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


Volume 18, Number 49

Monday, December 4, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: Esthetic Optometry
######### The Effect of Oral Contraceptive Pills on the Macula, the Retinal Nerve Fiber Layer and Choroidal Thickness
######### Factors Associated with the Occurrence of a Fall in Subjects with Primary Open-angle Glaucoma
######### The Association Between Visual Function and Retinal Structure in Chronic Central Serous Chorioretinopathy
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Esthetic Optometry

What’s that I said? Esthetic optometry? I realize that you’ve probably never heard those two words used together, but trust me, over the next few years you will be hearing a lot about esthetics and optometry. In fact, I predict that this practice niche will help save and redefine our profession, keeping it relevant despite an onslaught of well-financed and carefully contrived media assaults on traditional optometric practice.

So, what exactly is esthetic optometry? It is the practice of enhancing the appearance and related function of our patients’ eyes. While it’s not plastic surgery in the contemporary sense, rapid advances in technology and new medications will likely have a very positive impact on our ability to make our patients’ eyes look as good as they see.

With my focus on ocular surface disease, and more and more patients suffering the effects of “dry eye” and digital device overuse, I see this coming like a runaway freight train. Every week, the number of patients complaining of cosmetically objectionable red eyes steadily increases. While some issues are the result of the “dry eye” triad—discomfort, diminished and unstable vision, and conjunctival injection—for many patients, red eyes are their primary complaint.

The good news is that we are on the edge of new and more effective treatments for these patients. In addition to managing lid disease and bacterial overpopulation, new eye whitening drops, like B+L’s long-awaited Luminesse, will hopefully be approved by the FDA in the near future.

A variety of energy forms including intense pulsed light (IPL) and radio frequency-based Thermi treatments have been proposed as therapies for MGD. They also tighten and smooth periorbital skin. In some states, ODs are already licensed to use these technologies and perform procedures. Even in restricted states, working with an MD or DO medical director, or hiring a laser/IPL-certified aesthetician can immediately propel many practices directly into esthetics.

Perhaps the most compelling reason to get involved is the economics. At a time of diminishing reimbursement and increased competition for traditional sources of optometric income, virtually all esthetic procedures are out of pocket. All require human-to-human contact and can’t be performed online, and, as has been generally true for investments in most advanced technology, the return on investment is usually both rapid and rewarding. All of that said, we need to get involved in this area of practice because it is something that our patients want. Esthetic optometry is clearly part of our future.

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.



The Effect of Oral Contraceptive Pills on the Macula, the Retinal Nerve Fiber Layer and Choroidal Thickness
The aim of this study was to evaluate the effect of oral contraceptive pills (OCP) on the macula, the retinal nerve fiber layer (RNFL) and choroidal thickness (CT). A total of 24 healthy women taking monophasic OCP (3mg drospirenone and 0.03mg ethinylestradiol) for contraception for at least one year were compared with a control group of 24 healthy women who were not taking an OCP. Optical coherence tomography (OCT) was used to evaluate the posterior ocular segments, and measurements were taken in the follicular phase (day 3) of the cycle in all women.

No disparity in terms of age and body mass index between the groups was observed. In comparison between the macular region and CT between groups, researchers found that all variables except foveal center thickness and CT were significantly thinner in the OCP group. Nasal and temporal inferior parts of the RNFL and average RNFL were significantly slimmer in the study group vs. the control group.

OCP resulted in several structural changes in the posterior ocular segment. Thus, researchers wrote that women using OCP for more than one year might experience some related eye problems, and suggested that OCT should be performed for these women. They added that further clinical trials researching long-period effect of OCP on the eyes would be needed.

SOURCE: Madendag Y, Acmaz G, Atas M, et al. The effect of oral contraceptive pills on the macula, the retinal nerve fiber layer, and choroidal thickness. Med Sci Monit. 2017;23:5657-61.

