Optometric Physician

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


Volume 20, Number 6

Monday, February 3, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: Should I Stay or Should I Sell?
######### Survey of Ehlers-Danlos Patients' Ophthalmic Surgery Experiences
######### Pseudotumour Cerebri Syndrome in China: a Cohort Study
######### Changes in Corneal Biomechanics During Pregnancy in Chinese Healthy Female
######### News & Notes

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Off the Cuff: Should I Stay or Should I Sell?

2019 saw more and more of our colleagues selling to equity capital. Friends you never imagined would sell have transitioned from owner to employee or, in some cases, retired. The sell-off is even more profound in ophthalmology. On Long Island, a friend shared that he was selling his practice—one of the last independent ophthalmology practices still standing—to the hospital, a merged conglomerate. In Phoenix, virtually every large ophthalmology group is owned by equity capital.

For some, it's worked out well. For others, not so much. The transition to employee can be a rocky road. Still, the lure of cashing out at several-times-what-you-thought-your-practice-was-worth is strong. The fear of missing the last train out is even stronger, and former optometric allies like VSP that have turned against us are not helping to make remaining independent practitioners feel safe or secure.

So what should you do? Should you stay or should you sell? As I see it, joining a large group has advantages, but some friends who have made the jump are unhappy and filled with remorse. Eventually, some of the larger players will fail, and some practices will fail along with them. So if you are going to sell, selecting the right partner is critical.

As for us, we have no plans to sell. One reason is we've been preparing for this changing environment since we opened the office. As a referral-based practice focused on providing complex and often time-consuming care, we fill a niche that isn't profitable for the larger, higher-volume megapractices. Outsourcing complex specialty care improves patient satisfaction for the larger and busy providers, and creates synergy and opportunity for independents. Word to the wise: If you're independent now and want to stay that way, finding a viable specialty niche will help ensure your survival during the turbulent times that are surely to come.

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.



Survey of Ehlers-Danlos Patients' Ophthalmic Surgery Experiences

Ehlers-Danlos Syndrome (EDS) is a rare disease affecting approximately one in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients. Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists.

Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery and laser surgery for glaucoma. The rate of confirmed complications was: 23%-refractive, 33%-lens/cataract, 33%-retina, 59%-strabismus, 23%- oculoplastics, 0%-cornea and 25%-glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis.

Researchers reported that patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. They wrote that systematically and prospectively studying how patients with EDS respond to ophthalmic surgery might be a possible area of exploration. Furthermore, they wrote, it would seem circumspect to ask surgical candidate patients about whether they carry a diagnosis of EDS, or have signs and symptoms of EDS prior to surgery.

SOURCE: Louie A, Meyerle C, Francomano C, et al. Survey of Ehlers-Danlos Patients' ophthalmic surgery experiences. Mol Genet Genomic Med. 2020; Jan 27:e1155. [Epub ahead of print].

Pseudotumour Cerebri Syndrome in China: a Cohort Study

Pseudotumour cerebri syndrome (PTCS) remains to be fully investigated in Chinese patients, and this study reported PTCS-related clinical differences between Chinese patients and Western patients. This study enrolled 55 consecutive patients (females: 44, median age: 37 years, age range: 14 to 62 years) with PTCS diagnosed from October 2015 to December 2017. Nine (16.4% females) patients had primary PTCS, and 46 (83.6%) had secondary PTCS.

At presentation, 81.8% of patients had grade >three papilloedema, with 23.6% having diffusely constricted fields. Mean subarachnoid space around the optic nerve measured by retrobulbar ultrasonography during lumbar puncture was 1.12mm ± 0.17mm and decreased to 0.86mm ± 0.11mm after treatment. Optical coherence tomography (OCT) showed that 92.9% of eyes with intact macular ganglion cell-inner plexiform layer (GCIPL) at baseline had good outcomes after treatment.

Patients' demographic and clinical characteristics showed that secondary PTCS was more common than primary idiopathic intracranial hypertension in Chinese patients. Polycystic ovarian syndrome was the main associated factor in females. Poor visual function was common at presentation. Noninvasive ocular ultrasonography and OCT were the prognostic indicators of PTCS treatment in intracranial pressure and visual function, respectively, after PTCS treatment.

SOURCE: Chen Q, Feng C, Zhao G, et al. Pseudotumour Cerebri Syndrome in China: a cohort study. Sci Rep. 2020;10(1):1222.



Changes in Corneal Biomechanics During Pregnancy in Chinese Healthy Female

A total of 222 unrelated Chinese females were recruited: 52 non-pregnant, 15 pregnant in the first trimester, 68 pregnant in the second trimester and 87 pregnant in the third trimester, to evaluate the changes of corneal biomechanics and the intraocular pressure during pregnancy in a Chinese healthy female population. The intraocular pressure and corneal biomechanical parameters, including corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, corneal hysteresis and corneal resistance factor, were measured by an Ocular Response Analyzer G3. Central corneal thickness was measured by Lenstar LS900.

Corneal hysteresis and corneal resistance factor were significantly higher in pregnant women at the second and third trimesters. Corneal-compensated intraocular pressure was lower in women at the third trimester of pregnancy, but the difference became insignificant after adjustment for corneal hysteresis. Central corneal thickness was marginally higher in pregnant women than non-pregnant women. There was a negative correlation between corneal-compensated intraocular pressure and corneal hysteresis, and a positive correlation between central corneal thickness and corneal hysteresis. After adjustment for corneal-compensated intraocular pressure, corneal hysteresis remained significantly higher in the second and third trimesters of pregnant women than non-pregnant women.

