vaccinated, 87% were 60 or older. “There are so many breakthrough infections that they dominate and most of the hospitalized patients are actually vaccinated,” says Uri Shalit, a bioinformatician at the Israel Institute of Technology (Technion) who has consulted on COVID-19 for the government. “One of the big stories from Israel [is]: ‘Vaccines work, but not well enough.”

We are responsible for the safety and well-being of our staff and our patients. Based on this data, extensive research and the current situation in Las Vegas, we concluded that the risk far exceeded the benefit. Perhaps more importantly, we need to realize that the safety of in-person meetings will fluctuate wildly and that we need a better plan than just hoping it will be okay.



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


Brimonidine Related Acute Follicular Conjunctivitis: Onset Time and Clinical Presentations, A Long-term Follow-up

Researchers retrospectively enrolled patients who presented brimonidine allergy from December 1, 2008, to November 30, 2020, to evaluate the duration of topical brimonidine therapy before the onset of brimonidine-related allergic conjunctivitis and the clinical characteristics associated with the development of brimonidine allergy. The duration of brimonidine treatment, concomitant medications, benzalkonium chloride (BAK) exposure, change in IOP and season of onset were evaluated.

A total of 292 patients were included, among which 147 were female and 145 were male. The mean age was 58.3 ± 13.6 years old. The mean (median) duration of brimonidine therapy was 266.6 (196) days, with a peak at 60 to 120 days. The duration was similar whether the patients received brimonidine monotreatment or in combination with other glaucoma drugs, with or without BAK. The IOP increased by 5.6% after brimonidine allergy, which was even higher in the brimonidine monotherapy group (9.2%). There was no significant IOP elevation in patients treated with multiple glaucoma medications. Around half of brimonidine allergy occurred within six months, with a peak in two to four months. The duration did not differ in patients receiving brimonidine monotherapy or multiple glaucoma medications. The presence of BAK did not affect the duration either. When brimonidine allergy occurred, there was a loss of IOP control, especially in patients receiving brimonidine monotherapy.

Researchers recommended that clinicians switch to other types of glaucoma medications for better IOP control.

SOURCE: Yeh PH, Cheng YC, Shie SS, et al. Brimonidine related acute follicular conjunctivitis: Onset time and clinical presentations, a long-term follow-up. Medicine (Baltimore). 2021 Jul 23;100(29):e26724.


Changes of Trabecular Meshwork Pigmentation in Patients with Pigment Dispersion Syndrome: A 15-year Study

To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block, 21 eyes of 11 PDS patients were followed up periodically for 15 years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every six months postoperatively. TM pigmentation was quantitatively evaluated and graded every five years after the treatment, in which the circumference of anterior chamber angle was divided into four quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline.

Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25 ± 6.93 years (range, 31 to 55 years) at initial diagnosis. The mean IOP level was 33.1 ± 9.8 mmHg (range, 22 to 56 mmHg) at diagnosis. Ten PDS eyes received LPI, and the other 11 eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15 to 16) on admission, which changed to 14 (IQR, 13 to 15), 13 (IQR, 12 to 14), 12 (IQR, 10.5 to 12) at five-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in the inferior quadrant, while in the nasal, temporal and superior quadrants the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. The majority of these enrolled eyes (19/21) had stable VA and BCVA, with average endpoint IOP of 15.1 ± 3.4 mmHg.

Investigators wrote that TM pigmentation in PDS patients attenuated with time after reverse pupillary block was resolved and that it appeared to decrease faster in the inferior quadrant than in the other quadrants.

SOURCE: Zhou R, Tang Q, Pu L, et al. Changes of trabecular meshwork pigmentation in patients with pigment dispersion syndrome: A 15-year study. Medicine (Baltimore). 2021 Aug 6;100(31):e26567.


Optometrist-enabled Selective Laser Trabeculoplasty (SLT) and Barriers to a Shift in Service Delivery

Optometrists, fellowship and consultant-grade ophthalmologists, hospital managers and patients were interviewed using pre-defined topic guides to explore the acceptability, training requirements, enablers and barriers of optometrist-delivered SLT. Interviews were audio-recorded, transcribed and subjected to thematic analysis. Overarching themes were defined by the study aims and the topic guides; subthemes were derived from the interview data.

