Optometric Physician

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


Volume 21, Number 1

Monday, January 11, 2021


Inside this issue: (click heading to view article)
######### Off the Cuff: We Begin Again

######### Prevalence of Contact Allergens in Best-selling Ophthalmic Products
######### Aerobic Exercise Reduces Intraocular Pressure and Expands Schlemm's Canal Dimensions in Healthy and Primary Open-angle Glaucoma Eyes
  Disruption of 24-hour Rhythm in Intraocular Pressure Correlates with Retinal Ganglion Cell Loss in Glaucoma
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: We Begin Again

Welcome to 2021 and a belated, but sincere Happy New Year. With 2020 finally in the rearview mirror, it’s time to start looking forward. Yes, I suspect 2021 will have its own challenges and unpleasant twists and turns, but for now, let’s focus on the bright spots of the new year. 2021 will usher in major innovation and broader use of advanced ocular diagnostics and therapeutics. Let’s take a look.

In much of medicine, cutting-edge therapies have become commonplace. I am sure you are familiar with genetically engineered biologics like Enbrel, Xeljanz, Humira and Cosentyx that treat a variety of autoimmune diseases. These highly targeted disease-modifying agents represent a quantum leap advance in the management of these disorders. There have been giant leaps forward in cancer treatment. If you’ve watched television recently, you’ve likely seen advertisements for Opdivo and Yervoy, two odd-sounding drugs indicated as first-line treatment of specific forms of metastatic non-small cell lung cancer. The stuff of science fiction just a few years ago, these highly advanced and specifically targeted drugs have been lifesaving for many patients.

In eye care, Spark Therapeutics’ Luxturna gene therapy was approved in 2017 for the rare but often blinding biallelic RPE65 mutation-associated retinal dystrophy. Dompe’s highly effective Oxervate, a recombinant form of human nerve growth factor for neurotrophic keratitis, is produced by farms of genetically re-engineered e-coli. Clinical trials are well underway for a variety of next-generation medications aimed at a broad variety of anterior and posterior segment eye disorders. The Foundation for Fighting Blindness is offering a CE program on Gene Therapy on January 23 at 11am CST for those who interested.

What is especially exciting is that I think 2021 will mark the intersection of cutting-edge therapeutics with advanced genetic testing. Avellino’s cheek swab AvaGen test for keratoconus and their Universal genetic test for corneal dystrophies are good examples of state-of-the-art diagnostics. Advanced diagnostics combined with targeted therapeutics will create effective treatments beyond what we can currently imagine.


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.



Prevalence of Contact Allergens in Best-selling Ophthalmic Products

Ophthalmic products are a common but often overlooked contributor to allergic contact dermatitis. Frequency of allergenic ingredients in over-the-counter ophthalmic products has not been well characterized. The purpose of this study was to determine the prevalence of allergenic ingredients in most commonly bought eye lubricants and contact lens solutions. A product list of Amazon.com's best-selling ophthalmic products was curated by searching for "Best Sellers in Eye Drops, Lubricants & Washes" and "Best Sellers in Contact Lens Care Products." For exploratory analysis, indication, price, consumer ratings, number of reviews, and FDA approval status were recorded. The products' ingredients were compiled using NLM DailyMed, and products that had one or more allergens or relevant cross-reactors on either the 2018 American Contact Dermatitis Society Core Allergen Series or the 2015-2016 North American Contact Dermatitis Group Standard Allergen Series were noted.

Forty-eight percent (n=49) of the total products, (57.8% [n=37] of eye lubricants, and 31.6% [n=12] of contact lens solutions) had one or more allergens or associated cross-reactors. Identified allergens were benzalkonium chloride, propylene glycol, sorbic acid, amidoamine, sorbitan sesquioleate, chlorhexidine digluconate, lanolin alcohol, parabens, benzyl alcohol and butylated hydroxytoluene.

Authors wrote that awareness of potential allergens is crucial to diagnosing allergic contact dermatitis to ophthalmic products and helping patients navigate online pharmacological chaos.

SOURCE: Om A, Yeung H, de la Feld S. Prevalence of contact allergens in best-selling ophthalmic products. dermatitis. 2020; Sep 8. [Epub ahead of print].


Aerobic Exercise Reduces Intraocular Pressure and Expands Schlemm's Canal Dimensions in Healthy and Primary Open-angle Glaucoma Eyes

Researchers wrote that aerobic exercise (AE) has been reported to decrease intraocular pressure (IOP) in healthy subjects, and there are concomitant morphological changes in the anterior segment of the eye including Schlemm's canal (SC). However, its effects on IOP and SC morphology in glaucoma patients had not been studied before. Researchers aimed to investigate the effect of AE on the IOP and SC dimension in both healthy and primary open-angle glaucoma (POAG) eyes. The area and diameter of SC and IOP were measured in 35 primary open-angle glaucoma (POAG) patients (59 eyes) and 36 healthy subjects (72 eyes) before and after performing moderate intensity of AE by running on a treadmill for 30 minutes. SC was imaged by swept-source optical coherence tomography (SS-OCT) for evaluation.

