Review Of Optometry - Optometric Physician

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

Volume 16, Number 32

Monday, August 8, 2016

Inside this issue: (click heading to view article)

		Off the Cuff: 1-800 Contacts and the Future. What's the Opternative?

		Globe Rupture of a Post-LASIK Keratectasia Eye From Blunt Trauma

		Life Experiences of Patients with Glaucoma: A Phenomenological Study

		Myopic Choroidal Neovascularization: Diagnosis and Treatment

		News & Notes

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Off the Cuff: 1-800 Contacts and the Future. What's the Opternative?

At some point we must accept the inevitably of unending, ever faster change. Today, technology touches everything we do. And while we've slowly, albeit sometimes grudgingly, accepted high-tech diagnostic tools, when it comes to consumer facing advances, we've largely stuck our heads in the sand. As a result, change has happened to us rather than we initiating and harnessing change. The growth of 1-800 Contacts is just one example.

Make no mistake: 1-800 is not a company I admire. Its indiscriminate lens distribution policies disgust me as does their underhanded gaming of the FCLCA rules. With a business model that frequently violates FDA patient safety device regulations, it's no wonder 1-800 and eye care providers are perpetually at odds.

Yes, 1-800 is an effective marketer and an efficient contact lens seller. Where it fails miserably is that it does nothing to keep patients safe. Doing so would only get in the way of profits. Oddly enough, at one time 1-800 could have partnered with eye care practitioners, and it did try, but never was really serious about it. Unfortunate, since one way or another the conflict is not likely to end well.

This past week 1-800 announced that it is partnering with Opternative. At best a first-generation technology, Opternative is neither effective nor efficient. Perhaps one day, accurate remote refractions and other testing will not only be possible, but routine. The reality is that day has not yet come. Partnering allows 1-800 to completely circumvent the intent, if not the extent, of patient protective laws and regulations. For Opternative, it allows an immature and potentially dangerous technology to be irresponsibly used to circumvent common sense and much-needed real eye care. Sadly, here too, the long-term interests of the company would have best been served by partnering with ECPs.

While our future demands we embrace technology and adapt to use it for our patients’ benefit, we must take a strong stand to ensure that technology is used in ways that keep patients safe. We must work together with ophthalmology leaders—both nationally and locally—to ensure that nascent technology is nurtured, and most importantly, that it is used to enhance care rather than bolster corporate profits at patients' expense.

Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com

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.

			Globe Rupture of a Post-LASIK Keratectasia Eye From Blunt Trauma
			A 42-year-old man with a history of post-LASIK ectasia sustained paracentral corneal rupture secondary to blunt trauma from a fist to his left eye (OS). Slit-lamp examination revealed rupture in the posterior stroma (inferior paracentral) of the OS with an overlying intact LASIK flap; however, the inferior edges of the LASIK flap were Seidel positive. The anterior chamber was flat. Although he was initially managed with cyanoacrylate glue and a bandage contact lens, the patient eventually required tectonic penetrating keratoplasty. The postoperative course was unremarkable, and more than one year later, the visual acuity OS was 20/25 with -7.50 +2.00 × 0.50. Researchers wrote that globe rupture from blunt trauma has not been shown to be more common in patients with a history of LASIK. They added that, although blunt trauma to the post-LASIK globe would generally incur a similar risk of rupture to that of the normal eye, keratectasia after LASIK may predispose the globe to rupture.
			SOURCE: Cheung AY, Heidemann DG. Globe Rupture of a Post-LASIK Keratectasia Eye From Blunt Trauma. Cornea. 2016; Jul 27. [Epub ahead of print].

			Life Experiences of Patients with Glaucoma: A Phenomenological Study
			Studies that describe the experiences of patients with glaucoma from different cultures may help health professionals gain a broader perspective on this issue. The aim of this study was to explore the experiences of patients with glaucoma. This descriptive phenomenological study used purposive sampling to enroll 20 patients with glaucoma. A qualitative, in-depth, face-to-face interview technique was used to collect data during January and February 2014. The data were analyzed using to the Van Kaam method. Seven themes were identified, including confirming the diagnosis by acute symptoms or unrelated symptoms, grateful to God for having a non-life-threatening disease, feeling happy after receiving more accurate information, coping with the disease by using eye drops and attending follow-up examinations regularly, managing daily life to avoid further damage to eyesight, emotional reactions related to going blind, and urging family members or friends to attend regular glaucoma checkups. Patients with glaucoma experience physiological and psychological problems throughout the course of their disease. Being informed, and cultural practices such as "praising God" and "resignation," helped patients cope with the disease. Furthermore, because of the cultural characteristic of social collectivism, participants acted to protect the health of others by informing them about glaucoma.
			SOURCE: Iyigun E, Tastan S, Ayhan H, et al. Life Experiences of Patients With Glaucoma: A Phenomenological Study. J Nurs Res. 2016; Aug 2. [Epub ahead of print].

