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


Volume 18, Number 8

Monday, February 19, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: Who’s Who
######### Relationships Between Meibomian Gland Loss and Age, Sex and Dry Eye
######### Nonsurgical Procedures for Keratoconus Management
######### Chronic Ocular Sequelae of Stevens-Johnson Syndrome in Children
######### News & Notes

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Off the Cuff: Who’s Who

I just had an interesting conversation with a close friend who is high up in the eye care industry. He bemoaned how difficult it has become to find true experts to work with and shared a discussion he recently had with one of the world’s top corneal surgeons. The surgeon spoke about his own career and how he had become renowned in his specialty. He talked of countless hours of research, myriad publications, of his teaching and leadership, and how that was the norm as he came up through the ranks. He then expressed of how frustrating it has become to see how trade and now social media aggrandize colleagues who seem more interested in fame and fortune than contributing to knowledge and improving care for patients. I couldn’t help but agree.

It wasn’t always this way. There was a time when greatness surrounded leading clinicians who were well-recognized and admired. I recall meeting Frederick Theodore of SLK fame. He may not have been the most gracious of men, but as I shook his hand I was touched by the significance of his presence. In my early career, I was surrounded and inspired by greatness. Hank Perry, a brilliant corneal specialist and key mentor showed his true depth when treating the worst cases or those who could least afford to pay for his care. His partner, Eric Donnenfeld, took me under his wing and opened countless doors for me. Eric went on to become among the most influential ophthalmologists of our generation.

In optometry, Donald Korb and Irvin Borish come to mind for their overwhelming significance and profound influence on our profession. Donald’s extraordinary clinical acumen and brilliant analytical mind will impact generations to come. Had he not blazed a wide path, I would not be who I am today. Norman Haffner, past president of SUNY College of Optometry, was a mentor and later a friend. Haffner was a major force in optometry’s evolution to primary eye care. The sheer power of the man would electrify a room. Our profession would not be what it is today if not for Norman. These role models and the many others I had the good fortune to encounter throughout my career set standards and direction for me and for many others.

There are many individuals in optometry and ophthalmology whom I have the utmost respect for. These men and women have paid their dues, and most continue to contribute throughout their careers. However, we are seeing the emergence of a growing number of self-appointed experts who are more focused on personal agenda than advancing the field. Being able to tell the difference is sadly becoming an increasingly important skill.

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.


Relationships Between Meibomian Gland Loss and Age, Sex and Dry Eye
This study evaluated relationships between meibomian gland loss (MGL) and age, sex and dry eye. Dry eye and MGL of the lower eyelid was evaluated from 112 randomly selected subjects (66 women; mean age 62.8; SD ±15.7; and age range: 19 to 89 years) from Horst Riede, Weinheim, Germany. In addition, subjects were grouped into dry eye and non-dry eye by the Ocular Surface Disease Index (OSDI) score, lid-parallel conjunctival folds and non-invasive break-up time. Symptoms were evaluated by the OSDI. Meibography of the lower eyelid was performed using a Cobra camera (bon Optic, Lübeck, Germany), and images were analyzed using digital grading. Data were analyzed by backward, multiple regression analyses and Pearson correlation.

Multiple regression analyses detected that age and dry eye status (dry eye diagnosis or OSDI) but not sex were significantly related to MGL. In non-dry eye (n=66) and dry eye subjects (n=46), dry eye status (OSDI) but not age or sex was significantly related to MGL. Ocular Surface Disease Index scores were significantly correlated with MGL, but this correlation was stronger among all subjects and dry eye group subjects than in non-dry eye group subjects.

Dry eye group subjects showed significantly increased MGL of the lower eyelid. Researchers concluded that age and dry eye status were related to MGL of the lower eyelid, but sex was not; dry eye status was the dominant factor.

SOURCE: Pult H. Relationships between meibomian gland loss and age, sex, and dry eye. Eye Contact Lens. 2018; Feb 12. [Epub ahead of print].

Nonsurgical Procedures for Keratoconus Management
These authors described correction modalities used over the past 20 years for keratoconus with associated visual outcomes and possible complications. A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed.

