Optometric Physician



Vol. 23, #8   •   Monday, February 28, 2022


Off the Cuff: As US Cities Become Unsafe, Where Do We Go?

Growing up in the Bronx, I learned how to navigate big cities early on. I rode the subways by myself when I was 8 or 9. My highly developed Spidey sense for danger held me in good stead even as I travelled the world. I’ve walked and travelled in cities around the globe with confidence and a sense of personal safety. Unfortunately, those days are gone.

Shortly before COVID hit, a long-awaited trip to San Francisco for a lecture was an eye opener. San Francisco is one of our favorite cities in the world. Oddly, although I never lived there, I know it like the back of my own hand. The San Francisco we visited was dirty, tense and filled with angry homeless young people. It was unrecognizable.

In the intervening months, which seem like years, the cancer of San Fran has spread. It’s now infected many, if not most, large cities throughout the US where record-breaking crimewaves and social unrest have combined to make life more dangerous than it’s been in years. Some cities are essentially becoming unlivable.

Many of the big cities that we looked forward to visiting every year are simply not worth the risk, at least as I see it. In my beloved NYC, mid-day carjackings take place in Times Square. Over this past weekend, six people were stabbed on the NYC subway system while entry barriers are being erected to prevent people from being pushed onto the subway tracks.

If our large professional meetings are to survive as COVID recedes, safety must be a concern. Until we come to grips with our fall into societal madness, meeting organizers must recognize the dangers and shift meetings to safer venues. Some meetings may survive the difficult transition. For those who don’t recognize the risk and the increasingly evident benefits of online education, extinction awaits.



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 Jobson Medical Information LLC (JMI), or any other entities or individuals.




Bitemporal Peripapillary Hemorrhages: Toxic-Ischemic Optic Neuropathy Caused By Ethanol and Cocaine Abuse

A 36-year-old man presented complaining of bilateral painless vision loss. He was admitted with chronic ethanol abuse, as well as sporadic cocaine consumption three days before symptom onset. General medical evaluation dismissed cerebral and cardiovascular events. Blood tests revealed folic acid deficiency. Visual acuity (VA) included counting fingers with both eyes (OU). Fundoscopic findings included remarkable bitemporal peripapillary hemorrhages. A diagnosis of toxic-ischemic optic neuropathy was made. The hemorrhages resolved after three weeks, with VA recovering to 20/20 OU. The sequelae included bitemporal peripapillary retinal fiber loss on optical coherence tomography, and central scotomas observed on visual field tests. This is the first report of cocaine as a triggering agent for a classical presentation of toxic optic neuropathy and the presence of peripapillary hemorrhages in its initial stages.

SOURCE: Burggraaf-Sánchez de Las Matas R, Sandino-Pérez ML. Bitemporal peripapillary hemorrhages: Toxic-ischemic optic neuropathy caused by ethanol and cocaine abuse. Am J Ophthalmol Case Rep. 2022; Feb 3;25:101374.





Current Practice in the Management of Ocular Toxoplasmosis

Ocular toxoplasmosis is common across all regions of the world. Understanding of epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialized ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy.

For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing—usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%.

Our report presents a current management approach for ocular toxoplasmosis, as practiced by a large international group of uveitis-specialized ophthalmologists.

SOURCE: Yogeswaran K, Furtado JM, Bodaghi B, et al; International Ocular Toxoplasmosis Study Group, Smith JR. Current practice in the management of ocular toxoplasmosis. Br J Ophthalmol. 2022 Feb 23:bjophthalmol-2022-321091.





Late Onset Corneal Decompensation Following Retained Lens Fragment in Anterior Chamber Years After Uneventful Phacoemulsification

A 65-year-old female presented with a complaint of gradual dimness of vision in left eye for four months. She underwent uneventful phacoemulsification with posterior chamber intraocular lens implantation elsewhere four years earlier. On examination, the CDVA in left eye was 20/200. Slit-lamp examination revealed corneal edema with Descemet's folds. The woman was diagnosed with pseudophakic bullous keratopathy and was being treated with topical steroids, cycloplegics and hyperosmolar agents for the same. She was also counseled about a lamellar corneal transplant. Posterior segment examination was within normal limits.

Since the position of the IOL (sulcus vs. bag) was not clearly seen, ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) imaging was performed to try and better understand the possible cause for corneal decompensation. To the surprise of researchers, on both UBM and ASOCT, a single, retained lens fragment was noted at 6 o'clock in the anterior chamber. AC wash was performed to remove the retained lens fragment. Three months post-AC wash, corneal edema resolved completely with improvement in the BCVA to 20/40.

This case highlights the importance of a thorough clinical evaluation supplemented with imaging modalities in order to make a complete diagnosis and eventually achieve better outcomes for the patient. In any case of unexplained corneal edema, either in the early or late postoperative period, UBM and ASOCT can become very helpful to determine the underlying cause.

SOURCE: Vasavada A, Pandit R, Nath V, et al. Late onset corneal decompensation following retained lens fragment in anterior chamber years after uneventful phacoemulsification. Am J Ophthalmol Case Rep. 2022; Feb 7;25:101303.








Industry News

Oyster Point Announces Tyrvaya Nasal Spray Covered by Express Scripts

Oyster Point Pharma announced Tyrvaya Nasal Spray’s placement on the Express Scripts National Preferred, Basic, and High Performance Formularies, effective February 19. Tyrvaya is the first and only nasal spray approved for the treatment of the signs and symptoms of dry eye disease. Read more.

Treehouse Eyes Develops New Myopia Treatment Decision App

Treehouse Eyes released the Myopia Treatment Decision App, or MY-TDA, to help partner practices discuss and track myopia progression with parents. Thanh Mai, OD, Treehouse Eyes director of myopia management services, said in a press release that MY-TDA enables partner doctors to show parents projected progression with and without treatment, displaying both refractive error and axial length, and it powerfully shows parents the impact of treatment over time.” Learn more about Treehouse Eyes.

IDOC Offers Inventory Management Service

IDOC added IDOC Inventory Management, a monthly inventory management service, to its suite of practice management solutions. The service empowers opticians to improve frame selection, pricing and physical management of inventory assets, along with providing sales training opportunities for practice staff. Learn more about IDOC.
















Journal Reviews Editor:
Shannon Steinhauser, OD, MS, FAAO

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