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


Volume 18, Number 50

Monday, December 11, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: “Can You Hear Me?” and Other Flimflam Scams From Contact Lens Bottom Feeders
######### Ocular Rosacea Causing Corneal Melt in an African American Patient and a Hispanic Patient
######### Treating Amblyopia in Adults with Prosthetic Occluding Contact Lenses
######### Glaucoma and Alzheimer Disease: a Single Age-related Neurodegenerative Disease of the Brain
######### News & Notes

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Off the Cuff: “Can You Hear Me?” and Other Flimflam Scams From Contact Lens Bottom Feeders

Your office phone rings, the receptionist answers and says “hello.” Nothing can be heard except for the sound of faint background noise. Your receptionist says “hello” more loudly this time. More seconds tick by before a distant-sounding female voice asks, “Can you hear me?” Your receptionist answers “yes,” the call disconnects. It’s over. The caller got what they wanted. Damage done. A contact lens Rx for a lens you never fitted, for a brand you never heard of, that was never even mentioned during the call, was verified as soon as your staff said “yes.”

That “yes” was digitally merged onto any Rx verification request the seller wants and stands as proof positive that your office okayed it. Sounds Machiavellian? Trust me, it’s happening even now as I type.

All of those calls, even the unanswered ones, add up. There are big dollars at stake. Junk lens substitutions (often sphere in place of torics), long-expired prescriptions and even made-up Rxs are being filled.

Until someone gets hurt—and eventually someone will—there is little that will be done about it. The long-held image of a caring, patient-first ECP is being trashed by equity fund-hired “consumer advocate authors” filling the fringe press with righteously indignant, anti-optometric claptrap. The current FTC is unlikely to do anything that will favor patient safety over common cents. So, we’re on our own.

What do we do? Make sure everyone in your office never says “yes” unless they know who they are speaking to and what they are saying yes to. They can still be friendly and helpful while being suspicious and cynical of those who would harm your patients and your practice.

Always respond to Rx verification requests as quickly as possible. Remember that passive verification is still verification. If something goes wrong and the patient is harmed—even if it’s not your patient and you’ve never seen them—you can still bear responsibility for not at least attempting (and documenting) that you rejected the Rx request.

Our world is getting more complicated and more dangerous. Be careful out there.

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.



Ocular Rosacea Causing Corneal Melt in an African American Patient and a Hispanic Patient
In case  1, a 43-year-old Hispanic woman presented with right eye corneal perforation. Her prior medical history was significant for rosacea only, diagnosed clinically by a dermatologist. Her eye exam showed signs of bilateral ocular rosacea. An emergent, full-thickness, tectonic corneal patch graft was performed. The patient's bilateral eye symptoms improved one month after initiating rosacea treatment.

In case  2, a 51-year-old African American man with longstanding history of untreated rosacea presented with bilateral peripheral corneal thinning with neovascularization that led to right eye corneal perforation. Glue and bandage contact lens were applied. The patient did well four weeks after starting antibacterial, oral steroids and rosacea treatment.

Researchers concluded that ocular rosacea presented in these Hispanic and African American patients with severe manifestations such as corneal perforation.

SOURCE: Saade JS, Abiad B, Jan J, et al. Ocular rosacea causing corneal melt in an African American patient and a Hispanic patient. Case Rep Ophthalmol Med. 2017;2017:2834031.

Treating Amblyopia in Adults with Prosthetic Occluding Contact Lenses

This study investigated the feasibility, effectiveness and acceptability of using prosthetic occluding contact lenses (OCLs) to treat moderate amblyopia in adults, and assessed the role of the multifocal visual evoked potential (mfVEP) as a predictor of post-amblyopic therapy. A comparative, prospective, interventional case series pilot study with amblyopic adults (mean age: 40 years, range 20 to 50 years) allocated subjects into two intervention groups: eye patching and OCL. The primary outcome variable was logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA); secondary outcomes were mfVEP amplitude and latency, and the National Eye Institute Visual Function Questionnaire (NEI VFQ-25).

