Optometric Physician



Vol. 24, #8 •   Monday, February 20, 2023


Off the Cuff: More Than Meets the Eye

I have a patient who at 6 years old was diagnosed with an orbital rhabdomyosarcoma. He had surgery that successfully removed the cancer but disfigured his orbit yet saved his life. Amazingly, the eye was still sighted. You can only imagine the difficulties of navigating his childhood as a cancer patient who looked different and what kind of lifelong impact that would have on him. After undergrad, he was finally able to undergo a long-awaited reconstruction of the orbit. Unfortunately, during this surgery his optic nerve was “nicked” instantly blinding that eye. He now has so little eyelid tissue that the nasal half cannot close, subsequently leaving him with chronic exposure, blepharitis, trichiasis, meibomian gland dysfunction, and an inability to be fit with a scleral shell, so the resulting recurrent corneal ulcerations and scarring was not surprising.

One weekend when another of these ulcerations recurred, he was seen at one of our not-so-friendly corneal specialist's office. He was given a prescription for antibiotics along with a referral for enucleation. The next day I got a panicked phone call from his wife. Was this his only option? Was there anything else that could be done? The patient's history with surgeries and his left eye were far from stellar so neither he or his wife were prepared when this was the recommendation given. When I saw the ulcer later that day, it was bad but salvageable. An amniotic membrane healed it quickly and after another discussion stressing the importance of maintenance care for that eye, that he admittedly would get lax on, he still has the eye.

Was the enucleation recommendation the wrong call? Not really. I had had a discussion with him in the past about blind painful eyes and the potential for enucleation, so the procedure would make sense. However, for this patient, his case was more than treating recurrent ulcers on a blind eye. His eye represented a physical and emotional journey that started in childhood, and the idea of losing the eye, even if it was essentially nonfunctional, would be another in a long series of traumatic events. Cases like these act as reminders that we need to take into consideration the whole patient—including their psychological and emotional, as well as their physical, well-being when recommending a course of treatment.


Shannon L. Steinhäuser, OD, MS, FAAO
Chief Medical Editor


Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.


Pediatric Myopia Shift During the COVID-19 Pandemic Home Quarantine

Outdoor activities were restricted during the COVID-19 outbreak, although digital learning grew. Concerns have been raised about the impact of these environmental changes on myopia status. This literature search aimed to examine myopia shift during the COVID-19 pandemic and offer the community evidence-based data. The literature search was undertaken in PubMed, SCOPUS, Science Direct, Web of Science and Google Scholar databases on published papers before May 17, 2022. The main outcome was mean spherical equivalent refraction (SER) before, at the onset and at the end of follow-up, during the COVID-19 pandemic.

Among 518 articles, 10 studies were included in the meta-analysis. The mean SER differences during the COVID-19 pandemic follow-up (mean follow-up time was 10 months) compared with before the pandemic was 0.15 diopter. After age adjustment using meta-regression, the mean SER differences during the COVID-19 follow-up compared with before the pandemic was -0.46D. Over the mean follow-up time during the COVID-19 pandemic, the SER mean difference was -0.55D showing that the mean SER had decreased significantly during the COVID-19 pandemic. The mean SER differences in myopic patients before COVID-19 compared with during the pandemic follow-up was -0.49D. Thus, the prior pandemic myopic patients became more myopic during the pandemic follow-up time.

This literature review indicates that during home quarantine, the mean SRE shifting in pediatrics accelerated. The authors wrote that this phenomenon should be given more attention by policymakers, eyecare experts, educators and parents.

SOURCE: Abounoori M, Aghajani A, Chaibakhsh S, et al. Paediatric myopia shift during the COVID-19 pandemic home quarantine: a systematic review and meta-analysis. BMJ Paediatr Open. 2022;6(1):e001755.



Prevalence of Meibomian Gland Atrophy in Patients Undergoing Cataract Surgery

The aim of this study was to determine the prevalence of meibomian gland (MG) atrophy in a US-based population of patients presenting for cataract surgery. In this retrospective study, case records of 391 patients ages 50 years or older, who had undergone a preoperative cataract surgery workup with meibography, were included. The amount of atrophy in the lower eyelid was graded as described by Arita et al. (grade 0=no atrophy, grade 1=1%-33% atrophy, grade 2=34%-66% atrophy, and grade 3=>66% atrophy), and the prevalence of MG atrophy was determined. Associations between MG atrophy and demography, comorbidities, and risk factors were evaluated.

