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


Volume 19, Number 6

Monday, February 11, 2019


Inside this issue: (click heading to view article)
######### Off the Cuff: Hey! This is Impor-unt
######### Absorption and Extraction of Inflammatory Mediators From Contact Lens Materials
######### Changes in Intraocular Pressure and Angle Status After Phacoemulsification in Primary Angle Closure Hypertension
######### Rates of Ganglion Cell-Inner Plexiform Layer Thinning in Normal, Open-Angle Glaucoma and Pseudoexfoliation Glaucoma Eyes: A Trend-Based Analysis
######### News & Notes

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Off the Cuff: Hey! This is Impor-unt

I’m not sure you’ve noticed it, but the spoken English language is becoming increasingly dysphonic. All you need to do is listen. At first, it was the rare mispronunciation of the word button. Button is a simple word, with a simple meaning, and it’s a word that’s simple to pronounce. But + tin = Button. Yet, with increasing frequency, I started to hear people pronouncing it with a strange-sounding, cockney inflection. Button was becoming buh-in, with the “t” nowhere to be found.

Then it was important. The word “important,” that is. A bit more complex than buh-in, but it’s a word you hear almost every day. Little by little, im + port + tint = important was becoming impor + unt. Gone was the tint and the “t” at the end, replaced by a grunt like noise. I again tried to rationalize it, thinking it might be yet another British invasion, wondering if British immigration was up pre-Brexit and now afraid that Taco Bell would soon be replaced by blood pudding and kidney pie joints.

Then, the other day, I was watching the news—something I do when I find myself insufficiently aggravated. On was a video of Alexandria Ocasio-Cortez, the newly elected democratic socialist from the Bronx. If you didn’t know, AOC, as the media likes to call her, is the new face of the Democratic Party (no political intent intended). Anyway, AOC was being interviewed and in the middle of the interview she said “impor” then paused—a lengthy intentional pause, before she ended the word with that grunt-like sound. She said that whatever she was talking about was imporunt. Oddly, I don’t remember what she was talking about. Only that it was imporunt.

It took me a while, but I think I finally figured it out. The missing "T"s and end-grunts are not British. It’s a Bronx accent.

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.


Absorption and Extraction of Inflammatory Mediators From Contact Lens Materials
This report aimed to explore whether certain inflammatory mediators were absorbed, extracted or bound by various contact lens materials. Comfilcon A, balafilcon A, omafilcon A and etafilcon A were soaked in 500pg/mL and 100pg/mL of interleukin-8 (IL-8), matrix metalloproteinase-9 (MMP-9) or interleukin-1 receptor antagonist (IL-1Ra), and also in combined solutions of inflammatory mediators (500pg/mL or 100pg/mL) separately. Lenses were then extracted in 1:1 2% trifluoroacetic acid:acetonitrile. The extracted and residual concentrations of inflammatory mediators were determined using enzyme-linked immunosorbent assays. Absorbed (control-residual) and firmly bound (absorbed-extracted) concentrations were calculated for analysis.

More MMP-9 was absorbed by omafilcon A (466pg/mL ± 9pg/mL) than balafilcon A (437pg/mL ± 11pg/mL) or etafilcon A (428pg/mL ±13pg/mL) when soaked in 500pg/mL, with no differences in 100pg/mL. More MMP-9 remained firmly bound to omafilcon A (174pg/mL ± 3pg/mL), comfilcon A (168pg/mL ± 34pg/mL) and balafilcon A (186pg/mL ±14pg/mL) than etafilcon A (128pg/mL ± 22pg/mL). There were no differences in IL-8 absorption between lenses; however, more IL-8 remained firmly bound to omafilcon A (336pg/mL ± 25pg/mL) than etafilcon A (106pg/mL ± 133pg/mL) when soaked in 500pg/mL. No differences were found in concentrations of absorbed or firmly bound IL-1Ra between materials. When the mediators were combined, IL-8 was absorbed more in etafilcon A than in other lens materials, but the absorbed IL-8 did not remain firmly bound.

Researchers determined that the uptake and extraction of inflammatory mediators from contact lenses was affected by competitive binding between the mediators.

SOURCE: Chao C, Richdale K, Willcox M. Absorption and extraction of inflammatory mediators from contact lens materials. Eye Contact Lens. 2019 Jan 29. [Epub ahead of print]

Changes in Intraocular Pressure and Angle Status After Phacoemulsification in Primary Angle Closure Hypertension
A case-series of 18 eyes of 18 subjects was conducted to study the change in intraocular pressure (IOP) and angle status after phacoemulsification in a cohort of primary angle-closure hypertension (PACHT) patients. Preoperative biometry including axial length, anterior chamber depth (ACD), lens thickness and central corneal thickness were studied. Preoperative and postoperative IOP, number of topical glaucoma medications, angle swept-source optical coherence tomography (SS-OCT) parameters of nasal and temporal angle opening distance, trabecular iris space area, scleral spur angle, lens vault and circumferential iridotrabecular contact (ITC) were studied and their correlations derived.

