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


Volume 19, Number 1

Monday, January 7, 2019


Inside this issue: (click heading to view article)
######### Off the Cuff: Turning a New Leaf
######### Comparison of Three Different Tonometers in Eyes with Angle Closure
######### Dry Eye Symptoms May Have Association with Psychological Stress in Medical Students
######### Acute Narrow-angle Glaucoma Induced by Topiramate with Acute Myopia And Macular Striae: A Case Report
######### News & Notes

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Off the Cuff: Turning a New Leaf

If 2019 turns out anything like 2018 did, this should be a very interesting year. To get things rolling, I thought I would start off with some good news for a change—or at least what I hope will turn out to be good news.

Barely noticed in the end of the year holiday hubbub was the mid-December announcement that ARBO, ASCO and the AAO have forged an alliance for the governance of COPE, optometry’s primary continuing education overseer. Overall, I think this is wonderful news for the profession, although the devil will obviously be in the details. All three organizations involved in this enterprise have valid interest and acknowledged expertise in education. Our schools define optometric education, the Academy’s primary focus is education and ARBO’s mission is to ensure the public wellbeing through professional advancement, with ongoing practitioner education at its central core.

Cooperation and synergy aside, to insure the integrity of this process, it is important to recognize potential conflicts and biases up front. While ARBO does not provide CE and has no vested interest in offering or financially benefitting from CE, such is not the case for the schools or the AAO. It is also important to acknowledge the critical leadership role ARBO has played in COPE’s development, the council’s significant positive impact on our profession, and, most importantly, the organization’s independence and neutrality. Indeed, notable leaders in medical education have openly described COPE’s independence as the envy of other professions. As a result, last January, COPE was invited to join the Joint Accreditation for Interprofessional Continuing Education. This important achievement represents de facto reciprocity and CE equivalence with medicine’s ACCME and other healthcare accrediting bodies.

While optometry needs to welcome and support this new educational alliance, I do not believe it can credibly be made up of three equal partners. While contributions from ASCO and the AAO will undoubtedly be valuable, the independence and public service mission of ARBO must place them firmly as the lead of this new troika. As I see it, our profession’s integrity and future depend upon it.

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.


Comparison of Three Different Tonometers in Eyes with Angle Closure
Precise measurement of intraocular pressure (IOP) is essential when diagnosing and managing glaucoma. Researchers compared the IOP readings of three different tonometers and analyzed agreement among tonometers in eyes with high IOPs. The purpose of this study was to compare the IOP readings obtained using a Goldmann applanation tonometer (GAT), a rebound tonometer (RT), and a Tono-Pen (TP) in angle-closure eyes with elevated IOP before and after medical IOP-lowering therapy. Twenty-five eyes of 25 patients with angle closure and IOPs of greater than 30 mmHg were enrolled. Intraocular pressure was measured using RT (iCare Pro), TP (Tono-Pen XL), and GAT before and after medical treatment. The mean IOP readings of the tonometers were compared before and after treatment. The agreement among the tonometers was assessed via Bland-Altman analysis.

The measurements from 22 eyes of 22 patients were suitable for statistical analyses. Before medical treatment, the mean TP-IOP was significantly lower than the mean GAT-IOP (44.0 ± 10.3 vs. 50.4 ± 8.9 mmHg, respectively), but no significant difference was evident between the RT-IOP and the GAT-IOP (50.8 ± 10.9 vs. 50.4 ± 8.9 mmHg, respectively). After IOP-lowering treatment, the mean GAT-IOP (14.9 ± 4.7 mmHg) did not differ from either the mean RT-IOP (15.6 ± 4.4 mmHg) or the mean TP-IOP (15.4 ± 5.0 mmHg). The random measurement error among tonometers was greater for high IOP readings.

Researchers wrote that, compared with RT or GAT, TP underestimated IOP in angle-closure eyes with a GAT-IOP of greater than 30 mmHg. They added that intraocular pressure reading agreement among the three tonometers was lower in eyes with high IOP.

SOURCE: Lee TE, Yoo C, Kim YY. Comparison of three different tonometers in eyes with angle closure. Optom Vis Sci. 2018; Dec 26. [Epub ahead of print].

Dry Eye Symptoms May Have Association with Psychological Stress in Medical Students
This cross-sectional study included 209 students at a medical school in Korea to evaluate the prevalence and risk factors of symptomatic dry eye disease (DED) among medical students. Dry eye symptoms were assessed using a nine-item questionnaire, and DED was defined as having one or more dry eye symptoms often or all the time. The ocular surface disease index (OSDI) and visual analog scale (VAS) questionnaires were also administered to quantify the dry eye symptoms. A survey including demographic data, potential risk factors for DED, personal habits and psychological stress was also performed.

