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weekly e-journal by Art Epstein, OD, FAAO
Off the Cuff: A Tree Doesn’t Grow in The Garden State
In the ever-shifting sands of society, it has become painfully obvious that medical providers have steadily declined in influence, trust and credibility. While some of this may be explained by the increasing cost of health care or because insurers, who are largely responsible for most of this misery, doctors and the pharmaceutical industry have absorbed more than their fair share of the public’s rancor.
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Association Between Optic Nerve Head Deformation & Retinal Microvasculature in High Myopia | ||||
These investigators evaluated the retinal microvasculature of peripapillary and macular regions in highly myopic eyes and assessed the association between vascular parameters and optic nerve head (ONH) deformation. Seventy-one subjects with highly myopic eyes and 26 subjects with emmetropic eyes were included. Horizontal B-scan images of the ONH were obtained using optical coherence tomography (OCT), and horizontal tilt angles were measured. Integrated automated algorithms in the Avanti OCT angiography were used to quantify the peripapillary vessel density and area of the foveal avascular zone (FAZ) at the level of superficial and deep vascular networks. Association between horizontal disc tilt and the vascular parameters was evaluated. The mean axial length and horizontal tilt angle were 26.73 ± 0.63mm and 9.77 ± 3.00 degrees in the highly myopic group and 23.46 ± 0.55mm and 5.95 ± 3.48 degrees in the emmetropic group, respectively. Highly myopic eyes exhibited significantly lower average peripapillary vessel density, and larger superficial and deep FAZs compared with emmetropic eyes. Linear regression analyses showed that horizontal tilt angle significantly correlated with the average peripapillary vessel density and the areas of superficial and deep FAZs. Investigators determined that the retinal microvasculature was significantly different in highly myopic eyes according to the degree of horizontal optic disc tilt. They added that, in addition to peripapillary vessel density, FAZ can be affected by the degree of optic disc tilt. |
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SOURCE: Sung MS, Lee TH, Heo H, et al. Association between optic nerve head deformation and retinal microvasculature in high myopia. Am J Ophthalmol. 2018; Feb 5. [Epub ahead of print]. |
Corneal Biomechanical Properties in Obstructive Sleep Apnea Syndrome | ||||
Fifty-four eyes of 54 patients with OSAS and 20 eyes of 20 healthy subjects were evaluated to investigate the corneal biomechanical properties and anterior segment parameters in patients with obstructive sleep apnea syndrome (OSAS). Patients with mild and moderate OSAS (Respiratory Disturbance Index [RDI] <30) were enrolled in group 1, those with severe OSAS (RDI≥30) were enrolled in group 2 and controls were enrolled in group 3. Corneal biomechanical properties including: corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) were measured with an ocular response analyzer. Maximum (Kmax), minimum (Kmin), and mean simulated (SimKm) keratometry values, corneal astigmatism (CA) and central corneal thickness (CCT) were evaluated with Pentacam Scheimpflug imaging.
The mean CH and CRF were significantly lower in group 2. The mean CH was 10.9±1.4mm Hg in group 1, 10.1±1.1mm Hg in group 2, and 12.1±1.2mm Hg in group 3. The mean CRF was 11.1±1.8mm Hg in group 1, 9.9±1.1mm Hg in group 2 and 12.2±1.2mm Hg in group 3. The CH and CRF values were similar between the groups 1 and 3. Corneal-compensated intraocular pressure, IOPg, Kmax, Kmin, SimKm, CA and CCT values were not statistically different among the three groups. Patients with severe OSAS had lower CH and CRF values. They suggested that the lower CH and CRF values in the severe group were possibly related to changes of the structural properties in the cornea. |
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SOURCE: Dikkaya F, Yıldırım R, Erdur SK, et al. Corneal biomechanical properties in obstructive sleep apnea syndrome. Eye Contact Lens. 2018; Feb 7. [Epub ahead of print]. |
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Progressive Change in Peripapillary Atrophy in Myopic Glaucomatous Eyes | ||||
These investigators evaluated the progressive changes in peripapillary atrophy (PPA) according to shape, and explored the relationship between PPA progression and glaucoma worsening in myopic eyes. A total of 159 eyes of 159 patients with myopic (axial length (AXL) >24 mm) glaucoma (mean follow-up 4.4 years, 35 eyes with minimal PPA, 40 concentric-type PPA eyes [>270° around the optic disc] and 84 eccentric-type PPA eyes [<270°]) were included. Sequential stereoscopic color optic disc photographs were evaluated to qualitatively determine PPA progression. Factors associated with PPA progression were explored by Cox proportional hazard modeling in each PPA group.
Patients with concentric PPA were older than patients with eccentric PPA (54.1±11.7 vs. 44.1±11.7 years), and AXL was longer in the eccentric group than in the other groups (25.54±1.68mm vs. 25.28±1.53mm vs. 26.41±1.29mm). Twenty-six eyes (65%) in the concentric group and 36 eyes (42.9%) in the eccentric group showed PPA progression. Older age (hazard ratio (HR) 1.059), worse baseline visual field mean deviation (HR 0.857) and greater baseline PPA area (HR 1.000) were associated with PPA progression in the concentric type. Glaucoma progression (HR 3.690) and longer AXL (HR 1.521) were associated with PPA progression in the eccentric type. Investigators found that the relationship between glaucoma worsening and PPA progression was strongest in myopic glaucomatous eyes with eccentric type PPA. |
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SOURCE: Song MK, Sung KR, Shin JW, et al. Progressive change in peripapillary atrophy in myopic glaucomatous eyes. Br J Ophthalmol. 2018; Feb 2. [Epub ahead of print]. |
News & Notes | ||||||||
Stereo Optical Launches Newly Designed StereoOptical.com Essilor Instruments announced the launch of a newly designed website for its Stereo Optical business unit offering vision screening tools and equipment. The website summarizes all major product offerings, including the Optec Plus digital vision screener and Functional Vision Analyzer for use in ophthalmology, optometry, clinical trials and more. Read more. |
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J&J Vision Appoints Dr. Mayers as Director of US Advocacy, Vision Care Michael Mayers, OD, FAAO, the new director of U.S. Advocacy, Vision Care at Johnson & Johnson Vision, joined the company in 2011, and has held roles in R&D clinical development, global medical affairs and global marketing. Prior to joining the company, Dr. Mayers practiced in his own optometric practice and consulted as a key opinion leader with several eye health companies. Dr. Mayers is a graduate of The Ohio State University College of Optometry, a fellow of the American Academy of Optometry and a member of the American Optometric Association and the Contact Lens and Cornea Section within the AOA. Editors Note: Warmest congratulations to Dr. Mayers on this well deserved promotion. I’ve known Mike for years and expect great things from him in his new role! |
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EyePromise Announces Senior Leadership Changes EyePromise and its parent company ZeaVision Holdings announced a series of organizational changes designed to help eye care practitioners manage their practices efficiently, effectively and profitably. Effective immediately, ZeaVision Chairman and CEO Dennis Gierhart, PhD, will serve as EyePromise’s interim-president while the company performs an executive search to identify a successor to Chris Barber. Read more. |
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Optometric Physician™ (OP) newsletter is owned and published by Dr. Arthur Epstein. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073. HOW TO ADVERTISE |