Optometric Physician

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


Volume 20, Number 2

Monday, January 6, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: 2020: Beginning Our Third Decade
######### Widefield Imaging of Retinal and Choroidal Tumors
######### Effect of Multipurpose Care Solutions Upon Physical Dimensions of Silicone Hydrogel Contact Lenses
######### Stopping the Rise of Myopia in Asia
######### News & Notes

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Off the Cuff: 2020: Beginning Our Third Decade

It was a little more than 20 years ago that the idea for Optometric Physician first came to me. It was a very different time, and optometry was changing rapidly. Scope expansion was spreading throughout the country, and the profession was undergoing incredible transformation. The internet as we know it was in its infancy. Painfully slow dialup and AOL ruled, and Facebook was still five years away. Except for Walt Mayo’s Optcom List, there was virtually nothing online. Worse yet, there was no voice for the growing number of medically focused ODs.

Optometric Physician exists today because of many people who helped along the way. If not for the trust and support of Rick Bay, former publisher of Review of Optometry, who let me run with my crazy idea, I would not be writing this now. Over the years, Rick and I became very close, and I am still saddened by his loss in 2012. The format of OP, which has largely endured to this day, came from collaboration with Dan O’Connor, among the greatest editors I’ve ever worked with. Today, OP remains a collaborative effort with the entire Review and Jobson family. A very special, personal thanks to Matt Egger, who assembles OP every week, and Jill Gallagher, who polishes my prose and keeps News & Notes current and relevant. They put up with my crazy schedule without complaint and have always been there for me. I also want to thank the companies who support OP. I know it’s not always easy; I sometimes need to write things that are hard to read.

I am especially proud that OP has done a lot of good over the past two decades. During Hurricane Katrina, our advocacy for relaxing state licensure requirements for displaced Louisiana ODs allowed many to continue to work and feed their families. I have had the pleasure of shining a spotlight on colleagues who have made a difference in our profession and in my own life. Donald Korb, Lou Catania, Murray Fingeret and the late Uncle Frank Fontana immediately come to mind. My strong, often-strident positions on important topics like “board certification,” expanded scope, CE governance, kiosk exams in Utah and 1-800 Contacts sometimes facilitated positive change and sometimes didn’t, but I would like to think that my views reflected the perspective of the rank and file OD.

One question I often get is how I am able to write Off the Cuff week after week, year after year and always have something to say. The answer is simple: Optometric Physician has always been a labor of love. Love of our profession. Love of caring for patients and love for the people who surround me. The love of my life, Dr. Shannon Steinhauser, has edited OP abstracts for the past 16 years. She complains only rarely. Writing OP is also about friendships and life’s meandering currents. It has brought me closer to colleagues across the country and created lasting friendships around the world.

As many of you have shared, I too look forward to every Saturday morning, waiting to read Optometric Physician. Although it may seem hard to believe, at my core, I am a private person, and OP is a connection to my thoughts and who I am. Some of you have been here since the beginning. Some have joined more recently. Know that I appreciate each and every one of you more than I can express in words. I expect 2020 to be challenging and a year of great change for our profession. As always, I look forward to sharing my thoughts with you every week.

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.



Widefield Imaging of Retinal and Choroidal Tumors
Widefield imaging plays an increasingly important role in ocular oncology clinics. The purpose of this review was to describe the commonly used widefield imaging devices and review conditions seen in ocular oncology clinics that underwent widefield imaging as part of the multimodal evaluation.

Widefield or wide-angle imaging is defined as greater than 50-degree field of view. Modern devices can reach far beyond this, reporting fields of view up to 267 degrees when utilizing montage features, with increasingly impressive resolution. Widefield imaging modalities include fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine angiography (ICG), spectral-domain optical coherence tomography (SD-OCT) and recently widefield OCT angiography (OCTA). These imaging modalities are increasingly prevalent in practice. The widefield systems include laser, optical and lens-based systems that are contact or non-contact lens systems, each with their own benefits and drawbacks. The purpose of this review was to discuss commonly used widefield imaging modalities for retinal and choroidal tumors, and demonstrate the use of various widefield imaging modalities in select ocular oncology cases.

Clinical examination remains the gold standard for the evaluation of choroidal and retinal tumors. Widefield imaging plays an important role in ocular oncology for initial documentation, surgical planning, determining the relationship of the tumor to adjacent ocular structures, following tumor size after treatment and monitoring for recurrence, the authors wrote.

SOURCE: Callaway NF, Mruthyunjaya P. Widefield imaging of retinal and choroidal tumors. Int J Retina Vitreous. 2019;5(Suppl 1):49.

