Optometric Physician

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


Volume 20, Number 52

Monday, December 14, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: Are Our Patients Going COVID Crazy?

######### Clinical Significance of Contact Lens Related Changes of Ocular Surface Tissue Observed on Optical Coherence Images
######### Ocular Findings in Metabolic Syndrome: a Review
  Frequency of Contact Lens Complications Between Contact Lens Wearers Using Multipurpose Solutions Versus Hydrogen Peroxide in the United States and Canada
######### News & Notes

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Off the Cuff: Are Our Patients Going COVID Crazy?

Growing up in the bowels of the Bronx in a one-bedroom apartment in a working-class neighborhood, I experienced the best and worst of humanity at an early age. Like most New Yorkers, I am a reflexive cynic and while I hope for the best, I usually expect the worst. As a result, I have a pretty thick skin, and I am rarely surprised by anything, especially when it concerns human behavior.

I spent most of my professional career practicing in or around New York City. Most New Yorkers are pleasant, but they are also direct. If there is an issue, they characteristically let you know what they think or where they think you should go. When I practiced on the Upper East Side in the 1990s, I examined Lou Reed, the somewhat famous rocker known for Walk on the Wild Side. His sister had been a patient of mine on Long Island, and while I thought that would be a good way to connect with him, apparently knowing that I knew his sister rubbed him the wrong way—something he had no reticence in sharing with me. Just so you don’t think all famous New Yorkers are jerks, famous actress and comedian Madeline Kahn, who I also saw at that practice, was one of the loveliest, warmest, down-to-earth people I’ve ever met.

You’re probably wondering what growing up and practicing in New York has to do with COVID. One of the really great things about relocating to Phoenix is that patients here are generally less demanding, nicer and more appreciative than New York patients are. However, over the past few months, especially since COVID has spiked, our patients have changed. My associate, Cory Lappin, who grew up in the overly nice Midwest, commented about how demanding and unpleasant some patients have become. Perhaps because of my New York DNA I didn’t see it first, but there clearly has been a decided shift. Our patient population is more complex, perhaps because lesser problems are being put off, and patients are clearly under stress from isolation and continued uncertainty.

While much of the focus on COVID has been on life-and-death, tragedy and triumph, politics and pettiness, the greatest impact of COVID on humanity may turn out to be far subtler, but just as profound. I suspect recovering any semblance of the normal lives we knew will take far longer than simply discovering or deploying an effective cure or vaccine. Patience and understanding are powerful tools for mending the fabric of society. Be kind to each other.


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.



Clinical Significance of Contact Lens Related Changes of Ocular Surface Tissue Observed on Optical Coherence Images

Seventeen participants (mean age=26.6 SD ± 3.6 years; 7 females) were fitted with three different contact lenses’ base curves of the same silicone hydrogel custom lens type (Visell 50; Hecht Contactlinsen, Au, Germany) in a randomized order to investigate the relationship between the real contact lens imprint into the conjunctival tissue, observed by optical coherence tomography (OCT) and conjunctival staining and contact lens wearing comfort. One lens was optimally fitted according to the manufacturer's recommendation, one fitted 0.4mm flatter and one fitted 0.4mm steeper. After four hours of lens wear, the contact lens edge in the area of the conjunctiva was imaged nasally and temporally using OCT (Optovue iVue SD-OCT). To correct the artifact due to optical distortion with OCT, the imprint of all worn lenses was measured on a glass plate afterwards. Conjunctival staining in the limbal region after four hours of lens wear was classified using the CCLRU Grading Scale. Comfort scoring was based on visual analog scales from 0 (very poor) to 100 (excellent).

The mean conjunctival imprint of all contact lens edges was 32.0±8.1μm before and 7.3±6.5 μm after distortion correction of the OCT images. The distortion corrected conjunctival imprint with the 0.4 mm steeper lens (11.5±6.2μm) was statistically significantly greater compared to the optimally fitted lens (6.5±5.9μm) (One-way ANOVA followed Tukey-test; p=0.017) and greater compared to the 0.4 mm flatter lens (3.9±5.3μm). There was no statistically significant difference between the optimally fitted lens and the 0.4mm flatter lens. The nasally measured imprint (11.4±9.0μm) was significantly greater than the temporally measured (3.3±7.6μm). There was no statistically significant correlation between the amount of conjunctival imprint and the graded conjunctival staining or the wearer's comfort.