Sixty-six participants (three managers, eight glaucoma specialist consultant ophthalmologists, seven clinical glaucoma fellows, 12 optometrists (two of them performing SLT), two ophthalmic nurses and 34 patients participated in the study. Overarching themes (and subthemes) were: necessity of non-medical SLT delivery, clinical practice and training, advantages, disadvantages, concerns, challenges, community delivery of SLT, patient values and other healthcare professionals that could also deliver SLT.

Certain clinical pre-requisites, such as gonioscopy and independent prescribing rights, were perceived as necessary for undertaking SLT training. An optometrist-delivered SLT service was expected to benefit the NHS, but there was an identified need of a standardized training scheme and robust governance. Patients were accepting of an optometrist-delivered SLT service in the hospital eye service.

SOURCE: Konstantakopoulou E, Jones L, Nathwani N, et al. Selective laser trabeculoplasty (SLT) performed by optometrists-enablers and barriers to a shift in service delivery. Eye (Lond). 2021 Aug 13:1-7.





Industry News

AAOF Announces Fredric Rosemore Low Vision Educational Grant Recipient

The American Academy of Optometry Foundation, in collaboration with the Fredric and Marion Rosemore Family Foundation, named Tracy Matchinski, OD, FAAO, FVI, an associate professor at the Illinois Eye Institute – Rosenbloom Center, Low Vision Rehabilitative Services in Chicago, the 2021 recipient of the Fredric Rosemore Low Vision Educational Grant. Dr. Matchinski has been practicing optometry for 25 years and is an expert on low vision rehabilitation. Read more.




M&S Technologies Launches Smart System VR Headset

M&S Technologies introduced the Smart System VR Headset, a virtual reality vision testing system. The system is portable, enabling testing in a fully illuminated room, and requires no internet connection to operate. With built-in eye tracking for fixation monitoring, the headset provides 10-2, 24-2 and 30-2 visual field and contour stereo testing. Read more.



Registration Now Open for NORA 2021 Online Conference


Registration is now open for the Neuro-Optometric Rehabilitation Association, International 2021 Online Conference, which will be live online from Oct. 14 to 16, with select presentations available on demand through the end of the year. This year’s program offers up to 14 COPE-approved CE credits with presentations by key opinion leaders in optometry and other specialties. Register here.

Bonnie Strickland Champion for Children’s Vision Award Recipient Announced

The National Center for Children’s Vision and Eye Health at Prevent Blindness announced the recipient of the 7th annual Bonnie Strickland Champion for Children’s Vision Award is Shavette L. Turner, vice president, Children’s Vision Services at Prevent Blindness Georgia. The award will be presented at the NCCVEH Annual Meeting, held virtually, on Sept. 10, 2021. Read more.

Metrovision Receives FDA Clearance for MonPackONE

Metrovision received FDA clearance for its MonPackONE Vision Monitor for vision electrophysiology applications, including ganzfeld flash ERG and VEP, pattern ERG and VEP, multifocal ERG and VEP, and sensory EOG. Compatible with ISCEV standards for vision electrophysiology, the monitor’s design combines a central LCD panel with an LED backlight surrounded by peripheral panels illuminated with LEDs. The result is constant luminance and elimination of luminance artifacts generated by standard LCD monitors. It is able to perform dark- and light-adapted full-field perimetry. Other capabilities include dark adaptometry, FST, pupillometry and vision electrophysiology testing. Learn more.

Visus Expands Adds Investigational Glaucoma & AMD Therapies to Portfolio, Secures License for Novel Ophthalmic Drug Delivery Technology

Visus Therapeutics entered into a worldwide exclusive licensing agreement with Cella Therapeutics to develop an array of investigational ophthalmic therapies to treat glaucoma and age-related macular degeneration. The company also announced a worldwide exclusive licensing agreement with DelSiTech, a provider of biodegradable, silica-based, controlled-release materials, to develop novel drug delivery technology to help optimize ophthalmic therapies. Read more.








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