Optometric Physician



Vol. 23, #44  •   Monday, December 5, 2022


Off the Cuff: Unlikely Inspiration

Flipping through the channels, I was looking for something to watch and came across the movie Moneyball. If you haven't seen it, this 2011 film starring Brad Pitt and Jonah Hill is based on a true story of when the Oakland As implemented a new unconventional strategy to create a team based on player statistics rather than the traditional thinking of the scouts. I love this movie.

Something that very few, if any, people know about me is my affinity for sports movies. My all-time favorites include Bull Durham, Major League, The Replacements, and Moneyball. (Come to think of it, it's probably also why I love the streaming series Ted Lasso.) The common thread running between all these movies is the underdog element; they're underestimated, mocked, and misunderstood. Many times it's not even just the fans or the owners that doubt these teams, but it's even the teams themselves. Typically something happens to bring these teams to their lowest low. In the movie Moneyball, the general manager, played by the late great Philip Seymour Hoffman, refuses to cooperate with the new strategy and doesn't play the team as it was designed. They continue to lose, seemingly validating all the doubters. I don't believe I would spoil this or any of these sports movies for anybody by saying they ultimately rise above, gloriously proving themselves to their naysayers and themselves, ultimately winning the game, the championship, and/or sometimes the girl.

A report published in the Sept 2022 JAMA1 reported sharp increases of emotional exhaustion in healthcare workers over 3 years of the COVID pandemic. The study's conclusion stated, "current health care worker well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions." This spells bad news for patient care and outcomes on an already strained system.

For me, sports movie stories are always uplifting and positive. The vindication raises goosebumps every time I watch them. After rewatching Moneyball, I realized how much I needed to feel that small glimmer of positivity again, especially now. Yes, it's just another predictable sports movie, but it also served as a reminder that inspiration can be found in the most unlikely of places. This holiday season, my hope is you find yours.


Sexton JB, Adair KC, Proulx J, et al. Emotional exhaustion among US health care workers before and during the COVID-19 Pandemic, 2019-2021. JAMA Netw Open. 2022 Sep 1;5(9):e2232748.



Shannon L. Steinhäuser, OD, MS, FAAO
Chief Medical Editor


Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.






Diabetic Patients With Rosacea Increase the Risks of Diabetic Macular Edema, Dry Eye Disease, Glaucoma, and Cataract

Inflammation plays a role in diabetic eye diseases, but the association between rosacea and eye diseases in patients with diabetes remains unknown. This retrospective cohort study used claims data from the National Health Insurance Research Database in Taiwan to investigate the association between rosacea and eye diseases in patients with diabetes.

Taiwanese patients diagnosed as having diabetes mellitus between January 1, 1997, and December 31, 2013, and using any hypoglycemic agents were included and divided into rosacea and non-rosacea groups. After applying 1:20 sex and age matching and exclusion criteria, 1:4 propensity score matching (PSM) was conducted to balance the covariate distribution between the groups. The risk of time-to-event outcome between rosacea and non-rosacea groups in the PSM cohort was compared using the Fine and Gray subdistribution hazard model. A total of 4,096 patients with rosacea and 16,384 patients without rosacea were included in the analysis. During a mean follow-up period of 5 years, diabetic patients with rosacea had significantly higher risks of diabetic macular, glaucoma with medical treatment, dry eye disease), and cataract surgery compared with diabetic patients without rosacea. A cumulative incidence analysis performed up to 14 years after the index date revealed that the risks of developing ocular diseases consistently increased over time. No significant differences in diabetic retinopathy, age-related macular degeneration, retinal vascular occlusion, ischemic optic neuropathy, optic neuritis, uveitis, or retinal detachment were identified according to rosacea diagnosis. However significant associations between rosacea and psoriasis, irritable bowel syndrome, anxiety, and major depressive disorder among patients with diabetes.

Rosacea is associated with diabetic macular edema, glaucoma, dry eye disease, and cataract development in diabetic patients, as well as increased risks of psoriasis, irritable bowel syndrome, anxiety, and depression in diabetic patients.

