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


Volume 18, Number 52

Monday, December 10, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: Why We Should Be Thankful
######### Polishing of Bowman's Membrane with Diamond Burr in the Treatment of Recurrent Corneal Erosion Syndrome
######### Rates of Visual Field Loss in Primary Open-angle Glaucoma and Primary Angle-closure Glaucoma: Asymmetric Patterns
######### Aberrant Visual Pathway Development in Albinism: From Retina to Cortex
######### News & Notes

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Off the Cuff: Why We Should Be Thankful

In all of the tumult of current times in America, it’s easy to forget about the things that are truly important. We fixate on politics and personality, party and privilege, making it easy to lose sight of the truly important things like security, family and freedom. We take many things for granted like the ability to practice our chosen profession and how it empowers us to change the world, one life at a time.

Sadly, things are not the same for all of our colleagues in other parts of the world. In Nigeria, where optometry still struggles to be recognized as an independent healthcare profession, optometrists increasingly find themselves victims of organized violence throughout the country. The Nigerian Optometric Association (NOA) recently reported a growing number of violent attacks targeting its members and called for urgent protection from the Nigerian government.

As incredible as this seems for a profession dedicated to doing so much good, in the past year, a disturbing number of Nigerian optometrists have been murdered, robbed and kidnapped. Perhaps more ominously, Dr. Ozy Okonokhua, the current president of the NOA, described these attacks as targeted and aimed at deterring expansion of eye care services in Nigeria by scaring optometrists out of practice. He called the attacks on (NOA) members, particularly office holders, “a deliberate attempt to silence optometrists in the country given their commitment to the growth of the nation.”

While it’s easy to conclude that Nigeria is crime ridden, given that incidents like these are commonplace, it’s hard to understand why even in the most violent of countries, local optometrists would be singled out for attack. Sadly, this serves as a reminder of just how lucky we are to live in a country governed by the rule of law, with a Constitution and Bill of Rights that guarantees basic human liberties and relative safety. While America is far from perfect, we must be thankful for what we do have. Much of the earth's population is not so fortunate. GBA

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.


Polishing of Bowman's Membrane with Diamond Burr in the Treatment of Recurrent Corneal Erosion Syndrome
This study evaluated the effectiveness of polishing Bowman's membrane with a diamond burr (DBPBM) in the treatment of recurrent corneal erosion syndrome (RCES). The study included 22 patients (22 eyes) with RCES ages 20 to 56 years who underwent original modification of DBPBM. All patients had topography examined, endothelial cell density measured, and optical coherence tomography (OCT) of the cornea taken before and after the procedure. Additionally, conjunctival scraping, blood test for types I and II herpes (fluorescent antibody method) were performed before the surgery. Postoperative treatment included one to two weeks of anti-inflammatory and anti-bacterial steroid therapy, and six months of artificial tear Cationorm usage.

Rehabilitation of all patients after the procedure went quickly, and no relapses were noted during follow-up. Complete epithelialization of the area of surgical intervention under soft contact lens occurred over two to three days. Epithelial thickness was measured with OCT including epithelial mapping; after the surgery, it was almost even over the entire corneal surface. No complications such as induced postoperative refractive error or corneal haze were registered during the course of the study. Disruption of basal epithelial layer and epithelial basal membrane in the area of erosion relapse detected with scanning electron microscopy confirmed the need for their removal in the course of the surgery.

Researchers concluded that conservative treatment of RCES rarely yielded positive results. Removal of inadequate epithelium and following DBPBM using the researchers’ original method was a highly effective and accessible procedure for RCES treatment with low risk of complications and relapse.

SOURCE: Mamikonyan VR, Trufanov SV, Tekeeva LY, et al. Polishing of Bowman's membrane with diamond burr in the treatment of recurrent corneal erosion syndrome. Vestn Oftalmol. 2018;134:162-7.

Rates of Visual Field Loss in Primary Open-angle Glaucoma and Primary Angle-closure Glaucoma: Asymmetric Patterns
The purpose of this study was to evaluate the rate of visual field (VF) loss in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). A total of 440 eyes of 282 patients with POAG (ages 53.4 ± 12: mean ± standard deviation, years) and 79 eyes of 49 patients with PACG (ages 62.7 ± 9 years) with at least six or more reliable VF tests studied. Point-wise, region-wise and global rates of VF change were assessed for POAG and PACG eyes. Only the VF records prior to laser iridotomy or cataract surgery were included in PACG eyes. The global and superior-inferior asymmetric rates of VF loss were compared between POAG and PACG eyes.

The mean total deviation (mTD) values at baseline were -6.4 ± 5.7 dB in POAG patients and -6.4 ± 7.3 dB in PACG patients. There was not a significant difference in the progression rates of mTD between POAG eyes (-0.23 ± 0.38 dB/y) and PACG eyes (-0.29 ± 0.45 dB/y). In POAG eyes, the VF progression rate was significantly asymmetric across the horizontal line; the central, paracentral and peripheral arcuate 2 regions in the superior hemifield had a significantly faster rate of VF loss than their inferior counterparts. In contrast, this asymmetry was not observed in the rate of VF loss in PACG eyes.

POAG eyes showed a faster rate of VF loss in the superior hemifield compared with the inferior hemifield, particularly in central and paracentral regions. This difference was not observed in PACG eyes.