Significant improvements in pre- to post-amblyopic therapy BCVA were seen at 1.5 months in the OCL group and eye patching group. Post-treatment BCVA was inversely related to age and the presence of strabismus. No significant changes in the number and size of the abnormal mfVEP amplitude and latency defects were observed after occlusion. The NEI VFQ-25 composite score showed significant improvement in OCL users at 12 months compared with eye patching.

Investigators wrote that significant vision improvement could be achieved with OCLs such that occlusion with OCLs could be considered effective and more acceptable therapy for adults with amblyopia.

SOURCE: Garcia-Romo E, Perez-Rico C, Roldán-Díaz I, et al. Treating amblyopia in adults with prosthetic occluding contact lenses. Acta Ophthalmol. 2017; Nov 20. [Epub ahead of print].



Glaucoma and Alzheimer Disease: a Single Age-related Neurodegenerative Disease of the Brain
Authors wrote that open-angle glaucoma is one of the leading causes of irreversible blindness worldwide. Elevated intraocular pressure is considered an important risk factor for glaucoma, although a subset of patients experience disease progression even in presence of normal intraocular pressure values, they added. They wrote further that this fact indicates that risk factors other than intraocular pressure are involved in the pathogenesis of glaucoma. Some research suggests a possible relationship between glaucoma and neurodegenerative diseases such as Alzheimer’s disease. In this regard, the authors recently described a high prevalence of alterations typical of glaucoma, using the Heidelberg Retinal Tomograph-3 (HRT-3) in a group of patients with Alzheimer’s disease. They found that these alterations were not associated with elevated intraocular pressure or abnormal central corneal thickness values.

Alzheimer’s disease is the most common form of dementia associated with progressive deterioration of memory and cognition, and complaints related to vision are common among Alzheimer’s disease patients, authors wrote. They added that features common to both diseases, including risk factors and pathophysiological mechanisms gleaned from the recent literature, suggest that Alzheimer’s disease and glaucoma can be considered age-related neurodegenerative diseases that may co-exist in the elderly.

SOUCRE: Raffaele M, Alessio M, Massimo C, et al. Glaucoma and Alzheimer disease: a single age-related neurodegenerative disease of the brain. Curr Neuropharmacol. 2017; Dec 6. [Epub ahead of print].

News & Notes
SCO Provides More Than $1.8 Million in Uncompensated Care
During its 2016-2017 fiscal year, Southern College of Optometry’s clinical programs provided $1.8 million in uncompensated optometric care in the Memphis community, a 183 percent increase since the college began tracking it in 2009. Uncompensated care represents outreach programs geared toward bringing eye care to the community, as well as care for uninsured or underinsured patients. The numbers represent 17 percent of SCO’s gross charges. This year’s number is bolstered by the expansion of MobilEYES, SCO’s mobile care unit, and the college’s new strategic plan. Read more.


NovaBay Names Stuart Chief Commercial Officer
NovaBay Pharmaceuticals, a biopharmaceutical company focusing on commercializing its prescription Avenova for lid and lash hygiene in the domestic eye care market, appointed Lewis J. Stuart as chief commercial officer. Previously, Stuart was vice president of U.S. Oncology for Genomic Health. He was also a member of the board of directors for Linkage Biosciences, recently acquired by Thermo Fisher. Read more.

Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia

Heidelberg ISS Event Videos Available
Videos from Heidelberg Engineering’s 15th International Spectralis Symposium (ISS) are available on the company’s Academy website. The event took place in Boston, Oct. 13-14, and brought together users from all over the world. View the videos.

2018 Winter Ophthalmic Conference

Review of Optometry's New Technologies and Treatments in Eye Care in Nashville, April 6-8, 2018, at the Nashville Marriott at Vanderbilt University








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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