			Myopic Choroidal Neovascularization: Diagnosis and Treatment
			This study reviewed and summarized the latest developments in the diagnosis and management of myopic choroidal neovascularization (mCNV). A review of the literature was performed, focusing on tests and investigations for diagnosing mCNV, as well as the key treatment options available for mCNV. Standard essential tests and investigations for diagnosing mCNV include spectral-domain optical coherence tomography for screening, fluorescein angiography for confirmation, and indocyanine green angiography and fundus autofluorescence for providing supplementary information. The current first line treatment of mCNV is the use of anti-vascular endothelial growth factor therapy. Various investigations can assist the differentiation of mCNV from other coexisting retinal pathologies associated with myopia or choroidal neovascularization resulting from other causes. Researchers concluded that prompt use of anti-vascular endothelial growth factor therapy had good efficacy and safety in the treatment of mCNV.
			SOURCE: Lai TY, Cheung CM. Myopic Choroidal Neovascularization: Diagnosis and Treatment. Retina. 2016; Jul 29. [Epub ahead of print].

News & Notes

Study: Oral Omega-3 Supplementation Effective Treatment for Dry Eyes
A new study available ahead of print in Cornea demonstrated that oral consumption of re-esterified omega-3 fatty acids was an effective treatment for dry eye disease and resulted in a statistically significant improvement in its primary endpoint of tear osmolarity, as well as its secondary endpoints after 12 weeks. A total of 105 subjects completed the study that assessed oral nutrition as the primary therapy for dry eye disease in patients with confirmed Meibomian gland dysfunction focused on the effect of oral re-esterified omega-3 fatty acids on tear osmolarity, MMP-9, Ocular Surface Disease Index, tear break-up time, Schirmer's score, corneal staining and the omega index. The multicenter, prospective, interventional, placebo-controlled, double-masked study randomized subjects (54 in treatment group, 51 in control group) to receive four softgels (PRN Dry Eye Omega Benefits) containing 1,680mg of eicosapentaenoic acid (EPA)/560mg of docosahexaenoic acid or a control of 3,136mg of safflower oil (linoleic acid), daily for 12 weeks. Study participants were measured at baseline, week six and week 12 for tear osmolarity, TBUT, OSDI, fluorescein corneal staining and Schirmer test with anesthesia. MMP-9 testing and omega-3 index were done at baseline and at 12 weeks. View the study.

Alcon Achieves FDA Approval for CyPass Micro-Stent
Alcon received FDA approval for the CyPass Micro-Stent, a minimally invasive glaucoma surgical device to treat individuals with mild-to-moderate primary open-angle glaucoma in conjunction with cataract surgery. The approval is based on the COMPASS Study, with a two-year follow-up of more than 500 mild-to-moderate glaucoma cases undergoing cataract surgery. The primary effectiveness endpoint was met, with 73 percent in the Micro-Stent group achieving a statistically significant decrease (>= 20 percent) in intraocular pressure. The secondary effectiveness endpoint was also met, with 61 percent of individuals in the Micro-Stent group achieving a target IOP (between 6mm Hg and 18mm Hg) at the 24-month postoperative exam without medication—a statistically significant difference. Acquired in February by Alcon, Transcend Medical developed the CyPass Micro-Stent, which is implanted just below the surface of the eye in conjunction with cataract surgery to treat less severe glaucoma by enhancing part of the natural drainage pathways of the eye, with minimal tissue disruption. This enables excess eye fluid to drain in order to reduce intraocular pressure levels. Read more.

ARVO Publishes 25th Anniversary Edition Commemorating OCT Invention
The Association for Research in Vision and Ophthalmology published a special anniversary edition in its journal Investigative Ophthalmology & Visual Science with more than 70 articles to commemorate the 25th anniversary of the invention of optical coherence tomography technology, co-invented by Oregon Health & Science University Casey Eye Institute's David Huang, MD, PhD, while Huang was a doctoral student with James Fujimoto, PhD, at the Massachusetts Institute of Technology. OCT technology has evolved over the past 25 years with advances in imaging speed and quality. Eye care practitioners can now study disease at the microscopic level without biopsy, and with complete patient comfort. For the first time, eye physicians can visualize and measure blood flow in the smallest blood vessels, without the need to inject contrast agents. Dr. Huang was recently ranked the fourth most influential figure in the world of ophthalmology by The Ophthalmologist PowerList 2016. Read more.

Novabay Completes $11.8M Private Placement
NovaBay Pharmaceuticals closed a $4 million tranche of a private placement of common stock and warrants to accredited investors, bringing total proceeds to $11.791 million. The first tranche with proceeds of $7.791 million was completed in May 2016. The company is dedicated to increasing sales of Avenova and managing expenses to meet its goal of positive cashflow from operations by the end of 2016, said NovaBay’s chairman, president and CEO, Mark M. Sieczkarek, in a press release. 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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