Optometric Physician

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


Volume 21, Number 5

Monday, February 8, 2021


Inside this issue: (click heading to view article)
######### Off the Cuff: The Uncertain Future of Corporate Optometry

######### Combined Vision and Hearing Difficulties Results in Higher Levels of Depression and Chronic Anxiety
######### Effects of Scleral Contact Lenses for Keratoconus Management on Visual Quality and Intraocular Pressure
  Prevalence of Primary Angle Closure Glaucoma in the Last 20 Years: a Meta-Analysis and Systematic Review
######### News & Notes

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Off the Cuff: The Uncertain Future of Corporate Optometry

This isn’t an easy piece to write and I realize that what I am going to say will not be easy to hear for some. Understand that I am sharing these thoughts and observations because the profession needs to consider them and be proactive in dealing with these important issues before it is too late.

A few weeks ago, I wrote about the National Association of Optometrists and Opticians (NAOO), an organization that, in my opinion, has feigned representing optometry in order to undermine the profession’s advancement and—in some instances—our patients’ safety. While the NAOO has been operating for years lobbying against the profession, it recently joined with American’s for Vision Care Innovation—a proxy for online contact lens sellers to jointly lobby against common-sense telemedicine safety measures. Examining why, it would be naïve to believe that this sudden alliance was simply a coincidence or that existing NAOO members were unaware of this shift in direction.

While some corporate supporters have announced that they have abandoned the NAOO’s sinking ship, it is important to understand the underlying reasons why the NAOO ventured into telemedicine lobbying in the first place. For online contact lens providers, the reason is clear: Remove the eye care provider from the contact lens purchase equation. It appears that they not only perceive ODs and MDs (who don’t rubber stamp prescriptions) as a sales encumbrance, but, based on their manipulation of the FTC, their frequent media assaults, and their ongoing attempt to disrupt the AOA-supported Contact Lens Rule Modernization Act (S. 4613), it seems that they may actually want to marginalize us entirely.

So why would traditional, “big eye” corporate optometry members of the NAOO support this legislation? Put simply, eliminating or blocking patient protective telemedicine legislation is one step closer to changing laws regarding what constitutes an eye examination and who can perform it. Mix in the impact of rapidly evolving technology and AI, and it’s easy to see that “examination bots” may be closer than you think. If you believe the public won’t buy it, think again. Even if it’s completely absurd, convincing legislators and the public that advanced technology provides a more accurate and comprehensive eye exam is a relatively easy job for skilled marketers and lobbyists. If you still doubt it, some of this is already underway.

It doesn’t take much imagination to see where this is heading. Given the choice of employing a small army of costly ODs and paying their salaries and benefits, or spending a bit more upfront and incorporating OD-replacing technology, and based on what I just shared, what do you think some of the NAOO members would choose? Even for those who were once our “friends,” ultimately, it’s all about the bottom line.

Today, corporate providers depend on us to provide care in retail settings. Many of us have seen the handwriting on the wall and have embraced independent or group medical eye care practice. Many of us can’t. Right now,  if they organize quickly, our corporately employed colleagues still have bargaining power, but they must seize the opportunity before they no longer have a voice in their own futures. 


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.



Combined Vision and Hearing Difficulties Results in Higher Levels of Depression and Chronic Anxiety

Individually, vision and hearing impairments have been linked to higher levels of anxiety and depression. Researchers investigated the effect of dual sensory impairment (difficulty seeing and hearing) in a large representative sample of Spanish adults. Data from a total of 23,089 adults (age range: 15 to 103 years, 45.9% men) from the Spanish National Health Survey 2017 were analyzed. Self-reported difficulty of seeing and hearing (exposures), and depression and chronic anxiety (outcomes) were analyzed. Multivariable logistic regression was assessed for difficulty with vision alone, hearing alone and with difficulty with both, adjusting for gender, age, marital status, living as a couple, education, smoking, alcohol consumption, BMI, physical activity, use of glasses/contact lenses and hearing aid.

Visual difficulty, hearing difficulty and dual difficulties were all associated with significantly higher odds for depression (ORs: 2.367, 2.098 and 3.852, respectively) and for chronic anxiety (ORs: 1.983, 1.942, and 3.385, respectively). Dual sensory difficulty was associated with higher odds ratios for depression and anxiety when compared to either impairment alone.

Dual sensory difficulty is associated with significantly higher odds of anxiety and depression when compared to either vision or hearing difficulty alone. Appropriate interventions are needed to address any reversible causes of vision and hearing, as well as anxiety and depression in people in these specific groups.

SOURCE: Pardhan S, Smith L, Bourne R, et al. Combined vision and hearing difficulties results in higher levels of depression and chronic anxiety: data from a large sample of Spanish adults. Front Psychol. 2021; Jan 18. [Epub ahead of print].


Effects of Scleral Contact Lenses for Keratoconus Management on Visual Quality and Intraocular Pressure

This prospective case series compared visual acuity obtained with glasses, RGP and 16.8mm diameter scleral CL in 30 consecutive patients affected by keratoconus to evaluate the visual acuity level achieved by scleral contact lens (CL) fitting in patients affected by keratoconus and to evaluate possible intraocular pressure (IOP) changes during the scleral CL wear using a transpalpebral tonometer. IOP was tested during scleral CL wear by transpalpebral Diaton Tonometer (DT) and also by Goldmann applanation tonometer (GAT) before and after scleral CL wear.

