Optometric Physician



Vol. 24, #6 •   Monday, February 6, 2023


Off the Cuff: A Story Begins

Maybe someday you will be able to tell ‘Epstein Stories.’”— Arthur B. Epstein, OD, FAAO (May 28, 1951-September 27, 2022)

For those who do not know me, I am Dr. Cory Lappin, though many of you may know me better as the “young associate” Dr. Epstein referred to in previous columns. I was fortunate enough to have known and worked alongside Art for over three years, during which he shared many of his stories. He recounted tales of his travels around the world, his childhood in the Bronx, his exploits and triumphs, and even a few misadventures along the way. He joked that after all our talks I would one day be able to tell “Epstein Stories.” Well, it looks like he was right, and today I would like to share my personal “Epstein Story.”

I first met Art by chance on a cold, rainy night in Cincinnati almost exactly four years ago. I was in my ocular disease residency at Cincinnati Eye Institute at the time, and he was giving a dinner lecture for Shire. As a poor resident, I never passed up a free steak dinner. In the years prior to our providential meeting, I had developed a passion for dry eye. During my time as a student and resident, I couldn’t help but notice the countless patients with complaints of dry eye only to see very little being done about it. Thankfully, one of my rotations during residency was in CEI’s dry eye clinic, where I spent as much time as I could treating and learning about ocular surface disease. Through this experience, coupled with the need I saw on a routine basis, I knew it would be possible to run a practice seeing exclusively dry eye patients. However, when I shared the idea of such a practice with others, it was often met with derision or a dismissive scoff. But on that night in Cincinnati, I can still remember Dr. Epstein opening his presentation by stating, “Hello everyone, I am Dr. Art Epstein, and I practice at Phoenix Eye Care and the Dry Eye Center of Arizona. And in my practice, I exclusively see dry eye patients.” In that moment, all my experiences and beliefs were validated. His lecture was excellent, describing details of his practice throughout, and afterwards I felt compelled to introduce myself, which was not typical for me. I went up to him and thanked him for giving a great lecture and proving that a practice entirely dedicated to dry eye was truly possible. We talked for maybe two minutes, and afterwards he gave me his card and told me if I was ever in Phoenix to come and visit the practice—something I later found out he rarely ever did.

Little did I know this chance encounter would alter the course of my life. Although there is much more to this story, thanks to that brief meeting, I would ultimately end up moving 2,000 miles across the country to join the type of practice I always believed could exist, but so rarely does. And while I didn’t know it at the time, when I introduced myself to Dr. Epstein, I was actually introducing myself to the man who would become my mentor, my role model, and most importantly, my friend. He impacted the lives of so many, and I know countless others have their own “Epstein Story,” but today I wanted to start by sharing my own. While I miss him dearly, I will always be thankful I have his stories to carry with me.


Cory J. Lappin, OD, MS, FAAO


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.


Clinical Outcomes of Presbyopia-Correcting Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy

Fuchs endothelial corneal dystrophy (FECD) is considered a contraindication for the implantation of presbyopia-correcting IOLs, without sufficient corroborating evidence. This retrospective, case-control study included 19 eyes of 10 patients with grade 2-5 FECD (study group), and 57 healthy eyes of 57 patients (control group) who underwent cataract surgery with implantation of presbyopia-correcting IOLs. The target refraction was emmetropia for both groups. Two subgroups of IOLs were analyzed separately: extended depth of focus (EDOF) and multifocal IOLs. Main outcome measures were visual acuity and refraction 6 weeks after the surgery. Secondary outcomes were patient perceptions of visual acuity, spectacle independence, photic phenomena and satisfaction scores, reported in a self-assessment questionnaire.

FECD patients in the EDOF IOL subgroup had inferior uncorrected distance visual acuity and better uncorrected near visual acuity compared to the controls. They had less spectacle independence for the intermediate range and overall. However, they did not have more photic phenomena. In the multifocal IOL subgroup, no significant differences were found between the FECD and the control group in visual acuity for all ranges and in spectacle independence. FECD patients had more photic phenomena than the controls, but it did not interfere with daily life activities. There was no difference in postoperative mean spherical equivalent, patient reported visual perception, and general satisfaction between FECD and control patients in both groups.

The results of this study suggest that presbyopia-correcting IOLs can be carefully considered in patients with grade 2-5 FECD, with slightly inferior results compared with healthy eyes.

SOURCE: Blau-Most M, Reitblat O, Levy A, et al. Clinical outcomes of presbyopia-correcting intraocular lenses in patients with Fuchs endothelial corneal dystrophy. Sci Rep. 2023;13(1):786.



