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


Volume 18, Number 32

Monday, August 6, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: Concerning Trends
######### Vision-Specific Quality of Life: Laser-Assisted In Situ Keratomileusis vs. Overnight Contact Lens Wear
######### Changes in Anterior Chamber Volume After Implantation of Posterior Chamber Phakic Intraocular Lens in High Myopia
######### Efficacy of Trial Fitting and Software Fitting for Orthokeratology Lens: One-year Follow-up Study
######### News & Notes

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Off the Cuff: Concerning Trends

Just back from a wonderful extended trip to South Africa and recovering from 30 hours of flying, the realities of practice and profession hit hard. I decided to share some thoughts on important matters that should be of concern to each and every one of us.

The Death of Independent Practice – If you haven’t noticed, just about every large successful independent optometric practice is slowly being bought by equity capital firms. Whether this is good or bad remains to be seen, but it certainly signals a tectonic shift in the dynamics of a profession that once focused primarily on independent practice.

Overproduction of ODs
– In addition to broad consensus that we have too many schools producing too many students and a declining pool of qualified candidates and educators, recent evidence shows that OD graduates have the highest debt-to-income ratio of any health care profession—making optometry a questionable career choice. Also, simple observation suggests that the profession has not planned well for the impact of commercialization driven by technology. Needed like a hole in the head, more new schools have been recently announced. The danger all of this poses to optometry should not be underestimated.

Our Enemy is Who? – For optometry, the enemy of the profession has typically been the profession, but today things are much more complicated. Well-funded startups that care more about consumers and profits than patients and health care are growing in power and influence. Warby Parker just signed a deal with United Healthcare, and Colgate-Palmolive took an equity position in Hubble. Why a leading health insurer would partner with a trendy, but cheap, eyeglass seller may be perplexing, but the move clearly made sense to its bean counters. Likewise, Colgate-Palmolive apparently thinks Hubble’s experience selling contact lenses in pretty boxes without valid prescriptions makes them a good partner for a subscription-based tooth whitening business. I’m not convinced that millennials care that much about whitening their teeth, so good luck with that. Either way, though, both moves mark further consumerization of eye care.

AOA More May Turn Out to Be Much Less – AOA More is a registry developed by the AOA ostensibly to help eligible providers meet Medicare quality reported measures required under the Merit-based Incentive Payment System (MIPS). Despite the AOA’s recent back patting on the success of the program, we discovered that AOA more has been a huge and costly failure for us. I suspect we’re not alone. More on this to come.

I will have a lot more to say on these issues in weeks to come. For now, enjoy what remains of the summer of 2018.

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.



Vision-Specific Quality of Life: Laser-Assisted In Situ Keratomileusis vs. Overnight Contact Lens Wear
These researchers compared the visual-related quality of life in myopic subjects with different refractive treatments such as continuous wear of silicone-hydrogel contact lenses (CL), corneal refractive therapy (CRT) and laser-assisted in situ keratomileusis (LASIK). The National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) questionnaire was administered to 96 subjects with a mean age of 30 ± 7.9 years. There were 72 myopic subjects with a mean spherical equivalent of -2.74D ± 0.98D (-5.50D to -1.25D). Subjects were corrected with LASIK (n=24), Paragon CRT orthokeratology lenses (n=24) and lotrafilcon A silicone-hydrogel CL under continuous wear (n=24). The NEI RQL-42 survey was used to compare differences between groups as well as with an emmetropic group (n=24).

After one year of treatment, significant differences were found among all groups in the subscales glare, symptoms, dependence on correction and worry. The mean difference compared with emmetropes were -5.5% for LASIK patients, -2.0% for orthokeratology subjects and +1.6% for the silicone-hydrogel CL group.

Myopic subjects analyzed in this study reported better vision-related quality of life when they were corrected with continuous wear silicone-hydrogel lenses. The average score reached by CRT was similar to emmetropes, which showed the main disadvantage in worry subscale. The patients who underwent LASIK had the lowest valuation, highlighting the decreases in scores of diurnal fluctuations, glare and especially expectations and worry subscales, due to the first and second subscales, but especially to the false expectations created about treatment.

SOURCE: González-Pérez J, Sánchez García Á, Villa-Collar C. Vision-Specific Quality of Life: Laser-Assisted in situ Keratomileusis Versus Overnight Contact Lens Wear. Eye Contact Lens. 2018; Jul 25. Epub ahead of print].