The mean logMAR visual acuity improved from 0.2 ± 0.25SD with glasses and 0.1 ± 0.02SD with RGP, to -0.002 ± 0.041SD when using the scleral CL. The mean IOP value before scleral CL wear was 12.93mmHg ± 2.20SD when measured with GAT and 7.85mmHg ± 2.27SD when measured with DT. During scleral CL wear, IOP was assessed through DT, with a mean value of 8.86mmHg ± 2.36SD; values were stable after 8 hours of scleral CL use. Immediately after scleral CL removal, the mean IOP measured with GAT was 12.85mmHg ± 2.40SD, and the mean IOP measured with DT was 7.66mmHg ± 1.88SD. Therefore, during scleral CL wear, a small, but statistically significant, increase of the mean IOP value (1.01mmHg) was reported, with a reversion to values prior to application when the scleral CL was removed.

Researchers wrote that scleral CLs remarkably improved visual acuity in keratoconus patients when compared to glasses or RGP contact lenses. They added that, even if a small increase of the mean IOP value was reported during wear, it may not be significant in otherwise healthy eyes. Furthermore, they wrote that statistical analysis demonstrated good agreement between GAT and DT but their numerical values presented a constant gap that should be taken into account when there is a need to relate the DT values to the reference ones.

SOURCE: Formisano M, Franzone F, Alisi L, et al. Effects of scleral contact lenses for keratoconus management on visual quality and intraocular pressure. Ther Clin Risk Manag. 2021 Jan 25;17:79-85.




Prevalence of Primary Angle Closure Glaucoma in the Last 20 Years: a Meta-Analysis and Systematic Review

This meta-analysis aimed to investigate the worldwide prevalence of primary angle-closure glaucoma (PACG) and its risk factors in the last 20 years. Investigators conducted a systematic review and meta-analysis of 37 population-based studies and 144,354 subjects. PubMed, Embase and Web of Science databases were searched for cross-sectional or cohort studies published in the last 20 years (2000 to 2020) that reported the prevalence of PACG. The prevalence of PACG was analyzed according to various risk factors. A random-effects model was used for the meta-analysis.

The global pooled prevalence of PACG was 0.6% [95% confidence interval (CI) = 0.5-0.8%] for the last 20 years. The prevalence of PACG increased with age. Men were found less likely to have PACG than women (risk ratio = 0.71, 95% CI, 0.53 to 0.93, p<0.01). Asia was found to have the highest prevalence of PACG (0.7%, 95% CI, 0.6 to 1.0%). The current estimated population with PACG is 17.14 million (95% CI, 14.28 to 22.85) for people older than 40 years old worldwide, with 12.30 million (95% CI, 10.54 to 17.57) in Asia. It was estimated that by 2050, the global population with PACG will be 26.26 million, with 18.47 million in Asia.

Investigators wrote that PACG affects more than 17 million people worldwide, creating an especially heavy burden for Asia. They added that the prevalence of PACG varies widely across age, sex, population and geographic variations. Being Asian, female and at higher age are risk factors of PACG, they wrote further.

SOURCE: Zhang N, Wang J, Chen B, et al. Prevalence of primary angle closure glaucoma in the last 20 years: a meta-analysis and systematic review. Front Med (Lausanne). 2021; Jan 18. [Epub ahead of print].


News & Notes
  WebMD Announces New Effort to Combat Vaccine Misinformation
With misinformation continuing to undermine public confidence in the Covid-19 vaccines, WebMD has launched the WebMD Covid-19 Vaccine Misinformation Center to help combat inaccuracies with facts. The center provides reliable vaccine resources and online tools to help consumers make informed decisions, driven by science, and features articles and videos on topics including vaccine myths and how they take root, public health challenges and the role of social media in misinformation. Medscape, a division of WebMD Health Corp., will feature content and resources at its Covid-19 Resource Center, including vaccine overviews, late-stage vaccine development updates and news on vaccine research. WebMD and Medscape have also joined with corporate, nonprofit and media leaders in a global public service campaign, VaxFacts, to identify and counter misleading vaccine information. Led by HealthGuard, the campaign features a browser extension that flags health hoaxes, provides credibility ratings for hundreds of websites and guides users to sources that offer trusted information. The tool is a new service from NewsGuard, developed by two veteran journalists in 2018 to combat misinformation in the news. So far, HealthGuard has flagged nearly 400 websites for publishing misinformation and myths about COVID-19 vaccines. Read more.


  Surface Ophthalmics Announces First Patient Dosed in Phase II Trial for SURF-200 for Acute Dry Eye
Surface Ophthalmics announced the first patient was dosed in the Phase II clinical trial for its investigational product SURF-200 (betamethasone in Klarity vehicle) for the treatment of acute dry eye. In this dose-ranging study, SURF-200 will be studied in two different low-concentration formulations, which include betamethasone in the Klarity vehicle. Read more.


  J&J Vision Gets FDA Nod for Tecnis Eyhance & Tecnis Eyhance Toric II IOLs
Johnson & Johnson Vision announced the FDA approved the Tecnis Eyhance and Tecnis Eyhance Toric II intraocular lens for the treatment of cataract patients in the United States. With this approval and subsequent commercial launch, ophthalmologists in the United States now have the ability to choose this next-generation monofocal for patients with or without astigmatism. Read more.






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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