Contact lens edges imaged by OCT exhibited displacement artifacts. The observed conjunctival imprints were a combination of real conjunctival compression and artifacts. A deeper imprint of the contact lens into the conjunctiva caused by a steeper base curve was not related to clinically significant staining or changes in comfort after four hours of lens wear. The observed differences between nasal and temporal imprint are likely to be caused by variations of conjunctival thickness and the shape of the underlying sclera.

SOURCE: Jandl A, Ruland T, Schwarz D, et al. Clinical significance of contact lens related changes of ocular surface tissue observed on optical coherence images. Cont Lens Anterior Eye. 2020; Dec 5:S1367-0484(20)30199-5.


Ocular Findings in Metabolic Syndrome: a Review

Metabolic syndrome (MetS) has emerged as a worldwide health hazard of the modern lifestyle, representing a cluster of metabolic abnormalities and a risk factor for cardiovascular disease. Eye diseases, such as diabetic retinopathy, central retinal artery occlusion, cataract, age-related macular degeneration, glaucoma and dry eye syndrome have been linked with many of MetS components. Their relationship with MetS itself is, however, a recent topic of investigation. This review aimed to gather published evidence supporting associations between ocular findings and MetS, and to explore the related physiopathological processes that congregate in this syndrome and lead to these diseases.

After compiling interesting and compelling evidence, the authors suggested the need for further studies in this field to keep solidifying associations and unveiling the pathological processes that support them. The body of research ultimately targeted MetS patients as a population of individuals who are at increased risk of developing age-related eye diseases and vision loss.

SOURCE: Lima-Fontes M, Barata P, Falcão M, et al. Ocular findings in metabolic syndrome: a review. Porto Biomed J. 2020; Dec 3;5(6):e104.




Frequency of Contact Lens Complications Between Contact Lens Wearers Using Multipurpose Solutions Versus Hydrogen Peroxide in the United States and Canada

Researchers retrospectively compared the frequency of contact lens (CL) complications in soft CL users of hydrogen peroxide (H2O2) and multipurpose solutions (MPS). This was a multicenter, retrospective chart review of CL records from each patient's three most recent eye examinations at academic and private practices. Patients must have used the same solution type for at least three years. Univariate analyses were conducted using T tests, and chi-square or Fisher's exact test for categorical measures.

There were 1,137 patients included, with 670 (59%) using MPS and 467 (41%) H2O2. In total, 706 (62%) experienced at least one complication; 409 used MPS and 297 used H2O2. There was no difference in the proportion of patients experiencing at least one complication between MPS (61%) and H2O2 (64%) (p=0.38). Multipurpose solutions users were more likely to report discomfort compared with H2O2 users (p=0.04). Presumed microbial keratitis was experienced by 16 MPS and nine H2O2 users (p=0.60).

Researchers reported no significant differences were found in the frequency of CL complications between MPS and H2O2. H2O2 users were less likely to report discomfort, and thus, switching to a H2O2 system may be an alternative in CL users with discomfort.

SOURCE: Tichenor AA, Cofield SS, Gann D, et al. Frequency of contact lens complications between contact lens wearers using multipurpose solutions versus hydrogen peroxide in the united states and canada. Eye Contact Lens. 2020; Dec 7. [Epub ahead of print].


News & Notes

Bostonsight Forms Scientific Advisory Board
BostonSight a formed a scientific advisory board of experts to help its research initiatives. The board, chaired by Dan Brocks, MD, BostonSight’s chief medical officer, includes Demi Niforos, MS, vice president of biostatistics and statistical programming at eClinical Solutions; Michael Raizman, MD, a practitioner at Ophthalmic Consultants of Boston and associate professor of ophthalmology at Tufts University School of Medicine; Ali Djalilian, MD, professor of ophthalmology, Cornea Service and Director of the Stem Cell Therapy and Corneal Tissue Engineering Laboratory at Illinois Eye and Ear Infirmary; and Gloria B. Chiu, OD, FAAO, FSLS, associate professor of clinical ophthalmology at the USC Roski Eye Institute, Department of Ophthalmology at the University of Southern California Keck School of Medicine. Learn more.


  Research Confirms Presence of SARS-CoV-2 in Ocular Tissue
Eversight announced research findings showing a small but noteworthy prevalence of SARS-CoV-2 in ocular tissues from individuals who died from COVID-19. The findings were published in The Ocular Surface. A team of researchers from Eversight, Wayne State University, University of Michigan and Rush University conducted the study in regions heavily impacted by COVID-19 (Cleveland, Chicago, Ann Arbor, Mich. and New Jersey). 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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