Optometric Physician



Vol. 24, #5 •   Monday, January 30, 2023


Off the Cuff: Amazon Clinic?

On Monday when I got to the office, there was a note on my desk that we needed some office supplies: binder clips, AAA batteries, and some gel pens. I normally shop on Amazon from my phone but since I was at my desk and had some time, I decided to place the order from my desktop instead. After I logged in, I immediately noticed a link that is not on my cell phone app version of Amazon. It was a single word that piqued my curiosity—Clinic. Hmm? Click.

It’s essentially an online minute-clinic that Amazon refers to as a virtual clinic. There’s a list of commonly treated conditions such as sinusitis, heartburn, seasonal allergies, urinary tract infections, etc., as well as visits for hair loss, ED, lash growth, and smoking cessation. Interestingly, they will also refill prescriptions for patients that have already been diagnosed with high blood pressure and cholesterol, migraine, thyroid, and asthma. Of course what caught my eye was the “pink eye” link. It was the very first condition listed on the page. This type of visit is done entirely via text messaging. Under the “Commonly Prescribed Medications” was listed ciprofloxacin and erythromycin. I was glad to not see sulfacetamide or something with a steroid.

In November 2022, I wrote about my experience with do-it-yourself healthcare. Amazon announced this virtual clinic offering nearly at the exact same time. Currently available in 33 states, likely growing, and having its own pharmacy to fill the prescriptions of these virtual visits, the presence of the juggernaut that is Amazon in this healthcare space could really move the needle in shifting primary care into the virtual space.

So where does that leave us “brick and mortar” clinicians? In the “pink eye” visit type example, we essentially shift from primary care to secondary care if and when an initial virtual visit fails to address a patient’s problem. The simple pink eyes may become a thing of the past. Healthcare and eye care are ever evolving. We need to rid ourselves of outdated rigid constructs and keep our personal perceptions of our profession flexible, keep learning, and evolve with it.


Shannon L. Steinhäuser, OD, MS, FAAO
Chief Medical Editor


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.


Associations Between Serial Intravitreal Injections and Dry Eye

This retrospective controlled observational study investigates the effects of serial intravitreal injections (IVI) on the ocular surface and meibomian glands (MG) in patients treated with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD). Study patients were individuals with nAMD receiving unilateral IVI anti-VEGF agents with the fellow eye used as a control. Tear film and ocular surface examinations were performed on a single occasion at a minimum of four weeks after IVI. A pre-IVI asepsis protocol with povidone-iodine was applied. Main outcome measures included upper and lower MG loss, tear meniscus height (TMH), bulbar redness score (BR), non-invasive tear break-up time (NIBUT), tear film osmolarity (TOsm), Schirmer test, corneal staining, fluorescein tear film break-up time (TBUT), meibomian gland expressibility (ME) and meibum quality (MQ).

Ninety patients with a mean age of 77.5 years were included. The median number of IVI in treated eyes was 19.5. Mean MG loss in the upper eyelid was 19.1% in treated eyes and 25.5% in untreated fellow eyes. For the lower eyelid, median MG loss was 17.4% in treated eyes and 24.5% in fellow eyes. Mean BR was 1.32 in treated eyes vs. 1.44 in fellow eyes. Median TMH was 0.36 mm in treated eyes and 0.32 mm in fellow eyes. There were no differences between treated and fellow eyes regarding NIBUT, TOsm, Schirmer test, corneal staining, fluorescein TBUT, meibomian gland expressibility ME or MQ.

The authors of this study concluded that repeated IVI with anti-VEGF with preoperative povidone-iodine application was associated with reduced meibomian gland loss, increased tear volume and reduced signs of inflammation compared to fellow non-treated eyes in patients with nAMD. This regimen may thus have a beneficial effect on the ocular surface.

SOURCE: Malmin A, Thomseth VM, Forland PT, et al. Associations between serial intravitreal injections and dry eye. Ophthalmology. 2023 Jan 21. [Epub ahead of print].