Overall, 95.1% of patients had MG atrophy ≥grade 1, with 50.4% having grade 1, 25.8% grade 2, and 18.9% grade 3. MG atrophy had a statistically significant correlation with MG expressability but not with meibum grade and telangiectasia. The prevalence of MG atrophy (≥grade 1) was comparable among patients who had previously been diagnosed with dry eye disease (DED) vs. those who had not; however, the severity of MG atrophy was higher in patients with previous DED diagnosis (grade 2/3: 59% vs. 30.9%). Among patients with no previous history of DED, 18% (35/194) had moderate and 13% (25/194) had severe MG atrophy.

The authors concluded that MG atrophy is common in patients presenting for cataract surgery evaluation, indicating potential underdiagnosis. Routine use of meibography during preoperative screening in cataract surgery patients may facilitate more timely and effective diagnosis and treatment.

SOURCE: Yeu E, Koetting C, Calvelli H. Prevalence of meibomian gland atrophy in patients undergoing cataract surgery. Cornea. 2023; Jan 12 .[Epub ahead of prin]t.

Epidemiology and Burden of Astigmatism: A Systematic Literature Review

This is the first literature review to report and summarize the epidemiology, patient burden, and economic burden of astigmatism in the general adult population. The unmet needs of astigmatism patients with co-existing ocular conditions (cataract, glaucoma, dry eye, presbyopia, or macular degeneration) and risks associated with untreated astigmatism are also reviewed and reported. MEDLINE, EMBASE, and Cochrane Library databases were searched (January 1996-May 2021). Search results were limited to the English language. Proceedings (2018-2021) from ophthalmology congresses were searched along with gray literature using the Google Scholar platform.

The literature search yielded 6,804 citations, of which 125 met the inclusion criteria (epidemiology: 68; patient burden: 60; economic burden: 6). Astigmatism prevalence in the general population varied from 8% to 62%, with higher rates in individuals ≥70 years. The prevalence of with-the-rule astigmatism was higher in individuals ≤40 years, while rates of against-the-rule and oblique astigmatism increased with age. Astigmatic patients experienced decreased vision quality, increased glare (53 to 77%), haloes (28 to 80%), night-time driving difficulties (66%), falls, and spectacle dependence (45 to 85%). Astigmatic patients performed vision-related tasks slower (1D: 9% slower, 2D: 29% slower) and made more errors (1D: 38% more errors, 2D: 370% more errors) compared to fully corrected individuals. In cataract patients with astigmatism, the annual mean per patient productivity loss costs ranged from €55 ($71) to 84 ($108) and mean informal care costs ranged from €30 ($39) to 55 ($71), with a mean of 2.3 to 4.1 hours spent on informal care.

The authors wrote that from this literature review it can be concluded that uncorrected astigmatism decreases patients' vision-related quality of life, decreases productivity among working-age adults, and poses an economic burden on patients and their families.

SOURCE: Zhang J, Wu Y, Sharma B, et al. Epidemiology and burden of astigmatism: a systematic literature review. Optom Vis Sci. 2023 Feb 7. [Epub ahead of print].



Industry News

Bruder Now Exclusive Licensor of Dry Eye Drink

Bruder Healthcare announced an exclusive licensing agreement with Dry Eye Drink, the manufacturer of dry eye products and drink mixes formulated to provide relief for US adults suffering from symptoms of dry eye disease. The drink formulations pair known anti-inflammatory, anti-oxidative and antibacterial ingredients with an electrolyte hydration formula to help with ocular inflammation, tear health and meibum oil gland production. Learn more.

Harrow Launches Next-generation Compounded Atropine Formulations

Harrow launched its patent-pending, next-generation compounded atropine formulations, now available through Harrow’s wholly owned compounding and mail order pharmacy subsidiary, ImprimisRx. Read more.












Journal Reviews Editor:
Katherine M. Mastrota, MS, OD, EMBA, 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), 19 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. HOW TO SUBMIT NEWS E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

Advertising: For information on advertising in this e-mail newsletter, please contact sales managers Michael Hoster, Michele Barrett or Jonathan Dardine.

News: To submit news or contact the editor, send an e-mail, or FAX your news to 610.492.1039