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


Volume 18, Number 3

Monday, January 15, 2018


Inside this issue: (click heading to view article)
######### Live From the CES 2018
######### Adhesion of Acanthamoeba on Cosmetic Contact Lenses
######### Development of an In Vitro Model to Study the Biological Effects of Blinking
######### Pattern of Peripapillary Capillary Density Loss in Ischemic Optic Neuropathy Compared to that in Primary Open-angle Glaucoma
######### News & Notes

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Off the Cuff: Live From the CES 2018

Innovation has been a recurring theme in this column, as I’ve explored the impact of technology on optometry and health care. I’ve cautioned that advances will be nearly exponential and that we must be prepared to leverage them, if our profession is to remain relevant.

As I sit here this evening, my feet aching from miles of walking the exhibit halls of this year’s massive Consumer Electronics Show, I suspect I may have underestimated the impact of technology and how quickly change will come.

For those of you old enough to remember the 1960s’ original Star Trek, the universal translator that allowed the crew to communicate with aliens seemed like fantasy a decade before personal computers first appeared. Well, I just saw and used a fully functional incarnation today. Mymanu’s Clik+ will sell for under $300 per headset and translates 37 languages in real-time. The LG Tone Platinum HBS-1110 paired with the Tone & Talk app has similar functions and, as you can see, handles medical terminology with ease.

From accessibility to connectivity to AI and robots, this year’s CES was mind-blowingly more advanced than last year’s show was. What I saw suggests that innovation will soon outpace imagination, if that’s even possible.

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.



Adhesion of Acanthamoeba on Cosmetic Contact Lenses
This study aimed to evaluate the adhesion of Acanthamoeba trophozoites on cosmetic contact lenses (CLs) with and without CL care multipurpose solution (MPS) treatment. Acanthamoeba lugdunensis L3a trophozoites were inoculated onto disks trimmed from CLs: 1-Day Acuvue Moist, 1-Day Acuvue Define, Acuvue 2 and Acuvue 2 Define. After 18-hour inoculation, the number of adherent trophozoites was counted under phase contrast microscopy. The effects on Acanthamoeba adhesion of MPS, Opti-Free Express and soaking CLs for six hours were analyzed. Scanning electron microscopic examination was performed for assessment of Acanthamoeba attached on the lens surface.

Acanthamoeba trophozoites showed greater adhesion to cosmetic CL (p=0.017 for 1-Day CL and p=0.009 for two-week CLs) although there was no significant difference between the types of cosmetic CLs. On all lenses, the number of adherent Acanthamoeba was significantly reduced after treatment with MPS (p<0.001 for 1-Day Acuvue Moist, p=0.046 for 1-Day Acuvue Define, p<0.001 for Acuvue 2, and p=0.015 for Acuvue 2 Define), but there was still a significant difference between conventional and cosmetic CLs (p=0.003 for 1-Day CL and p<0.001 for two-week CLs, respectively). More attachment of Acanthamoeba was observed on colored area, and the acanthopodia of Acanthamoeba were attached on the rough surface of colored area.

Researchers found that Acanthamoeba showed a greater affinity for cosmetic CLs and mostly attached on colored area. Although MPS that contained myristamidopropyl dimethylamine reduced the adhesion rate, there was a significant difference between conventional and cosmetic CLs.

SOURCE: Lee SM, Lee JE, Lee DI, et al. Adhesion of Acanthamoeba on cosmetic contact lenses. J Korean Med Sci. 2018 Jan 22;33(4):e26.


Development of an In Vitro Model to Study the Biological Effects of Blinking

Researchers developed a mechanical model in which a contact lens was swept over ocular surface cells under conditions that mimicked the force and speed of the blink, and investigated the resulting biological changes. A computer controlled mechanical instrument was developed to hold a dish containing 3D, cultured, stratified human ocular surface epithelial cells, across which an arm bearing a contact lens was swept back and forth repeatedly at a speed and force mimicking the human blink. Cells were subjected to repeated sweep cycles for up to one hour at a speed of 120 mm/s with or without an applied force of 19.6 mN (to mimic pressure exerted by upper eyelid), after which the cell layer thickness was measured, the cell layer integrity was investigated using fluorescent quantum dots (6nm and 13nm) and the phosphorylation levels of various protein kinases were analyzed by human phospho-kinase arrays. Data for selected kinases were further quantitated by enzyme immunoassays.

The thickness of the cell layers did not change after exposure to sweep cycles with or without applied force. Quantum dots (6nm and 13nm) were able to penetrate the layers of cells exposed to sweep cycles but not layers of untreated control cells. The phosphorylation levels of HSP27 and JNK1/2/3 increased for cells exposed to sweep cycles with applied force compared with untreated control cells.

Researchers concluded that the in vitro mechanical instrument was a useful tool to investigate the effects of blinking on the ocular surface.

SOURCE: Qin G, Baidouri H, Glasser A, et al. Development of an in vitro model to study the biological effects of blinking. Ocul Surf. 2018; Jan 5. [Epub ahead of print].