Higher-Order Aberrations and Visual Performance in Myopic Children Treated With Aspheric Base Curve-Designed Orthokeratology

This prospective clinical study investigated the impact of aspheric base curve (BC)-designed orthokeratology (ortho-k) (AOK) lenses on higher-order aberrations (HOA) at different pupil diameters and visual performance. The study included subjects randomized to wear spherical BC-designed ortho-k (SOK) or AOK lenses. The Pediatric Refractive Error Profile (PREP) questionnaire was completed before and after three months of lens wear. The Strehl ratio (SR) and root mean square of ocular higher-order aberrations (HOAs), spherical aberration (SA), coma, and trefoil were measured under 4-mm, 5-mm, and 6-mm pupil diameters at baseline and three-month visits. Corneal topography, uncorrected low-contrast (LC) visual acuity (VA), and high-contrast (HC) VA were measured at baseline and at 1 day, 1 week, 1 month, and 3 month follow-ups.

Sixty-five participants completed the study. After 3 months with the ortho-k lens, there were no significant differences in ocular HOA, SA, coma, or trefoil between the SOK group and AOK group at 4-mm, 5-mm, and 6-mm pupil diameters, except for a significant increase in SA in the AOK group. Stratified analyses showed that the AOK group exhibited greater HOA and SA at 5-mm and 6-mm pupil diameters in the lower myopia subgroup and greater SA at 6 mm in the higher myopia subgroup. There were no significant differences between the groups in SR, HC VA, LC VA, or PREP scores.

It was concluded that aspheric BC-designed ortho-k lenses produced a significantly greater SA than SOK lenses, with more significance at lower diopters, without sacrificing subjective visual performance.

SOURCE: Chen C, Ma W, Wang J, et al. Higher-order aberrations and visual performance in myopic children treated with aspheric base curve-designed orthokeratology. Eye Contact Lens. 2023;49(2):71-6.

Early Lensectomy in Patients With Pseudoexfoliation: Long-Term Effectiveness and Safety Outcomes

The purpose of this study was to assess the long-term effectiveness, predictability, and safety of cataract surgery performed in patients with capsular PXF at an early stage of the disease. This retrospective, comparative study included PXF patients who underwent phacoemulsification with hydrophobic acrylic intraocular lens implantation in both eyes with a postoperative follow-up ≥5 years. Patients were classified in two groups: symmetric PXF (n=102) and asymmetric PXF (n=59). Preoperative and postoperative uncorrected and corrected distance visual acuity, manifest refraction, IOP, number of hypotensive drugs, visual field mean deviation, and the incidence of complications were registered.

The mean follow-up time was 8.5±2.8 years. Six months after cataract surgery, monocular uncorrected and corrected distance visual acuity were 0.3±0.4 and 0.1±0.3 logMAR, respectively, for the symmetric PXF, and 0.2±0.2 and 0.1±0.2 logMAR, respectively, for the asymmetric group. Total 95% and 96% of eyes were within ±1.00D in symmetric and asymmetric groups, respectively. At the final follow-up, IOP decreased only in the asymmetric group, with a reduction in the number of medications in both eyes. Mean deviation changed from -8.8 to -11.6 dB in the symmetric group, and from -5.0±6.2 to -7.9±10.6 dB in the asymmetric group. Intraoperative complications were only registered in the symmetric group: 7 (3.4%). Ten cases (4.9%) of late intraocular lens dislocation were found, all from the symmetric group.

This study suggests that early lensectomy in patients with PXF before its symmetric presentation resulted in effective, safe, and predictable long-term results with good intraocular pressure.

SOURCE: Rodríguez-Una I, Fernández-Vega Cueto A, Rodríguez-Calvo PP, et al. Early lensectomy in patients with pseudoexfoliation: long-term effectiveness and safety outcomes. J Glaucoma. 2023;32(2):93-100.



Industry News

Harrow Closes Acquisition of U.S. Rights to Five Products

Harrow announced acquisition of the exclusive U.S. commercial rights to five branded ophthalmic products: Ilevro, Nevanac, Vigamox, Maxidex and Triesence. Read more.












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

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