SOURCE: Yousefi S, Sakai H, Murata H, et al. Rates of visual field loss in primary open-angle glaucoma and primary angle-closure glaucoma: asymmetric patterns. Invest Ophthalmol Vis Sci. 2018;59(15):5717-25.





Aberrant Visual Pathway Development in Albinism: From Retina to Cortex
Albinism refers to a group of genetic abnormalities in melanogenesis that are associated with neuronal misrouting through the optic chiasm. Investigators performed quantitative assessment of visual pathway structure and function in 23 individuals with albinism (PWA) and 20 matched controls using optical coherence tomography (OCT), volumetric magnetic resonance imaging (MRI), diffusion tensor imaging and visual evoked potentials (VEP).

PWA had a higher streamline decussation index (percentage of total tractography streamlines decussating at the chiasm) compared with controls (Z=-2.24), and the streamline decussation index correlated weakly with inter-hemispheric asymmetry measured using VEP (r =.484). For PWA, a significant correlation was found between the foveal development index and total number of streamlines (r=.662). Significant positive correlations were found between the peripapillary retinal nerve fiber layer thickness and optic nerve (r=.642) and tract (r=.663) width. Occipital pole cortical thickness was 6.88% higher (Z =-4.10) in PWA and was related to anterior visual pathway structures including foveal retinal pigment epithelium complex thickness (r=-.579), optic disc (r=.478) and rim areas (r=.597). Investigators were unable to demonstrate a significant relationship between OCT-derived foveal or optic nerve measures and MRI-derived chiasm size or streamlined decussation indeces.

Investigators’ novel tractographic demonstration of altered chiasmatic decussation in PWA corresponded to VEP-measured cortical asymmetry and was consistent with chiasmatic misrouting in albinism. They also demonstrated a significant relationship between retinal pigment epithelium and visual cortex thickness, indicating that retinal pigmentation defects in albinism lead to downstream structural reorganisation of the visual cortex.

SOURCE: Ather S, Proudlock FA, Welton T, et al. Aberrant visual pathway development in albinism: From retina to cortex. Hum Brain Mapp. 2018; Dec 4. [Epub ahead of print].

News & Notes

The Myopia Meeting Opens Registration
They Myopia Meeting offers the latest research, clinical information and practice management strategies to manage myopia. The one-day event, scheduled for Feb. 3, 2019, at the Gaylord National Resort & Convention Center in National Harbor, Md., provides an opportunity to obtain five hours of CE presented by myopia experts. Speakers include: Thomas Aller, OD, FBLA; Patrick Caroline, COT; Gary Gerber, OD; Earl L. Smith III, OD, PhD; and Erin D. Stahl, MD. Early bird registration ends Dec. 31. Register online.


B+L Receives FDA 510(K) Clearance for Ultra Multifocal For Astigmatism Contact Lenses, Announces Agreement With Modulight to Develop Photodynamic Laser
Bausch + Lomb received 510(k) clearance from the FDA for Bausch + Lomb Ultra Multifocal for Astigmatism contact lenses, the first multifocal toric lens to be available as a standard offering in the eye care professional’s fit set. The monthly silicone hydrogel lens builds upon the success of the company’s Ultra for Presbyopia and Ultra for Astigmatism lenses. With the new contact lenses, eye care professionals will have the ability to immediately fit patients with diagnostic lenses as a standard offering in the fitting set. Read more.
In addition, Bausch + Lomb entered into an exclusive agreement with Modulight to develop a new laser designed for use with Bausch + Lomb’s Visudyne (verteporfin for injection) photodynamic therapy. Visudyne is an injectable photosensitizer drug indicated for the treatment of patients with predominantly classic subfoveal choroidal neovascularization due to age-related macular degeneration, pathologic myopia or presumed ocular histoplasmosis. Activated through use of a photodynamic laser via direct laser excitation, it delivers a targeted approach aimed at destroying abnormal choroidal blood vessels, preventing further disease progression and helping patients maintain vision. Read more.

Coburn Introduces Portable Slit Lamp
Coburn Technologies introduced a portable slit lamp, the SK-LS-1B, to its diagnostics product line. Users who don’t have the ability or cannot sit comfortably at a traditional slit lamp are able to examine patients via the handheld operation. The light and portable slit lamp comes in a custom case to carry and store, and includes a number of key features including:
• A one-touch magnification switch makes it easier for doctors to perform inspections.
• Built with a maximum illumination angle of 60 degrees, the device helps practitioners get a better slit view of the cornea.
• Powered by AA rechargeable or dry cell batteries, the SK-LS-1B operates for more than four hours after being fully charged.
• The slit lamp is designed with 3,500K color temperatures for prestige viewing, while helping users relieve visual fatigues.
• The device can be connected to an iPhone using an optional attachment to capture images. Read more.

Grizzaffi Joins Eaglet Eye
Eaglet Eye, manufacturer of the Eaglet Eye Surface Profiler, announced Kemberly Grizzaffi, NCLE, joined the team. Grizzaffi brings significant specialty lens experience with more than 25 years in practice and 10 years fitting and managing specialty contact lenses. She spent the last three years at SynergEyes concentrating on sales and account management.

2018 West Coast Optometric Glaucoma Symposium

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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