Optometric Physician

Vol. 22, #33   •   Monday, August 30, 2021


Off the Cuff: Clearing COVID Confusion

My last editorial about COVID, risk, and Expo West generated more emails and more chatter on social media than any Off the Cuff in recent memory. Writing op-ed pieces for more than 25 years, I expect people to read into things, but browsing through some of the comments, it was apparent that a fair number of people missed the point I was trying to make. It was an important point.

For those who think that I was recommending that people hunker down and start living in bunkers clothed in hazmat suits for the duration, that was absolutely not what I was advising. What I shared was a decision I made about relative risk for a specific event in a specific place and my responsibility to my staff and my patients. My decision was based on my knowledge of the science and my understanding of, and personal tolerance for, risk. The key variable here is risk, something that will change over time, from place to place and situation to situation.

The president of Pfizer just stated that a vaccine-resistant strain will likely emerge. Other credible sources predict lethality and transmissibility will increase as it did with the Spanish Flu in the early 1900s. We have no control over how COVID mutates, and as much as we would like to, we can’t wish COVID away; however, we can manage the risk it presents. We should assess risk by focusing on the science and medical facts, not the irrational politics, agendized media perspective or biased assurances that all will be fine.

Ultimately, every individual and organization will have to make their own decisions. A few days ago, the very right-leaning conservative NRA cancelled their annual meeting in Houston due to COVID. The NRA is financially struggling, and canceling their annual meeting is both telling and likely fiscally devastating. Here is what it said:

“The NRA’s top priority is ensuring the health and well-being of our members, staff, sponsors, and supporters. We are mindful that NRA Annual Meeting patrons will return home to family, friends and co-workers from all over the country, so any impacts from the virus could have broader implications. Those are among the reasons why we decided to cancel our 2021 event.”

The bottom line is that we need to accept that COVID is going to be with us for the foreseeable future, but COVID or no COVID, life must go on. If we do what Australia and New Zealand are doing, locking everything down completely, we will accomplish little in mitigating disease, but will turn our country into an economically devastated authoritarian hell. In the US, I suspect such draconian measures would lead to massive civil unrest. Like we need more of that.

Living with COVID means making wise decisions about when to stay and when to go. What is important and what isn’t. What can work virtually instead of in-person. Perhaps most importantly, how we can come together as a people to get through this together.

For those going to Las Vegas, enjoy the meeting, but be careful. I respect your right to make personal decisions regarding risk, but I won’t be joining you there. COVID, booster vaccines and risk permitting, I’ll see you at the Academy in Boston.



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.



Comparative Evaluation of Bandage Contact Lenses and Eye Patching After Bilateral Cataract Surgery

Sixteen (32 eyes) patients who planned to undergo bilateral cataract surgery were recruited to comparatively evaluate the safety and satisfaction of bandage contact lens (BCL) and eye patching in patients after cataract surgery. The two eyes of each patient were randomly divided into two groups. Group A and Group B were instructed to wear BCLs immediately at the end of the surgery until one week and eye patch immediately after surgery until one day, respectively. Visual analog scales of 10 specific symptoms, Visual Function Index (VF-14) questionnaires, and best-corrected visual acuity (BCVA) were conducted on the first day before the surgery and Day 1 and Day 7 after surgery. Oculus keratography was conducted on the first day before surgery and on Day 7. Patient satisfaction was determined on Day 1. Moreover, bacterial species in the conjunctival sac, meibomian gland secretions, and BCLs were subsequently identified using 16S rRNA gene sequencing.

The patient satisfaction scores of Group A were higher than Group B. Group A was more motivated to choose the same treatment and more likely to recommend BCLs to others. No statistically significant differences were found in bacterial culture positivity between the groups. The differences in ocular signs and symptoms between the two groups were not statistically significant. There were no significant differences in the BCVA and VF-14 between the groups at any time point.

The researchers concluded that BCLs could be safely and effectively used in patients after cataract surgery.

SOURCE: Jing D, Deng A, Wang H, et al. Comparative evaluation of bandage contact lenses and eye patching after bilateral cataract surgery. J Ophthalmol. 2021 Aug 13;2021:2873543.


Tonometry by Ocular Response Analyzer in Keratoconic and Warpage Eyes in Comparison with Normal Eyes

In a prospective, observational case-control study, 94 eyes of 47 warpage-suspected cases and 46 eyes of 23 keratoconic patients were enrolled to compare intraocular pressure (IOP) values measured by ocular response analyzer (ORA) in contact lens-induced corneal warpage, normal and keratoconic eyes. Warpage-suspected cases were followed until a definite diagnosis was made (warpage, non-warpage normal or keratoconus). ORA tonometry and corneal biomechanics testing were performed for all cases in each visit. Researchers had 2-3 measured corneal-compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) for each patient (based on group) with at least a two-week interval.