A "Clinical Tetrad" for Easy Diagnosis of Lacrimal Canaliculitis

The purpose of this study was to examine the clinical presentation and highlight the "diagnostic clinical features" in patients having lacrimal canaliculitis (LC). A retrospective analysis of all patients diagnosed with primary and secondary LC was performed. A detailed slit-lamp examination of the conjunctiva, lacrimal punctum, canalicular region, and lacrimal sac was done. Common and coexisting clinical features were highlighted. Posttreatment sequence of resolution of clinical features was also noted.

Forty eyes of 36 patients (28 females) with a mean age of 59.5 years were included in the study. Thirty eyes (75%) had primary LC, whereas 10 had a secondary type. Previous misdiagnoses were noted in 85% of eyes. The highlighting clinical features were medial eyelid edema, pouting and hyperemia of lacrimal punctum, yellowish canalicular hue, and canalicular distention and expressible discharge. No eyes had features suggestive of nasolacrimal duct obstruction. Thirty-two showed all four clinical features of LC, a tetrad. At a mean follow-up of 14.5 months, complete resolution was noted in 90% of eyes.

The authors proposed a "clinical tetrad" of 1. medial eyelid edema, 2. pouting and hyperemia of lacrimal punctum, 3. yellowish canalicular hue and, 4. canalicular distention and expressible discharge, for the easier clinical diagnosis of LC.

SOURCE: Singh M, Mehta A, Sharma M, et al. A "clinical tetrad" for easy diagnosis of lacrimal canaliculitis. J Curr Ophthalmol. 2022;34(3):347-51.

The Effect of Various Types of COVID-19 Vaccines on the Retinal Microvasculature

The purpose of this study was to detect the effect of various types of COVID-19 vaccine on macular and optic disc microvasculature. One hundred subjects receiving various types of COVID-19 vaccine (AstraZeneca, Sinopharm, Sinovac, Pfizer, and Moderna) were included in this study. A complete ophthalmic examination was done, which included best-corrected visual acuity measurement, slit-lamp biomicroscopy, intraocular pressure measurement with Goldmann applanation tonometry, and fundus examination. Optical coherence tomography angiography (OCTA) was done before and 1 week after subjects received the vaccine. Superficial and deep macular capillary densities were measured in the form of the whole image, fovea, parafoveal, and perifoveal capillary density. Optic disc vessel density in the form of the whole disc, inside disc, and peripapillary were also measured.

The superficial macular vessel densities, (whole image, fovea, parafoveal, and perifoveal) showed statistically non-significant changes. Also, the deep macular vessel densities showed statistically non-significant changes for the whole image, fovea, parafoveal, and perifoveal respectively. Moreover, RPC (radial peripapillary capillary) density showed no significant changes (the whole disc, inside disc, or peripapillary).

The authors concluded that, in the group studied, various types of COVID-19 vaccines had no statistically significant effects on macular or optic disc microvasculature.

SOURCE: El-Dien Mohammed El-Haddad NS, El-Wahed Hassan EA, El-Wahab Khalil AA, et al. The effect of various types of COVID-19 vaccines on the retinal microvasculature. Photodiagnosis Photodyn Ther. 2023;41:103275.



Industry News

Visionary Optics Introduces New Scleral Lens Design

Visionary Optics introduced a scleral lens, Europa Tangent, that combines an optimized customizable design with a streamlined fitting process. The enhanced lens design is based on clinical experience and analysis of over 10,000 fittings driven by profilometry data and Visionary Optics’ scleral shape classification expertise. The Europa Tangent design offers a 3-zone step-system to ensure advanced customization options remain available to eye care providers and their patients. The design has one landing zone curve, engineered to follow the natural slope of the scleral surface. Learn more.

Art Optical Awards Specialty Contact Lens Student Travel Grant

Art Optical Contact Lens, in partnership with Contamac, recently awarded a Specialty Contact Lens Student Travel Grant to Janna Pham, BSA, a fourth-year optometry student at the University of Houston College of Optometry. The $750 grant was awarded at the annual Global Specialty Lens Symposium in Las Vegas. Read more.

Tracey Technologies Releases Version 7.0 Upgrade

Tracey Technologies announced the release of iTrace Prime 7.0 software for the iTrace Ray Tracing Aberrometer and Corneal Topographer. New features include the Prime Dashboard with two new indices: the Corneal Performance Index (CPI) and the Quality of Vision Index (QVI) for the proprietary Dysfunctional Lens Index (DLI). This data provides practitioners additional information about patients’ eyesight. Learn more.

IDOC Adds Inventory Management Account Rebate

All new and existing IDOC Inventory Management accounts will receive an additional annual rebate designed to benefit the independence practice, the manufacturer, and the rep by driving ethical buying behavior. Learn more about IDOC.

Prevent Blindness Names February AMD and Low Vision Awareness Month

Learn more.















Journal Reviews Editor:
Katherine M. Mastrota, MS, OD, EMBA, FAAO

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