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


Volume 18, Number 7

Monday, February 12, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: A Tree Doesn’t Grow in The Garden State
######### Association Between Optic Nerve Head Deformation & Retinal Microvasculature in High Myopia
######### Corneal Biomechanical Properties in Obstructive Sleep Apnea Syndrome
######### Progressive Change in Peripapillary Atrophy in Myopic Glaucomatous Eyes
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


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.

I yearn for the days when Ben Casey, TV’s first neurosurgeon, would go to a patient’s tenement apartment to check on them after removing a subdural hematoma. Gruff and dispassionate as a doctor could be back then, he still cared. So much so, that his mentor Dr. Zorba had to remind him at the beginning of every episode that he was only a man—and implicitly, not God. Later, Dr. Kildare was too good looking to be anything but brilliant, and some still smile remembering the warm feeling toward doctors that Richard Chamberlain created in that role.

What of Marcus Welby? Loved by everyone, his GP instincts could diagnose the most obscure diseases, and his fees were paid with respect and love and the occasional chicken. Memorable as a counterpoint to Seinfeld was St. Elsewhere. Gritty and grimy, but despite the blood and the dark subplots, there was always time for the patient, and—absent the occasional intentionally poignant sad story or overbaked social issue—most got put back together.

Those TV shows were a glorified, larger-than-life reflection of how we saw ourselves and how the public saw us. Good decent people who chose health care because we wanted to make a difference. Yes, most of us wanted a stable job and a good living, but we wanted to earn it helping people.

Sadly, that’s all gone, and society will, ultimately, pay a price for its loss. On Dec. 22, 2017, the Attorney General of New Jersey, a state already recognized for its leadership in legislative and regulatory intransigence, enacted new regulations for health care providers. Forget the pens, coffee cups and other meaningless trinkets that have long ago disappeared. Forget the Sunshine Act and its inexplicable and undeserved indignities aimed squarely at health care providers. New Jersey’s disdain for doctors and the pharmaceutical industry was made clearer than in perhaps any other state.

While every doctor practicing in New Jersey will experience this thinly veiled anti-provider, anti-pharma sentiment firsthand, those who do promotional speaking or consulting are now limited to earning $10,000 a year. For the rest of you practicing in Jersey, you get to endure a $15 meal cap for events and meetings, as mean-spirited and absurd as that is. So, if you practice in the Garden State and want to learn about a new drug or indication, I suggest you bring along a sandwich.

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.



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.

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.

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].




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.

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.

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!

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.

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
Review of Optometry's New Technologies and Treatments in Eye Care



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



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.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add Optometricphysician@jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Optometric Physician.

E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

For information on advertising in this e-mail newsletter or other creative advertising opportunities with Optometric Physician, please click here for advertising information.