In comparison with baseline values, mean IOP decreased significantly following AE in both POAG and healthy eyes, and POAG eyes showed a greater degree of reduction compared to healthy eyes. In comparison with baseline values, in both POAG and healthy eyes, the average cross-sectional area of SC (POAG: 80.48 ± 59.54 vs. 99.20 ± 54.87 pixels; healthy: 151.84 ± 52.76 vs. 198.23 ± 53.70 pixels) and diameter (POAG: 3.73 ± 1.69 vs. 4.33 ± 1.74 pixels; healthy: 5.61 ± 1.02 vs. 6.47 ± 1.20 pixels) significantly increased after AE. In POAG, both treated and untreated with IOP-lowering medications, a significant reduction in mean IOP and increase in SC dimensions following AE were observed, and there were no significant differences of such measurements between the two subgroups.

Researchers wrote that AE induced reduction in IOP and an increase in SC dimensions in POAG eyes as in healthy eyes. They added that further studies to evaluate the long-term effect of AE on IOP control and SC morphology in POAG seemed to be warranted.

SOURCE: Yuan Y, Lin TPH, Gao K, et al. Aerobic exercise reduces intraocular pressure and expands Schlemm's canal dimensions in healthy and primary open-angle glaucoma eyes. Indian J Ophthalmol. 2020; Dec 31. [Epub ahead of print].



Disruption of 24-hour Rhythm in Intraocular Pressure Correlates with Retinal Ganglion Cell Loss in Glaucoma

Parameters of 24-hour rhythm in intraocular pressure (IOP) were assessed in patients with stable or advanced primary open-angle glaucoma (S-POAG/A-POAG) and referenced the phase of "marker" circadian temperature rhythm of each patient. Body temperature and IOP were measured over a 72-hour span in 115 participants (65 S-POAG and 50 A-POAG). Retinal ganglion cell (RGC) damage was assessed by high-definition optical coherence tomography.

Investigators found that the 24-hour IOP rhythm in A-POAG patients peaked during the night, opposite to the daytime phase position in S-POAG patients. The 24-hour IOP phase correlated with RGC loss. The internal phase shift between IOP and body temperature gradually increased with POAG progression. Angiotensin converting enzyme Alu-repeat deletion/insertion (ACE I/D) emerged as a candidate gene polymorphism, which may play a role in the alteration of the circadian IOP variability in advanced glaucoma.

Investigators concluded that a reliable estimation of the 24-hour rhythm in IOP requires the degree of RGC damage to be assessed. In advanced POAG, the 24-hour phase of IOP tended to occur during the night and correlated with RGC loss, being progressively delayed relative to the phase of temperature.

SOURCE: Neroev V, Malishevskaya T, Weinert D, et al. Disruption of 24-hour rhythm in intraocular pressure correlates with retinal ganglion cell loss in glaucoma. Int J Mol Sci. 2020; Dec 31. [Epub ahead of print].

News & Notes

Kala Announces Availability of Eysuvis, Updates Development Pipeline
Kala Pharmaceuticals launched Eysuvis (loteprednol etabonate ophthalmic suspension) 0.25% for the short-term (up to two weeks) treatment of the signs and symptoms of dry eye disease. Eysuvis is now available in national and regional US pharmaceutical distribution centers. Patients with a prescription can access Eysuvis through their local retail pharmacies or through home delivery. In addition, Kala’s payor account team is actively engaged in contract discussions with Commercial and Medicare Part D health plans. Read more.

  Coburn Announces New ProCoat Hard Lens Coating, Welcomes Lentocha as Director of Service
Coburn Technologies introduced ProCoat, a hard coating for backside lens coaters designed for abrasion resistance, adhesion, tintability, clarity and stability. It is intended to deliver higher abrasion resistance and offer a greater degree of adhesion across a broad range of lens materials and superior tintability. Like Coburn’s UVMAX and DURA-UV, ProCoat is approved for use in competitive coating systems, is fast curing and achieves high yields at an affordable cost. ProCoat is also free of volatile solvents for safer shipping and handling. Learn more.
In addition, the company welcomed Christopher Lentocha to its service team as the new director of service. Lentocha recently served as director of customer service at VITAS Healthcare, and he held managerial roles at Pelican Products and Meridian Medical Management.


  Bruder Introduces Pre-Surgical Patient Prep Kit
Responding to demand from eye-care professionals, Bruder collaborated with ophthalmic surgeons and comanaging optometrists to develop the Bruder Sx Pre-Surgical Patient Prep Kit. The hygiene products needed by presurgical patients are available in a single, self-contained kit that doctors can provide directly in their practices or via the company’s new online patient portal. The kit includes the company’s hygienic eyelid cleansing wipes, its hygienic eyelid solution, the Bruder Sx Pre-Surgical Compress and the Bruder Sx Case. Learn more.