Pattern of Peripapillary Capillary Density Loss in Ischemic Optic Neuropathy Compared to that in Primary Open-angle Glaucoma
Both non-arteritic anterior ischemic optic neuropathy (NAION) and primary open-angle glaucoma (POAG) damage retinal ganglion cell axons, which are perfused by the radial peripapillary capillaries, investigators wrote. To evaluate the pattern of ischemia, they compared peripapillary capillary density (PCD) in NAION eyes to POAG eyes matched for visual field mean deviation and retinal nerve fiber layer thickness. Thirty-one chronic NAION (>six months after the acute event) and unaffected fellow eyes (31 subjects), 42 moderate and severe POAG eyes (27 subjects), and 77 control eyes (46 healthy subjects) were imaged with a commercial optical coherence tomography angiography system (AngioVue, Avanti RTVue-XR, Optovue) at two academic institutions. Two concentric circles of diameters 1.95mm (inner) and 3.45mm (outer) were manually placed on images centered on the optic nerve head, producing an annular region-of-interest. Image analysis with major vessel removal was performed using a custom program. Whole-image, whole-annulus and sectoral PCDs were measured.

Whole-image and whole-annulus PCDs in NAION, and moderate and severe POAG eyes were significantly decreased compared with unaffected fellow eyes and control eyes (all p<0.001). Superior and temporal PCD values were affected more than other sectors in both NAION and POAG groups compared to control group. Whole-image and whole-annulus PCDs were not statistically different between NAION and POAG eyes (both p=0.99). However, of all peripapillary sectors, the inferior sector PCD value was less affected in POAG eyes compared to NAION eyes (p=0.001). Univariate analysis results also revealed a significant positive correlation between superior and inferior PCDs and corresponding RNFL thicknesses. The inferior sector correlation was greater in POAG than NAION eyes.

While the whole PCD values were not different in chronic NAION and POAG, the greater correlation of inferior PCD with corresponding RNFL sectors in POAG compared to NAION suggested greater susceptibility of the inferior radial peripapillary capillary in the pathogenesis of POAG.

SOURCE: Fard MA, Suwan Y, Moghimi S, et al. Pattern of peripapillary capillary density loss in ischemic optic neuropathy compared to that in primary open-angle glaucoma. PLoS One. 2018; Jan 10;13(1):e0189237.

News & Notes
TearLab Submits for 510(k) Clearance of TearLab Discovery
TearLab submitted a 510(k) application to the U.S. Food and Drug Administration for its Discovery Platform, an in-vitro diagnostic testing system. The submission covers the platform and a test card measuring the inflammatory biomarker MMP-9. TearLab Discovery will also be capable of performing the company’s FDA-cleared tear osmolarity test. Read more.

FDA Approves Sun Pharma NDA for OTX-101
The U.S. Food and Drug Administration accepted a New Drug Application, filed by Sun Pharmaceutical’s wholly owned subsidiary, for OTX-101 (cyclosporine A, ophthalmic solution) 0.09%, a novel nanomicellar formulation of cyclosporine A 0.09% in a clear, preservative-free aqueous solution. In a 12-week, multicenter, randomized, double-masked, vehicle-controlled Phase III study, 744 individuals with dry eye were treated either with OTX-101 or its vehicle. After 12 weeks of treatment, OTX-101 showed statistically significant improvement in the primary end point, Schirmer’s score (p<0.0001).

2018 Winter Ophthalmic Conference

Novaliq’s First Patient Enrolled in SEECASE Trial of NOV03, Company Forms U.S. Subsidiary
Novaliq GmbH began randomization of patients in its SEECASE Phase II clinical trial for the treatment of dry eye disease. NOV03 is designed to stabilize the tear film lipid layer, thereby preventing excessive evaporation of the lipid layer. As NOV03 further penetrates the meibomian glands, it potentially dissolves meibomian lipids and eventually helps to improve meibomian gland functionality. Read more.

In addition, Novaliq announced formation of subsidiary Novaliq Inc., which will be located in Cambridge, Ma. The office will be headed by Novaliq’s founder and current chief innovation officer, Bernhard Günther. Read more.

Kala NDA for Inveltys Accepted for FDA Review
Kala Pharmaceuticals announced the U.S. FDA accepted for review its New Drug Application for Inveltys (KPI-121 1%), a topical, twice-daily product candidate for the treatment of inflammation and pain in individuals who have undergone ocular surgery. The FDA set a target action date under the Prescription Drug User Fee Act of August 24. If approved, Inveltys is expected to be the first twice-daily ocular corticosteroid indicated for the treatment of post-operative ocular inflammation and pain. Read more.

Review of Optometry's New Technologies and Treatments in Eye Care in Nashville, April 6-8, 2018, at the Nashville Marriott at Vanderbilt University

Glaukos’ iDose Travoprost Achieves Sustained IOP Reduction
Glaukos announced that its Travoprost intraocular implant with the iDose delivery system continued to provide sustained reduction in intraocular pressure in a 12-month interim cohort in its U.S. Investigational New Drug Phase II clinical trial. Implanted during a microinvasive procedure, the iDose Travoprost is filled with a special formulation of travoprost and designed to continuously elute therapeutic levels of the medication from within the eye for extended periods of time. 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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