The most nonsurgical procedure used on keratoconus management was the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses formed the contemporary range of available lens types for keratoconus management with contact lenses. All strategies aimed to restore the vision, improve the quality of life and delay surgical procedures in patients with disease. Complications were derived from the intolerance of using contact lens, and the use of each depended on keratoconus severity.

Authors wrote that, in the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represented a good alternative to restore vision and improve the quality of live in this population.

SOURCE: Rico-Del-Viejo L, Garcia-Montero M, Hernández-Verdejo JL, et al. Nonsurgical procedures for keratoconus management. J Ophthalmol. 2017;2017:9707650.




Chronic Ocular Sequelae of Stevens-Johnson Syndrome in Children
This study, including 568 eyes of 284 children with Stevens-Johnson Syndrome (SJS) who presented between 1990 and 2015, described the long-term ocular and visual morbidity in children with chronic sequelae of SJS and visual outcomes of various management strategies. Affected eyes either received conservative therapy (n=440) or definitive management (n=128), including lid margin mucous membrane grafting (MMG), prosthetic replacement of the ocular surface ecosystem (PROSE) contact lenses, allogeneic limbal transplantation or keratoprosthesis using an algorithmic approach based on the severity of dryness, and cause and extent of corneal damage. The primary outcome measure was best-corrected visual acuity (BCVA).

Two-thirds of patients presented more than a year after acute SJS—99% without prior amniotic membrane grafting, with low-vision or blindness in 60% of eyes. Children eight years or younger in age had significantly worse ocular and visual morbidity. At five-year follow-up, definitive therapy significantly altered the natural history of the disease by improving BCVA and preventing the development or progression of keratopathy, as compared with conservative therapy. In eyes with lid-related keratopathy, MMG was significantly more effective than PROSE, although both were significantly better than conservative therapy, and the combination of MMG followed by PROSE provided the best results.

Children receiving suboptimal care during acute SJS presented later with severe ocular and visual morbidity. Timely therapy, particularly with PROSE and MMG in eyes with lid-related keratopathy changed the natural course, and helped in preserving and improving vision.

SOURCE: Basu S, Shanbhag SS, Gokani A, et al. Chronic ocular sequelae of Stevens-Johnson Syndrome in Children: Long-term impact of appropriate therapy on natural history of disease. Am J Ophthalmol. 2018; Feb 5. pii [Epub ahead of print].

News & Notes
Stereo Optical Launches Three Stereotests Including LEA Symbols
Essilor Instruments today announced the launch of three stereotests including LEA Symbols, the Original Stereo Fly, Butterfly, and Randot®, by its Stereo Optical division. Stereo depth perception tests are an effective and easy-to-use method of screening stereoscopic vision for all ages. The three new stereotests including LEA Symbols are designed to screen the vision of young children and supplement the existing extensive Stereo Optical product line. Read more.


MedPhoto Helps Clinicians Manage Photos
For clinicians who take and utilize a large number of photos and clinical images with their iPads or iPhones, a HIPAA-compliant service can help manage and organize these files. MedPhoto Manager is designed to provide doctors utilizing iPads/iPhones with streamlined organization of medical photography, as well as communication with colleagues and patients. Individuals can use their own mobile devices to take photos and store them automatically on a HIPAA-compliant cloud server without uprooting their existing electronic health records system. Patients have direct access to their photo folders, and practitioners can attach notes to the images. The app can be downloaded on the App store. Read more.

William L. Hudson BVI Workforce Innovation Center Launched
Envision partnered with sister agency LC Industries and launched the William L. Hudson BVI Workforce Innovation Center. The facility will provide resources to train people who are blind or visually impaired and place them into skilled positions, as well as offer accessibility inclusion expertise to businesses around the United States. Mike May, considered a pioneer and leader in the accessible technology sector, was appointed executive director. Efforts begun to raise $1.5 million by Dec. 1, 2018, to receive a $750,000 challenge grant from the J.E. and L.E. Mabee Foundation. Funds will support the construction and ongoing operation of the new facility.

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



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