Optometric Physician

Vol. 21, #7   •   Monday, February 22, 2021


Off the Cuff: Coming to America

With the isolation of COVID, Shannon and I have, more than in the past, turned to TV to keep our sanity and fill gaps previously satisfied by travel, friends and the normal routine of our lives. One show, PBS’ Finding Your Roots, hosted by Henry Louis Gates, is among our favorites, and as it has for many of the celebrities on the show, connected us to our own roots.

Growing up in a working-class section of the Bronx, I was surrounded by a veritable United Nations of ethnicities, races and cultures. A curious kid, I remember coming home from first grade and asking my father where we came from. My father didn’t talk much about his childhood, but he answered quickly, “sometimes Russia, sometimes Poland.” I insisted, “come on Dad, we can’t be from two places, Tommy’s parents came from Ireland and Louie’s grandparents from Italy. Where are we from?” He looked at me with growing impatience and said in a much louder voice, “sometimes Russia, sometimes Poland.” I knew it was time to stop asking. Years later, while cleaning out old papers after my parents had passed, I found my grandfather’s passport. Covered in fine leather and with a very formal picture, his country of origin was listed as “Sometimes Russia, Sometimes Poland.” Apparently, back then, the country changed hands so often that where you were from depended on what day of the week it was.

During an episode of “Who Do You think You Are?” on NBC, I discovered that actor Lisa Kudrow and I have something in common. Our families both came from a small village called Ilya that was sometimes in Russia and sometimes in Poland. Rounding up Ilya’s Jewish population, men women and children were stripped naked by the Nazis. They were forced to wait in the cold until they were pushed to the edge of a large pit where two or three at time were shot, and thrown into the pit dead or dying while the others watched. Those that somehow managed to survive being shot were doused in gasoline and burned alive.

Much of my father’s family died in Ilya, including my father’s oldest brother, Avraham, who I am named after and his family. Kudrow’s family met the same fate. You can see her reaction here. The stark reality of that horror finally brought complete understanding of why my father could not speak of his family or of a childhood scarred by beatings and constant persecution, as he hid in cellars and alleys to escape it.

Lately I’ve been thinking a lot about this country. I’ve been thinking about our parents and grandparents. I’ve thought back to my childhood and my friends from back then. Knowing what I know now, I can’t imagine what it must have been like for my father, still a child, coming to a new country on his own on a huge ship filled with strangers. I think about my grandparents and their journey and the journeys of my friends whose parents and grandparents came to America in search of hope and opportunity. Some came to escape beatings or worse. Some left behind horrible poverty or religious persecution, while others fled from famine and starvation. Some were brought here against their will.

As I ponder it all, few, if any of us had ancestors that did not come here without pain or suffering. Despite this, virtually all of us have benefitted from being in America no matter what our family history or story. In these confusing, uncertain and often tumultuous times, perhaps we should remember that all of us share something incredibly important in common. We are Americans. GBA

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.



Corneal Stromal Regeneration Therapy for Advanced Keratoconus: Long-term Outcomes at 3 Years

These researchers reported the three-year clinical outcomes of corneal stromal cell therapy consisting of the intrastromal implantation with autologous adipose-derived adult stem cells (ADASCs), and decellularized or ADASC-recellularized human donor corneal laminas in advanced keratoconus. Fourteen patients were enrolled in three experimental groups. Group 1 (G-1) patients underwent implantation of ADASCs alone (3 × 106 cells/1 mL) (n=5). Group 2 (G-2) patients received a 120-μm decellularized corneal stroma lamina (n=5). Group 3 (G-3) patients received a 120-μm lamina recellularized with ADASCs (1 × 106 cells/1 mL) (n=4). ADASCs were obtained by elective liposuction. Implantation was performed into a femtosecond pocket under topical anesthesia.

At three years, a significant improvement of 1 to 2 logMAR lines in uncorrected distance visual acuity was observed in all groups. A statistically significant decrease in corrected distance visual acuity was obtained in G-2 and G-3 when compared with that of G-1. Rigid contact lens distance visual acuity showed a statistically significant worsening in G-2 compared with that of G-1. A statistically significant increase in central corneal thickness was observed in G-2 and G-3; in the Scheimpflug corneal topography, the thinnest point was observed in G-2 and G-3 when compared with that of G-1.

Intrastromal implantation of ADASCs and decellularized or ADASC-recellularized human corneal stroma laminas did not have complications at three years. The technique showed a moderate improvement in (uncorrected distance visual acuity) and (corrected distance visual acuity) in advanced keratoconus.

SOURCE: El Zarif M, Alió JL, Alió Del Barrio JL, et al. Corneal stromal regeneration therapy for advanced keratoconus: long-term outcomes at 3 Years. Cornea 2021; Feb 15. [Epub ahead of print].


