Optometric Physician

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


Volume 21, Number 3

Monday, February 1, 2021


Inside this issue: (click heading to view article)
######### Off the Cuff: Is Being a Doctor in America DOA?

######### Multifocal Orthokeratology Versus Conventional Orthokeratology for Myopia Control: a Paired-Eye Study
######### Cholesterol and Glaucoma: a Systematic Review and Meta-analysis
  The Relationship of Dry Eye Disease with Depression in Saudi Arabia: a Cross-sectional Study
######### News & Notes

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Off the Cuff: Is Being a Doctor in America DOA?

Although this may seem odd to younger readers, there was a time when doctors were loved by all and could do no wrong. Movies and television glorified the doctor in society. One of the first movies I recall seeing was “The Last Angry Man,” a story about Dr. Sam Abelman, a testy but dedicated and uncompromising GP whose Brooklyn, N.Y., practice had distilled down to caring for the poor and abandoned in a NYC slum. Abelman’s life of selfless dedication to his patients was brought into sharp focus through the lens of TV producer David Wayne who desperately wanted to document the last of what he believed a dying breed. It was pretty impressive to a young me.

In the early 60s, Ben Casey, one of my all-time favorite TV shows, was one of the first hospital-based television medical dramas. Shot in stark black and white, it had a jarring opening, and followed the exploits of the stoic, serious and somewhat wooden Vince Edwards playing neurosurgeon Ben Casey. With his mentor Dr. Zorba and colleague Ted Hoffman, Casey saved nearly every patient he saw. My brother and I never missed an episode, and years later, while I waited for my first-born to arrive, I would stay up until 2 a.m. to watch Ben Casey reruns, viewing every episode at least twice.

Real life wasn’t all that much different than fiction back then. Our family GP, Dr. I. Aza Rosenstein could double-park at a fire hydrant with impunity while making house calls and never get a parking ticket. If he was speeding, a police cruiser would give him an escort thinking he was heading to an emergency. For kids growing up in the 60s and 70s, fictional Abelman and Casey, and the real Dr. Rosenstein left indelible impressions. Many of us grew up wanting to be doctors.

As specialties emerged, salaries and incomes soared, and a career in healthcare became more and more attractive. In the 70s and early 80s, competition for medical, dental and optometry schools was intense. At the same time, the cost of healthcare was rising, government and insurance company involvement increased, and managed care reared its ugly head. Forced to see more patients in less time for less money, doctors became increasingly insulated from their patients. Patients increasingly saw doctors as privileged, overpaid and uncaring. The love affair was over.

As respect for doctors among the public waned, interest in being a doctor also declined. Major dips in medical school applications occurred in the late 80s and early 2000s. As many of you know, optometry school applicant pools have also shrunk, reaching critical levels for some programs. However, there is a bit of good news, and oddly, it seems related to COVID. While I don’t know if this has translated to interest in optometry, medical school applications are at an all-time high. Calling it the Fauci effect (which I don’t quite get), this might be a good time to start discussing optometry with teen patients who are pondering a career choice. Frontline doctors and many of us who continued to see emergency patients at the worst of the pandemic just may have changed the way doctors are viewed in society. Maybe, being a doctor is in the recovery room.


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.



Multifocal Orthokeratology Versus Conventional Orthokeratology for Myopia Control: a Paired-Eye Study

Researchers conducted a prospective, paired-eye, investigator masked study in 30 children with myopia (-1.25D to -4.00D; ages 10 to 14 years) to test the efficacy of a novel multifocal orthokeratology (MOK) lens compared with conventional orthokeratology (OK) in slowing axial eye growth. The MOK lens molded a center-distance multifocal surface onto the anterior cornea, with a concentric treatment zone power of +2.50D. Children wore an MOK lens in one eye and a conventional OK lens in the fellow eye nightly for 18 months. Eye growth was monitored with non-contact ocular biometry.

Over 18 months, MOK-treated eyes showed significantly less axial expansion than OK-treated eyes (axial length change: MOK 0.173mm less than OK), and inner axial length (posterior cornea to anterior sclera change: MOK 0.156mm less than OK). The reduced elongation was constant across different baseline progression rates (range, -0.50D/year to -2.00D/year). Visual acuity was less in MOK vs. OK-treated eyes (e.g., at six months, MOK: 0.09 ± 0.01 vs. OK: 0.02 ± 0.01 logMAR).

Researchers conclude that MOK lenses significantly reduced eye growth compared with conventional OK lenses over 18 months.

SOURCE: Loertscher M, Backhouse S, Phillips JR. Multifocal orthokeratology versus conventional orthokeratology for myopia control: A Paired-Eye Study. J Clin Med. 2021; Jan 24;10(3):447.


Cholesterol and Glaucoma: a Systematic Review and Meta-analysis

Intraocular pressure is the main risk factor for glaucoma; however, additional risk factors may also matter. This systematic review and meta-analysis were conducted to summarize the evidence regarding the association of cholesterol parameters (total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein [HDL] levels) and glaucoma. Four electronic databases were searched for all publications containing “glaucoma” and one of various forms of “cholesterol” or “lipoprotein.” Two independent reviewers screened abstracts and potentially full texts of identified articles for eligibility. Risk of bias was assessed with the Newcastle-Ottawa Scale. A random-effects meta-analysis was used to investigate the differences in total cholesterol, LDL and HDL levels between patients with and without glaucoma.