  Volk Releases ClearPod to Solve Mask-related Fogging
Volk Optical released its newest product, the ClearPod, to solve the problem of mask-related fogging during fundus exams. This patent-pending design was created in collaboration with Bradley Sacher, MD, a cataract specialist and Jeremy Wingard, MD, a glaucoma specialist at Wheaton Eye Clinic. When a patient breathes naturally while wearing a mask, air escapes through the gaps in the mask and accumulates on the lens surface causing condensation and obstructing views of the retina and slowing down the exam. The ClearPod clips securely onto the Volk fundus lens and form a barrier, directing air currents away from the lens surface. Learn more.

  New Hi-Health Division Streamlines Product Ordering Using EHR
Hi-Health’s new eye care division will help streamline product ordering on electronic health records systems. Vista products will be available to select on the EHR, similar to the way prescriptions are filled out. Eye care professionals search for the Vista brand, select Hi-Health’s Pharmacy and input orders. Initial product offerings include artificial tears and tea tree oil-based lid cleansing products, along with a family of advanced macular and dry eye supplements. The company chose its unique business model after hearing complaints from doctors that patients’ retail purchases weren’t consistent with their recommended treatments. Learn more about the company.

  Ocular Therapeutix Announces Supplemental NDA for Dextenza
Ocular Therapeutix announced submission to the FDA of a supplemental New Drug Application for Dextenza (dexamethasone ophthalmic insert) 0.4 mg for intracanalicular use. If approved, the sNDA would include the treatment of ocular itching associated with allergic conjunctivitis as an additional approved indication. Read more.

  Eye Designs Group Launches Merchandiser Pro Software
Eye Designs announced the launch of merchandising software enabling users to generate planograms used by retailing professionals, and three-dimensional models featuring frame board layouts along with Eye Designs’ most popular accessories (frame holders, shelving, signage, etc). The software keeps track of all accessories being added while the user interacts with a real-time image of the design. Read more.

  Optos Introduces UWF Imaging Advancements
Optos’ line of ultra-widefield imaging devices are offering several advancements. The Daytona model has improved optics for visualization across the optomap image and automatic laterality detection to improve image capture time. It also features an updated design and user interface. The Silverstone model, which offers optomap-guided swept source optical coherence tomography, includes a Repeat Scan tool for monitoring changes over time, and an Explorer mode to display OCT scan type and location. In addition, auto contrast is available for angiography capture. Learn more about the company.

  Heru Completes FDA Registration
Heru, a Bascom Palmer Eye Institute medical technology company developing a next-generation AI platform for vision diagnostics and augmentation, announced its class I listing with the FDA for its cloud-based virtual reality platform’s first diagnostic application for visual field exams. Heru’s platform is designed to autonomously diagnose vision defects and customize individual vision augmentation based on the user’s unique vision defects. Read more.

  IDOC Reports Business Expansion in 2020, Opens Registration for 2021 Conference
IDOC added more than 250 independent optometry practices to the IDOC community in 2020. The privately held IDOC alliance, founded in 1999, includes private practice owners in all states. Over the past 12 months, IDOC launched a number of benefits for members, including a redesigned website and expanded consulting team, social media marketing services and a partnership with Illinois-based United Eye Care Providers, focused on advancing medical optometry expertise for independent ODs. Learn more. In addition, registration is now open for IDOC’s National Conference, The Connection 2021: A Virtual Experience!, which will be held virtually Feb. 3-5. Register here.

  Keeler Announces Global Portal
Keeler announced the launch of its Global Portal. The site will enable the ophthalmic industry to engage with Keeler on OEM manufacturing services, strategic partnerships and product ideas to bring to market. Learn more.


Prevent Blindness Launches Glaucoma Community, Calls for Nominations
To help educate the public on glaucoma, including risk factors, symptoms, treatment options and more, Prevent Blindness, in partnership with Responsum Health, launched the new resource, “The Glaucoma Community.” This comprehensive resource, accessible online or through the mobile app, provides users with a variety of features including:
• A personalized news feed
• A community chat function
• Dedicated Facebook page at: https://www.facebook.com/glaucomacommunity
• Glaucoma content in seven different languages
• A patient one-sheet, which allows patients to easily collect, maintain, and print their key medical information in a secure format.
• Access to extensive patient resources, including financial assistance programs and glaucoma support groups. Learn more.
In addition, Prevent Blindness is calling for nominations for this year’s Jenny Pomeroy Award for Excellence in Vision and Public Health, and the second annual Rising Visionary Award. The deadline for submissions for both awards is February 5. Learn 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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