Following up on warpage-suspected patients, 44 eyes of 22 patients had confirmed soft contact lens-related corneal warpage. Forty-six eyes of 23 people were diagnosed as non-warpage normal eyes. Forty-six eyes of 23 known keratoconus patients were also included for comparison. The demographic and refractive data were not different between the warpage and non-warpage normal groups but were different in the keratoconus group. Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups; the same trend was observed in central corneal thickness (CCT). The mean of IOPg was 14.94 ± 2.65, 13.7 ± 2.33 and 10.86 ± 3; and IOPcc was 15.73 ± 2.4, 15.28 ± 2.43 and 14.08 ± 2.55 in the warpage, normal and keratoconus groups, respectively. IOPg and IOPcc in the warpage group (based on baseline diagnosis) did not regress to become closer to IOP of normal eyes after discontinuation of contact lens wear. Both IOPcc and IOPg were significantly lower in keratoconic eyes in comparison with normal eyes. After correction for the confounding effect of CCT, a lower IOPcc in keratoconus vs. warpage remained significant.

Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups, just like their CCT. After correction for the confounding effect of CCT, there was no statistically significant difference between the three groups in their measured IOPcc and IOPg, except for IOPcc in keratoconus vs. warpage.

SOURCE: Alipour F, Hassanpoor N, Letafatnejad M, et al. Tonometry by ocular response analyzer in keratoconic and warpage eyes in comparison with normal eyes. J Curr Ophthalmol. 2021 Jul 5;33(2):118-23.


Complications Leading to Keratoplasty Among Contact Lens Users and LASIK Patients: A 10-Year Cross-Sectional Analysis

Population data was obtained from the United States Census Bureau and the Centers for Disease Control to determine the incidence and outcomes in patients who underwent penetrating keratoplasty (PK) resulting from complications related to contact lens (CL) use and laser in situ keratomileusis (LASIK) in a metropolitan area of the United States.

A retrospective, cross-sectional chart review was performed on all patients who underwent keratoplasty in a specific metropolitan geographic area over a 10-year period. The main outcome was best-corrected visual acuity (BCVA) at two years in patients who underwent PK secondary to complications related to CL use and LASIK. The secondary outcome was the relative risk of undergoing PK secondary to a complication related to CL use vs. LASIK.

The study's geographic area had 46,545 CL users in one or both eyes during any given year, and 10,285 patients who underwent LASIK in one or both eyes during the study interval. There were 24 CL users (0.52 per 1,000) and three post-LASIK patients (0.29 per 1,000) who underwent PK secondary to complications during the study interval. BCVA at two years was 1.45 [1.0-1.90] logMAR (20/564 Snellen) in the CL-using cohort and 0.07 [-1.19-1.33] logMAR (20/23 Snellen) in the post-LASIK cohort following PK.

Investigators found that patients who underwent PK secondary to complications related to CL use had worse visual outcomes at two years compared to those related to LASIK. Complications leading to PK were rare in both cohorts, but the incidence of undergoing PK secondary to CL use trended higher than LASIK.

SOURCE: Rush SW, Bulla B, Rush RB. Complications leading to keratoplasty among contact lens users and lasik patients: a 10-year cross-sectional analysis. J Ophthalmol. 2021 Aug 13;2021:5563545.






Industry News

AAOF Names Recipients of the Hopkins Comprehensive Eye Care, Bert C. and Lydia M. Corwin Contact Lens Residency, and Alfred A. Rosenbloom, Jr., Low Vision Residency Awards

The American Academy of Optometry Foundation announced the following award recipients:
• Jonathan D. Lam, MD, OD: Hopkins Comprehensive Eye Care Award. Dr. Lam is a primary care/ocular disease resident at the Chinle Comprehensive Health Care Facility in Chinle, Ariz. Read more.
• Liandra Jung, OD: Bert C. and Lydia M. Corwin Contact Lens Residency award. Dr. Jung is a primary care and contact lens resident at the University of California, Berkeley School of Optometry. Read more.
• Stephanie Aigbe, OD: Alfred A. Rosenbloom, Jr., Low Vision Residency Award. Dr. Aigbe is a graduate and low vision rehabilitation resident at the New England College of Optometry. Read more.



Visus Therapeutics Appoints Valorie and Moxie to Board


Visus Therapeutics appointed Tracy Valorie, former senior vice president and general manager, US Ophthalmology Rx and Surgical at Bausch + Lomb; and Dwight Moxie, senior vice president, general counsel and corporate secretary at Revance Therapeutics, to its board of directors. The company’s lead clinical candidate is Brimochol, an investigational drug designed to be a once-daily eye drop to correct for the loss of near vision associated with presbyopia. Read more.

Prevent Blindness Declares September Sports Eye Safety Month

Prevent Blindness declared September Sports Eye Safety Month in an effort to educate the public on the importance of eye protection. According to the organization’s recent annual data, pool and water sports are the leading causes of sports-related eye injury. These types of injuries include eye infections and irritations, and scratches or trauma. Read more.




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