Overall, 29 observational studies and 26 reported quantitative were included in the systematic review to investigate differences in cholesterol parameters between patients with glaucoma (n=7196) and patients without glaucoma (n=350441). Patients with glaucoma had significantly higher total cholesterol levels than patients without glaucoma (mean difference (MD) 7.9 mg/dl, 95% CI: 3.3 to 12.5, p=0.001) and lower mean HDL levels (MD -2.0 mg/dl, 95% CI: -3.1 to -0.9, p=0.001). Patients with glaucoma had higher mean LDL levels than patients without glaucoma, albeit not statistically significant (MD 6.1 mg/dl, 95% CI: -4.3 to 16.4, p=0.251).

This systematic review and meta-analysis of observational studies found an association of glaucoma and high total cholesterol and low HDL levels, respectively. Although this supports the hypothesis that lipid levels pose an additional risk for glaucoma development, heterogeneity was substantial and causality cannot be presumed from identified observational studies.

SOURCE: Posch-Pertl L, Michelitsch M, Wagner G, et al. Cholesterol and glaucoma: a systematic review and meta-analysis. Acta Ophthalmol. 2021; Jan 28. [Epub ahead of print].




The Relationship of Dry Eye Disease with Depression in Saudi Arabia: a Cross-sectional Study

This is descriptive cross-sectional study of 476 patients with dry eye disease (DED) was conducted to estimate the prevalence of depression among individuals with a DED in Saudi Arabia using two questionnaires—Patient Health Questionnaire (PHQ-9) and Dry Eye Questionnaire (DEQ-5)—and explore potential factors implicated in the development of depression among the DED population. The questionnaires were merged and distributed using Google Forms through various social media platforms targeting the Saudi population. After data collection, the data was revised, coded and fed to statistical software IBM SPSS version 22 (SPSS, Chicago).

Depression was diagnosed among 200 participants (42%) of the cases with dry eyes, of which 5.7% had mild depression, 13.9% had moderate depression, 12.6% had moderately severe depression and 9.9% had severe depression. A female predominance was noticed; 44.7% of the females with dry eyes had depression compared to 32.4% of males with recorded statistical significance. Depression was detected among 55% of those who were less than 20 years old compared with 27% of those who were 30 years or older. Laser-assisted in-situ keratomileusis (LASIK), prolonged electronic device usage and contact lens wear were reported as risk factors associated with an increase in dry eye symptoms. However, no statistically significant relationship was found between contact lens wear and depression among dry eye disease patients.

Researchers wrote that suffering from DED is a possible risk factor for developing depression, as DED was associated with depression of greater severity. Depression among DED patients was found to be significantly more prevalent among females and the young adult population rather than older adults.

SOURCE: Al-Dairi W, Al Sowayigh OM, Alkulaib NS, et al. The relationship of dry eye disease with depression in Saudi Arabia: a cross-sectional study. Cureus. 2020; Dec 18;12(12):e12160.


News & Notes
  J&J Vision Names Menziuso as Worldwide President for Vision Care
Johnson & Johnson Vision announced that Peter Menziuso is assuming the role of worldwide president, Vision Care, for Johnson & Johnson Vision immediately. Menziuso replaces Swami Raote, who retired at the end of 2020 after a 29-year tenure with Johnson & Johnson. Menziuso most recently served as president, Cardiovascular & Metabolism, Janssen, where he led the organization in its mission to advance cardiovascular and metabolic care. Additionally, he provided strategic oversight for Xarelto and Invokana in the United States as well as the full pharmaceutical portfolio of Janssen products in Puerto Rico and Canada.


  Surface Ophthalmics Announces First Patient Dosed in Phase II SURF-100 Trial
Surface Ophthalmics announced that the first patient was dosed in the Phase II clinical trial for its investigational product SURF-100 (mycophenolate sodium and betamethasone sodium phosphate in Klarity vehicle) for the treatment of chronic dry eye disease. SURF-100 utilizes a new and differentiated mechanism of action by combining mycophenolate sodium and betamethasone sodium phosphate in the patented Klarity diluent. This combination is designed to increase residence time and patient comfort, and promote ocular healing in a non-blurring formulation. The clinical trial will directly compare SURF-100 with lifitegrast ophthalmic solution 5% (marketed as Xiidra) and cyclosporine ophthalmic emulsion 0.05% (marketed as Restasis). Learn more.


  FastBack Launches FastCheck Thermal Imaging & Facial Recognition System
FastBack announces the launch of FastCheck, a thermal imaging and facial recognition system to keep businesses healthy, secure and organized. Designed to instantly read body temperature within two feet, the smart technology visually and/or audibly sends alerts via a green (go) or red (stop-elevated temperature alert) signal, reminds individual to wear a mask if not detected and keeps records for contact tracing, among other features. Learn more.

  Prevent Blindness & B+L to AMD Launch Video Series
B+L and Prevent Blindness are joining together for the sixth consecutive year during AMD Awareness Month in February to raise awareness about age-related macular degeneration. The two organizations will launch a year-long video series that will feature the personal stories of people who have AMD and the strategies they have for living a healthy lifestyle. The groups will post a variety of content on their social media pages in February to share facts and helpful information about AMD, and B+L will donate $1 to Prevent Blindness and its sight-saving fund for every “share” or “like” of certain posts from the company’s SightMatters Facebook page. Learn 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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