This study revealed a significant increase in corneal hysteresis and corneal resistance factor in the second and third trimesters. The increase of corneal hysteresis was independent of corneal-compensated intraocular pressure, indicating pregnant females have unique characteristics in corneal-compensated intraocular pressure and corneal biomechanical properties that may be related to glaucoma and corneal ectatic diseases in pregnancy.

SOURCE: Yang Y, Ye J, Ng TK, et al. Changes in corneal biomechanics during pregnancy in Chinese healthy female. Eur J Ophthalmol. 2020 Jan 27. [Epub ahead of print].

News & Notes
J&J Vision Care Appoints Dr. Charissa Lee as Head, North America Professional Affairs
Johnson & Johnson Vision announced that Charissa Lee, OD, FAAO, was appointed to the position of Head, North America professional affairs. Dr. Lee will be responsible for professional relations, professional education and advocacy efforts. Since May 2014, Dr. Lee has served as director of professional education, where she revitalized the focus on emerging doctors and oversaw the Johnson & Johnson Institute. Over the last five years, she has been involved in Vision Care product launches like Acuvue Oasys 1-Day and Acuvue Oasys with Transitions, and has also worked on multiple projects in ocular surface disease and surgical vision. Prior to joining Johnson & Johnson Vision Care, Dr. Lee operated a successful private practice in Irvine, Calif., and was a professional affairs consultant and program director at the Johnson & Johnson Institute.

New Lid Hygiene System From Bruder
Bruder recently introduced a Hygienic Eyelid Care Kit. The kit contains:
• Bruder Moist Heat Eye Compress (1)
• Bruder Hygienic Eyelid Sheets (10)
• Bruder Hygienic Eyelid Cleansing Wipes (30)
• Bruder Hygienic Eyelid Solution (1 fl. oz.)
Bruder also offers a Hygienic Eyelid Cleansers Combo Pack that offers 30 Bruder Hygienic Eyelid Cleansing Wipes and a 1 fl. oz. bottle of Bruder Hygienic Eyelid Solution. If someone from your practice plans to attend the SECO meeting (March 4 to 8, in Atlanta), the kit will be available for ordering at booth #625. Learn more.

Topology Eyewear Introduces 3D Digital Scans
Topology Eyewear will be introducing at Vision Expo East (March 26 to 29 in New York City) a patented technology that takes an intricate 3D digital scan of a patient’s face, including the unique contours of their nose, and automatically adjusts each style in 20 different dimensions to fit them perfectly. Each frame is manufactured in San Francisco and created with Italian acetate or surgical stainless steel. Topology’s in-store virtual try-on, powered by the latest iPad with FaceID, enables an ECP to provide an interactive and differentiated shopping experience. The app, driven by a trained optician, enables customers to preview what they will look like in each custom frame before an order is placed. The app also outputs all 3D-position-of-wear measurements needed for progressive lenses. Read more.

SECO 20/20 Expands Educational Offerings with Co-located Events & Partnerships
SECO 20/20 will partner with 10 affiliate and associated organizations to host co-located events during this year’s annual meeting. Between March 4 and 8 in Atlanta, SECO 20/20, along with the 10 partner organizations, will convene optometric professionals from across the US and world to learn about the latest research, innovations and techniques in the optometric profession. Learn more and register.

Aldeyra Appoints Dr. Karpecki to Advisory Board
Aldeyra Therapeutics announced the appointment of Paul Karpecki, OD, FAAO, to the company’s Anterior Segment Scientific Advisory Board (SAB). Dr. Karpecki is clinical director, corneal services and advanced ocular surface disease at Kentucky Eye Institute and a clinician for Gaddie Eye Centers. He is an associate professor at the Kentucky College of Optometry and medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. Dr. Karpecki is the chief medical editor for Review of Optometry, and has moderated or chaired the Congressional Hearing on the Impact of Dry Eye Disease, the Tear Film and Ocular Surface Society Symposium and the Dry Eye Summit. He has served on the International Task Force on Dry Eye and the TFOS DEWS II Diagnostic Methodology sub-committee, and is a TFOS Global Ambassador. Read more.

RightEye Study Reveals Concussion Biomarker
RightEye announced the Jan. 14 online edition of Concussion, co-authored by RightEye co-founder and Chief Science Officer Dr. Melissa Hunfalvay, that validates how tracking vertical smooth pursuit can help doctors accurately and quantifiably differentiate patients with moderate and severe traumatic brain injuries (TBIs). This news expands on RightEye’s previous announcement about the use of eye-tracking technology to identify and measure the severity of TBIs with a new vision biomarker. Read more.

IDOC Adds Team Members
IDOC will enter 2020 with a record number of participating independent OD practices. In addition, two new members were added to the Practice Development Team.
• Brian Adams (Central Region), previously at Wells Fargo, Pfizer and Alcon, will focus on helping IDOC members thrive in an evolving private practice environment.
• Denise Guy (West Region), who has been a part of the optical industry for more than 22 years, serving first as a manager of a large optometry office and later in a sales capacity for Vison Service Plan (VSP), Oakley, NVision Eye Centers, Hoya and Kodak.
IDOC member ODs and staff will gather at The Connection 2020, IDOC’s annual national conference (Feb. 13 to 15) in Orlando, Fla. The event will feature Keynote Guest Billy Beane of Moneyball fame. Register here.


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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