The mean preoperative IOP, 31mm Hg ±6mm Hg, decreased to 14mm Hg ±1mm Hg at six months postoperative period, a fall by 58% ± 14%. The number of glaucoma medications reduced from four (three to five) to two (one to three). All SS-OCT studied parameters denoted significant angle widening postsurgery. The ITC percentage reduced from 52 (16 to 100) to 19 (0 to 97). The preoperative ITC showed moderate to strong correlation with all preoperative nasal and temporal angle parameters. It also showed moderate positive correlation with percentage fall in IOP at the one-month postoperative period. The preoperative ACD showed significant negative correlation with preoperative and postoperative ITC.

Investigators wrote that PACHT patients benefited significantly from cataract surgery, with marked angle widening, IOP reduction and a decrease in the number of glaucoma medications. They added that SS-OCT-derived circumferential iridotrabecular contact indexes could be used as the single best parameter to indicate the preoperative angle status and predict postoperative change in IOP, as against the numerous single-section-measured angle parameters.

SOURCE: Selvan H, Angmo D, Tomar AS, et al. Changes in intraocular pressure and angle status after phacoemulsification in primary angle closure hypertension. J Glaucoma. 2019;28(2):105-110.



Rates of Ganglion Cell-Inner Plexiform Layer Thinning in Normal, Open-Angle Glaucoma and Pseudoexfoliation Glaucoma Eyes: A Trend-Based Analysis
The purpose of this study was to determine the rate of ganglion cell-inner plexiform layer (GCIPL) thinning by Cirrus high-definition optical coherence tomography (HD-OCT) in normal eyes and open-angle glaucoma (OAG) and pseudoexfoliation glaucoma (PXG) eyes. This was a longitudinal observational study. Researchers evaluated 282 subjects who visited a glaucoma clinic of a tertiary hospital in Korea: 60 healthy eyes, 193 medically treated OAG eyes and 29 medically treated PXG eyes with a minimum three-year follow-up involving serial spectral-domain OCT measurements of GCIPL thickness. The rates of thinning in the GCIPL thickness of the global region, six macular sectors and minimum thickness were determined by linear mixed models and compared within the normal, OAG and PXG groups. Additionally, the GCIPL thinning rates were compared between normal-baseline-IOP OAG (normal-tension glaucoma [NTG]) and high-baseline-IOP OAG (high-tension glaucoma [HTG]) eyes.

The mean rates of GCIPL thinning were -0.31μm/y in the normal eyes, -0.49μm/y in OAG and -1.46μm/y in PXG. The differences in the mean GCIPL thinning rates were statistically significant between OAG and PXG (normal vs. OAG; OAG vs. PXG; normal vs. PXG). Among the eyes with OAG, the treated NTG and HTG eyes showed no significant difference in GCIPL thinning rate (NTG vs. HTG=-0.41μm/y vs -0.66μm/y).

Researchers determined GCIPL thinning rates for normal and undertreated OAG and PXG eyes, and found that differences existed among normal eyes and glaucoma types, with PXG progressing significantly faster than OAG.

SOURCE: Lee WJ, Baek SU, Kim YK, et al. Rates of ganglion cell-inner plexiform layer thinning in normal, open-angle glaucoma and pseudoexfoliation glaucoma eyes: a trend-based analysis. Invest Ophthalmol Vis Sci. 2019;60(2):599-604.

News & Notes

B+L Launches Sightmatters.Com to Help People With AMD
Bausch + Lomb announced the launch of SightMatters.com, an educational online resource for people living with age-related macular degeneration, in conjunction with the start of AMD Awareness Month. The resource, which was designed for the visually impaired with an increased font size and distinctive color contrast between different elements in the site, will help individuals take charge of their conditions by offering a singular resource that is clear, concise and offers actionable content. Visitors will have the opportunity to join a supportive online community of people living with AMD. Read more.


IDOC Announces Leadership Team Members, Record Attendance and IDOC Insider Launch
IDOC announced four recent additions to the executive and management teams. Jill Johnson was named HR leader, Jan Cory became senior director, strategic partnerships, Bridgette O’Brien was named director of marketing and Scott Robinson joined as director of strategic partnerships. In addition, IDOC’s national conference, The Connection in Orlando (Jan. 30-February 2) was the largest in the group’s 20-year history. Finally, IDOC announced a new plan enhancement for members. Offered to members at no additional cost, IDOC Insider combines state-of-the-art data and sell-through analytics technology with customized, metrics-driven business recommendations and incentives based on individual practice data. 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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