Factors Associated with the Occurrence of a Fall in Subjects with Primary Open-angle Glaucoma

The aim of the study was to investigate risk factors for future falls in subjects with primary open-angle glaucoma (POAG). All participants answered the following question at their baseline ophthalmic examination: Have you had any falls in the last year? All study participants answered the same question every 12 months for three years. The means of total deviation values in the whole, superior peripheral, superior central, inferior central and inferior peripheral visual fields (VF) were calculated. The relationship between these measurements and various clinical factors against patients' future falls was analyzed using multiple linear regression.

A total of 294 POAG patients answered the baseline and follow-up fall questionnaires over three years. Among 294 subjects, 69 patients experienced a fall during the three-year follow-up. History of falls at baseline (coefficient=1.22), history of fear of falling at baseline (0.53), best corrected visual acuity in the worse eye (7.37), prevalence of diabetes mellitus (0.60) and prevalence of systemic hypertension (0.53) were selected in the optimal model.

Visual acuity in the worse eye, history of falls, fear of falling, diabetes mellitus and systemic hypertension were risk factors for falling in subjects with POAG.

SOURCE: Adachi S, Yuki K, Awano-Tanabe S, et al. Factors associated with the occurrence of a fall in subjects with primary open-angle glaucoma. BMC Ophthalmol. 2017;17(1):213.



The Association Between Visual Function and Retinal Structure in Chronic Central Serous Chorioretinopathy
The purpose of this study was to investigate the association between visual function and retinal structure in central serous chorioretinopathy (CSC). In 22 eyes of 22 chronic CSC patients with serous retinal detachments at the macula, retinal sensitivity was measured using MP3 microperimetry (Nidek). Also calculated was mean sensitivity within two degrees (MS2), four degrees (MS4) and six degrees (MS6), as well as foveal sensitivity (MS0). Retinal structure was measured using optical coherence tomography (Spectralis). The relationship between visual function (LogMAR best-corrected visual acuity [LogMAR VA], and MS0, MS2, MS4 and MS6) and serous retinal detachment height at the fovea (SRDH), central retinal thickness (CRT), macular volume (MV) and central choroidal thickness (CCT) was investigated.

Investigators found significant negative correlations between LogMAR VA and MS0 and MS2. No significant relationship was observed between LogMAR VA and SRDH although a significant negative correlation between SRDH and MS2, MS4 and MS6 was found.

In CSC, serous retinal detachment significantly correlated with retinal sensitivity measured with MP3, but not with LogMAR VA.

SOURCE: Sugiura A, Fujino R, Takemiya N, et al. The association between visual function and retinal structure in chronic central serous chorioretinopathy. Sci Rep. 2017;7(1):16288.

News & Notes
Academy Launches New Website
The American Academy of Optometry’s newly designed website for the Academy and the American Academy of Optometry Foundation features improved navigation and functionality. A more modern design facilitates user ease, and the website is optimized for mobile devices and various browsers. It also includes an enhanced Fellow and Diplomate Directory. Read more.


Volk Optical Releases Next-generation Lens Cases
Volk Optical’s new case design for its line of diagnostic and therapeutic ophthalmic lenses enhances the durability of its classic design and emphasizes functionality. Engineered to withstand 50,000 openings without hinge breakage, the modern design features thermoplastic rubber inserts to cushion the lens and a magnetic closure to hold the case securely shut. Volk’s digital series, slit-lamp, laser, gonio, surgical, bio and specialty treatment lenses are available with the new case. For quick identification, case exteriors are color coordinated by lens family and labeled with the lens name. The cover plate can be custom engraved with the doctor’s or practice’s name. Read more.

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

Salzburg Reading Desk Available in United States
The Salzburg Reading Desk, now considered 510K Class One exempt, is available to clinicians and researchers in the United States. The SRD, manufactured by SRD Vision, helps eye care professionals assess near, computer and intermediate reading speeds, and reading acuity with a high-resolution monitor and software that presents progressively smaller sentences. Stereophotogrammetry monitors the distance between the individual and the monitor. To prevent familiarization, sentences are randomized from an inventory. Other parameters such as contrast and luminance can be adjusted. Read more.

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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