Avoiding Mask-related Artefacts in Visual Field Tests During the Covid-19 Pandemic

Researchers reviewed a total of 307 VFs performed with a face mask (FPP2/KN95 or surgical masks) and compared them with prior visual fields (VF), performed before the pandemic to assess VF pseudoprogression related to face mask use. VFs with suspected pseudoprogression due to mask artefacts (VF test 1) were repeated with a surgical mask and an adhesive tape on its superior border (VF test 2) to distinguish from true VF loss. Several parameters including reliability indices, test duration, VF index (VFI), mean defect (MD) and pattern deviation probability plots were compared among last pre-COVID VFs, VF tests 1 and VF tests 2, using the Wilcoxon signed-rank test.

Researchers identified 18 VFs with suspected progression artifacts due to masks (5.8%). In all of them, the median VFI and MD significantly improved after fitting the superior border of the mask, showing no significant differences with pre-COVID tests. The median fixation losses were significantly higher when wearing the unfitted mask (13% vs 6%). The inferior hemifield was the most affected, either as a new scotoma or as an enlargement of a prior defect.

Researchers concluded that unfitted masks simulated VF progression in around 6% of cases, mainly in the inferior hemifield, and increased significantly the rate of fixation losses. A similar rate of artifacts was observed using FPP2/KN95 or surgical masks. They added that the use of a surgical mask with an adhesive tape covering the superior border may reduce mask-related artifacts, although concomitant progression cannot be ruled out in all cases.

SOURCE: Gómez Mariscal M, Muñoz-Negrete FJ, Muñoz-Ramón PV, et al. Avoiding mask-related artefacts in visual field tests during the COVID-19 pandemic. Br J Ophthalmol. 2021 Feb 17:bjophthalmol-2020-318408.


The Effects of Colour and Temporal Frequency of Flickering Light on Variability of the Accommodation Response in Emmetropes and Myopes

Myopia is hypothesized to be influenced by environmental light conditions. For example, it has been shown that color and temporal frequency of flickering light affect emmetropization in animals. Considering the omnipresence of flickering light in our daily life, investigators aimed to analyze the effect of color flickers on variability of the accommodation response (VAR) in emmetropes and myopes. They measured the dynamic accommodative responses of 19 emmetropic and 22 myopic adults using a Grand Seiko WAM-5500 open-field autorefractor. The subjects focused for more than 20 s on a black Snellen E target against three different backgrounds made up of three color flicker combinations (red/green, red/blue and blue/green) and under five frequency conditions (0.20 Hz, 0.50 Hz, 1.00 Hz, 1.67 Hz and 5.00 Hz).

Flicker frequency and color both had a significant effect on VAR. Lower frequencies were associated with larger variability. Color had an effect only at low frequencies, and red/blue color flicker resulted in the largest variability. The variability in myopes were larger than those in emmetropes.

These findings support the hypothesis that further studies on the color and temporal frequency of flickering light can lead to a better understanding of the development and progression of myopia.

SOURCE: Zhang L, Guo D, Xie C, et al. The effects of colour and temporal frequency of flickering light on variability of the accommodation response in emmetropes and myopes. BMC Ophthalmol. 2021; Feb 17;21(1):88.




Industry News

Alcon Announces Broad Retail Availability of Pataday

Alcon announced that Pataday Once Daily Relief Extra Strength (olopatadine hydrochloride ophthalmic solution 0.7%) is now available in-store and online at U.S. retailers, following its 2020 approval by the FDA for sale over-the-counter. It is available in select stores and via online retailers, such as Amazon, Walgreens, CVS, Target and more, with widespread commercial availability to begin this month in all major drug, food and mass-market retailers. Read more.




IDOC Partners With Diversity Perspective, Reports Successful Virtual Conference

IDOC announced a new strategic partnership with two of the eye care industry’s diversity leaders, Darryl Glover, OD, of Durham, N.C., and Adam Ramsey, OD, of Palm Beach Gardens, Fla. The two independent optometrists and founding members of Diversity Perspective will create and share strategic recommendations with the IDOC management team designed to increase the adoption of diversity, equity and inclusion principles. Results of the partnership include two training sessions with IDOC employees on “Unconscious Bias at Work” and “Courageous Conversations: Race in the Workplace,” with more planned throughout 2021. Learn about IDOC.
In addition, IDOC's Connection 2021, IDOC’s annual national conference, took place virtually this year, and the alliance reported a successful virtual event featuring general sessions, exhibitor booths, nightly entertainment and networking opportunities for more than 1,100 attendees. The three-day online event also featured live chat rooms, continuing education and a roster of noteworthy keynote speakers. ODs and their staff members can still register and access the on-demand material by visiting the website. View the on-demand materials through Feb. 28.

Reichert Debuts New Website

Reichert Technologies launched a newly redesigned website for an improved user experience. The website, still at reichert.com, features a streamlined, modern design with improved functionality optimized for mobile devices. The company’s revamped website offers improved security, enhanced navigation and more robust contact capabilities. With a renewed focus on customer usability, the site provides extensive product, technical and application information for customers in an easy-to-use interface. Read more.



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