SOURCE: Wang FY, Kang EY, Liu CH, et al. Diabetic patients with rosacea increase the risks of diabetic macular edema, dry eye disease, glaucoma, and cataract. Asia Pac J Ophthalmol (Phila). 2022;11(6):505-13






Corneal Edema Associated With Degenerating Soemmering Ring Cataract

This paper reports three patients with an uncommon, delayed complication of cataract extraction: corneal edema following dispersion of calcific lens particles from a degenerating Soemmering ring cataract.

The authors discussed three patients, 75 to 92 years old, presenting with corneal edema and dispersed, degenerated calcific lens material in the anterior chamber and vitreous 20 to 30 years after cataract surgery. In all patients, calcific particles studded the posterior surface of the cornea in a gravity-dependent distribution without apparent inflammation and were associated with localized corneal edema. In one patient, calcific particles were also associated with secondary open angle glaucoma. Deposits originated from the calcified Soemmering ring cataract. Histopathological examination demonstrated extracellular calcific deposits compatible with cataractous lens material on the posterior surface of stripped Descemet membrane of two patients. The deposits were associated with prominent localized loss of corneal endothelium and were not associated with inflammation. Morphologically similar acellular material was identified in the biopsied aqueous and vitreous fluid of one patient. Management included endothelial keratoplasty, anterior chamber lavage, pars plana vitrectomy, aspiration/removal of a portion of Soemmering ring cataract without intraocular lens implant explantation, and the removal of the entire capsular bag/implant complex. Cornea cleared and visual acuity improved in both patients who underwent endothelial keratoplasty. Persistent elevated intraocular pressure led to visual deterioration in one patient with secondary glaucoma.

Dispersion of calcific Soemmering ring cataract can occur decades following cataract surgery leading to corneal edema, secondary glaucoma, and vitreous opacities. Timely recognition of this phenomenon may prevent ocular morbidity, including corneal edema and glaucoma.

SOURCE: Safran JP, Nataneli N, Vazirani J, et al. Corneal edema associated with degenerating Soemmering ring cataract: Clinical-pathologic correlation. Am J Ophthalmol Case Rep. 2022;28




Impact of High Glucose on Ocular Surface Glycocalyx Components: Implications for Diabetes-Associated Ocular Surface Damage

The present study was designed to test the effect of a high glucose level on components of glycocalyx. The glycocalyx plays a vital role in barrier function. Diabetes mellitus causes several detrimental effects on the ocular surface, including compromised barrier function and an increased risk of infections.

Stratified human corneal and conjunctival epithelial cells were exposed to a high glucose concentration for 24 and 72 hours. Changes in Mucin (MUC) 1, 4, 16 expression were quantified using real-time PCR and ELISA. Rose bengal and jacalin staining were used to assess the spatial distribution of MUC16 and O-glycosylation. Changes in the gene expression of five glycosyltransferases and forty-two proteins involved in cell proliferation and the cell cycle were also quantified using PCR and a gene array. High glucose exposure did not affect the level or spatial distribution of membrane-tethered MUC 1, 4, and 16 either in the corneal or conjunctival epithelial cells. No change in gene expression in glycosyltransferases was observed, but a decrease in the gene expression of proteins involved in cell proliferation and the cell cycle was observed.

A high-glucose-mediated decrease in gene expression of proteins involved in cellular proliferation of corneal and conjunctival epithelial cells may be one of the mechanisms underlying a diabetes-associated decrease in ocular surface's glycocalyx.

SOURCE: Weng J, Trinh S, Lee R, et al. Impact of high glucose on ocular surface glycocalyx components: implications for diabetes-associated ocular surface damage. Int J Mol Sci. 2022;23(22)






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Prevent Blindness Declares GA Awareness Week

Prevent Blindness announced December 5 to 11, as its second annual Geographic Atrophy Awareness Week. Learn more.