Effect of Multipurpose Care Solutions Upon Physical Dimensions of Silicone Hydrogel Contact Lenses
Interactions between contact lens multipurpose solution (MPS) components and the contact lenses with which they are used are both lens and solution dependent. As such, lens dimensional changes may arise after cleaning and immersion cycling in different lens care solutions over different time courses. In this study, the dimensional stability of five planned-replacement silicone hydrogel lenses (lotrafilcon B, comfilcon A, senofilcon A, senofilcon C and samfilcon A) over 30 cycles in three different MPSs (Biotrue, Opti-Free Express, and Opti-Free Puremoist) was evaluated. Measurements of diameter, sagittal depth, power, roundness and center thickness were obtained prior to, during, and after 30 cycles of cleaning and storage.

Diameters of all lenses increased when soaked in Express or Biotrue but held the International Standards Organization (ISO) tolerance over the full course of 30 disinfection cycles; however, the diameters of comfilcon A, senofilcon A, senofilcon C and samfilcon A lenses soaked in Puremoist exceeded ISO tolerance after between four and nine immersion cycles. In contrast, the diameter of lotrafilcon B held tolerance. Similarly, all lenses cycled in Express or Biotrue held tolerance for sagittal depth, while in Puremoist, only lotrafilcon B held tolerance. All lenses became less round in all MPSs but held tolerance for both power and central thickness.

Given the lack of reported clinical issues with Puremoist when used with lenses other than lotrafilcon B, the researchers proposed that it may be appropriate to revisit the ISO test methods and tolerances to determine if they are still applicable for silicone hydrogel lenses.

SOURCE: Smith SM, Zhu D, Pierre D, et al. Effect of multipurpose care solutions upon physical dimensions of silicone hydrogel contact lenses. J Biomed Mater Res B Appl Biomater. 2019; Dec 26. [Epub ahead of print].



Stopping the Rise of Myopia in Asia
This review discussed the rapid rise of myopia among school-age children in East and Southeast Asia during the last 60 years. It described the history, epidemiology and presumed causes of myopia in Asia, but also in Europe and the United States.

The recent myopia boom is attributed primarily to the educational pressure in Asian countries, which prompts children to read for long hours—often under poor lighting and on computer screens. This practice severely limits the time spent outdoors, and reduces exposure to sunlight and far vision. As a consequence, the eyes grow longer and become myopic. In a breakthrough study in Taiwan, it has been found that by increasing the time spent outdoors, the incidence of new myopia cases was reduced to half when children were sent onto the schoolyard for at least two hours daily. This protection is attributed to the light-induced retinal dopamine, which blocks the abnormal growth of the eyeball.

Once myopia has set in, low-dose atropine and orthokeratology have shown positive results in slowing myopia progression. Also, prismatic bifocal lenses and specially designed multifocal soft contact lenses have recently been tested with promising results. The authors wrote that treatment, however, must be initiated early, as the disease progresses once it has started, thereby enhancing the risk for severe visual impairment and, ultimately, blindness.

SOURCE: Spillmann L. Stopping the rise of myopia in Asia. Graefes Arch Clin Exp Ophthalmol. 2019; Dec 23. [Epub ahead of print].

News & Notes
Bausch Health Licenses Novaliq’s Nov03 Investigational Treatment
Bausch Health Companies, Bausch + Lomb and Novaliq announced that Bausch Health acquired an exclusive license for the commercialization and development in the United States and Canada of the investigational treatment NOV03 (perfluorohexyloctane), a first-in-class investigational drug with a novel mechanism of action to treat dry eye disease associated with meibomian gland dysfunction. NOV03 is a proprietary, water-free, preservative-free solution based on Novaliq's patented EyeSol technology. In a Phase II study, NOV03 met its primary sign endpoint of improvement of total corneal fluorescein staining over control at eight weeks with high statistical significance (p<0.001). In addition, NOV03 showed statistically significant and clinically meaningful improvement in a variety of symptoms over the entire duration of the trial. A Phase III study is underway for NOV03, and Bausch Health anticipates starting an additional Phase III study in 2020. Read more.

X-Cel Adds Customizable Expansion to Atlantis Scleral Product Line
X-Cel Specialty Contacts announced the extension of its Atlantis Scleral product line, featuring expansion of current lens options along with independent zone manipulation. The ability to independently adjust the central SAG (up to 200 microns in 50-micron steps), quadrant-specific landing zone options (up to 250 microns in each quadrant in 25 micron steps) and quadrant-specific limbal vault zone options are all included. Two new fitting sets have been designed: a 15.5-diameter, 12-lens set for existing set holders, and a 24-lens set for new users containing 14.5, 15.5 and 16.5 diameters. A new, comprehensive, yet simplified, fitting guide will be introduced with the launch of the lens that will apply to all Atlantis designs. The new Atlantis will be highlighted during its worldwide launch at the 2020 Global Specialty Lens Symposium (Jan. 22-25) in Las Vegas and via the company’s complimentary in-office fitting services. 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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