Of the 209 students, 188 (93 men and 95 women) completed the survey. The average age was 28 ± 2.5 (mean ± SD; range, 23-37) years. Prevalence of DED was 27.1% (51/188). Participants with DED had significantly higher VAS and OSDI than those without DED. Univariate analysis revealed that female sex (p=0.001), contact lens (CL) wear (p=0.034), prolonged computer use (p=0.001) and higher psychological stress score (p<0.001) had significant association with DED. Multivariate analysis also showed the significant association between DED and female sex (p=0.026), CL wear (p=0.042), prolonged computer use (p=0.004) and higher stress score (p=0.014).

Symptomatic DED was prevalent among medical students. Increased psychological stress was associated with higher risk of DED. DED risk also increased among women, CL wearers and prolonged computer users.

SOURCE: Hyon JY, Yang HK, Han SB. Dry eye symptoms may have association with psychological stress in medical students. Eye Contact Lens. 2018; Dec 21. [Epub ahead of print].



Acute Narrow-angle Glaucoma Induced by Topiramate with Acute Myopia And Macular Striae: A Case Report
Investigators reported the case of a 29-year-old epileptic woman who had been treated with topiramate 25mg/day for nine days. She was referred to the emergency department due to reduction in distance visual acuity (VA) after increasing the dose to 50mg/day two days before.

Ocular examination showed bilateral acute angle-closure glaucoma (AACG) and macular striae in both eyes (AO) observed by retinography and optical coherence tomography (OCT). Investigators wrote that AACG is a well-known side effect of topiramate, but macular striae rarely accompanies it.

Although macular striae have been previously described in other cases, very few report using retinography and OCT images. Therefore, investigators suggested, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action and treatment. Mismanagement can have potentially serious consequences, investigators added.

SOURCE: Sierra-Rodríguez MA, Rodríguez-Vicente L, Chavarri-García JJ, et al. Acute narrow-angle glaucoma induced by topiramate with acute myopia and macular striae: A case report. Arch Soc Esp Oftalmol. 2018; Dec 24. [Epub ahead of print].

News & Notes

Primary Eyecare Network Offering Scleral Lenses Workshop with Leading OD
Primary Eyecare Network (PEN), a division of ABB Optical Group, is offering a workshop on scleral lenses on Feb. 9 from 8 a.m. to 1 p.m. at the Crowne Plaza Concord in Concord, Calif. This hands-on, comprehensive workshop is designed to cover all bases of scleral lenses from fitting to billing and will be led by Melissa Barnett, OD. A fellow of the American Academy of Optometry and the Scleral Lens Society, Dr. Barnett is an internationally recognized authority on specialty lenses. Participants will learn about the major disorders for which scleral lenses are prescribed, selection and follow-up up care, troubleshooting and lens fit modifications, managing patients with chronic and complex eye disease, and appropriate billing and coding. Additionally, the workshop will include a scleral wet lab that will focus on patient fitting, insertion and removal training, and troubleshooting. The event is pending approval for two hours’ worth of continuing education credits from the Council on Optometric Practitioner Education (COPE). Learn more or register here.


Optometric Organizations Establish New COPE Governing Committee
The American Academy of Optometry, the Association of Schools and Colleges of Optometry and the Association of Regulatory Boards of Optometry announced a joint agreement was reached to restructure the governance of the Council on Optometric Practitioner Education (COPE). The newly established COPE Governing Committee will be comprised of representatives from ARBO, ASCO and the Academy to assure collaboration and the ongoing advancement of the quality of optometric continuing education. COPE accredits optometric continuing education for use by ARBO’s member regulatory boards in assessing and determining eligibility for licensure by optometrists. COPE accreditation serves the public, regulatory boards and the profession by promoting improvement in competence, performance and patient outcomes. Initial nominations to the COPE Governing Committee are underway, with expected completion in January 2019. Read more.

Alcon Acquires Tear Film Innovations
Alcon acquired Tear Film Innovations, a privately held company and manufacturer of the iLux Device, used to treat meibomian gland dysfunction. Handheld and portable, the iLux enables eye care professionals to target a patient's blocked meibomian glands and provide therapy through an in-office treatment. A practitioner can warm the eyelids via disposable silicone pads to address blocked meibomian glands through the application of light-based heating. While applying the device, the practitioner is able to view the eyelid margin and apply manually controlled compression to express blockages, making adjustments as needed to tailor treatment to the individual needs of the patient. 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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