Changes in Anterior Chamber Volume After Implantation of Posterior Chamber Phakic Intraocular Lens in High Myopia
This study aimed to assess changes in, and the factors that influence, anterior chamber volume (ACV) after implantable contact lens (ICL) implantation in high myopia eyes using a Pentacam. The study sampled 26 high myopia patients (45 eyes) who were treated with ICL implantation. These patients were followed for an average of 4.28 months postoperatively. ACV was measured with a Pentacam preoperatively and at three months postoperatively. The data were analyzed by paired sample Wilcoxon signed-rank test. Generalized estimating equation (GEE) model adjusting within patient intereye correlations in addition to Pearson's and Spearman's correlation tests were performed to determine associations.

The mean ACV was 198.33mm3  ± 33.08mm3 before surgery and 118.65mm3 ± 17.70mm3 after surgery. A significant decrease of 79.68mm3 (40.18%) was detected. Positive correlations were found between ACV changes and ICL central vault and preoperative anterior chamber depth (ACD). There were positive correlations between postoperative ACV and postoperative anterior chamber angle (ACA) at 3:00 o'clock and at 9:00 o'clock. GEE regression model showed that postoperative ACV significantly positively correlated with preoperative ACV, ACD and horizontal ACA, and negatively correlated with ICL central vault.

Researchers concluded that, ACV, complementary to vault and ACD, is a sensitive parameter with certain value of preoperative assessment and postoperative monitoring in ICL implantation.

SOURCE: Zhu Y, Zhu H, Jia Y, Zhou J. Changes in anterior chamber volume after implantation of posterior chamber phakic intraocular lens in high myopia. BMC Ophthalmol. 2018;18(1):185.



Efficacy of Trial Fitting and Software Fitting for Orthokeratology Lens: One-year Follow-up Study
One hundred myopes who received vision correction with the use of orthokeratology lenses form July 2016 to September 2017 were included in this study. Subjects were assigned randomly into the two groups: the trial fitting group (group A) and the software fitting group (group B). For the right eye of each subject, measurements such as uncorrected visual acuity (UCVA, logarithm of minimal angle of resolution), refractive error, corneal topography, ocular health status and the fitting situation were obtained at baseline, one week, one month, three months, six months and 12 months after lens wear. Axial length and corneal endothelium cells (CECs) were also measured at baseline and 12 months after wearing the lens.

Compared with the baseline, the spherical equivalent refraction, UCVA and central corneal curvature changed significantly after orthokeratology (OK) lens wear. Between groups A and B, the parameters aforementioned were insignificant at each time point. Axial length and CECs showed no significant changes during the first year of OK treatment. Rates of corneal staining between the two groups revealed no difference during one-year visit.

Both the trial lens fitting and software fitting approaches were effective in temporarily reducing myopia, providing good UCVA and delaying the elongation of axial length for moderate and high myopic adolescents. Researchers wrote that both approaches could be combined in OK lens fitting.

SOURCE: Lu D, Gu T, Lin W, et al. Efficacy of trial fitting and software fitting for orthokeratology lens: one-year follow-up study. Eye Contact Lens. 2018; Jul 25. [Epub ahead of print].

News & Notes

IDOC Appoints Dr. Thimons and Yordy to Board
IDOC appointed two new members to its board of directors. James (Jim) Thimons, OD, FAAO, medical director and founding partner of Ophthalmic Consultants of Connecticut, will provide guidance to the alliance’s executive team on strategic planning, development of programs and educational opportunities. Dr. Thimons is widely known as the founder of The Glaucoma Institute, where he served as its first director. In 2002, he founded the National Glaucoma Society, and in 2005, he was inducted into the Optometry Hall of Fame. Matt Yordy is senior vice president, strategy and business development at McKesson, a healthcare company providing health information technology, medical supplies and care management tools. Yordy brings a strong background in sales, marketing, account management, business development and strategy. Learn more.

ISVA Appoints Esterow as Executive Director
The International Sports Vision Association, an organization of optometrists, athletic trainers, therapists, physicians and sports teams dedicated to evaluating, training and improving vision performance in athletes, named Gary Esterow as executive director. Esterow will assume the position on a part-time basis while still serving as executive director of The Neuro-Optometric Rehabilitation Association, International and operating Esterow Communications, a consulting agency he established in 2016. Learn more.

Glaukos CEO Joins Avedro’s Board of Directors
Avedro announced that Thomas W. Burns, president, chief executive officer and a member of the board of directors at Glaukos Corp., was elected to its board of directors. During his 16 years at Glaukos, Burns has led the company from a small startup to the completion of an initial public offering in June 2015 and beyond. Over the course of his career, he has raised nearly $400 million in private offerings and in the public markets. Burns also previously led Eyetech Pharmaceuticals (acquired by OSI Pharmaceuticals) as president and chief operating officer. Read more.

2018 Ophthalmology Update

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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