Review Of Optometry - Optometric Physician

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

Volume 18, Number 2

Monday, January 8, 2018

Inside this issue: (click heading to view article)

		Off the Cuff: Shifting Standards of Care

		Switching From BAK-Preserved to Preservative-free Latanoprost Decreases Anterior Chamber Flare in POAG Patients

		Severe Corneal Ulcer with Progression to Endophthalmitis and High-grade Bacteremia

		A Novel Adaptive Deformable Model for Automated Optic Disc and Cup Segmentation to Aid Glaucoma Diagnosis

		News & Notes

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Off the Cuff: Shifting Standards of Care

I hope everyone had a happy holiday. As I write this, it’s 75 degrees with the sun streaming through my office window here in Phoenix. I feel for those of you back East who are stuck in the throes of the bitter winter cold. Shannon and I had a taste of it during a brief holiday visit to her family in Nebraska. Kicking off our 2018 travels next week, we’ll be making our now annual pilgrimage to the Consumer Electronics Show in Las Vegas, where I expect to see more than a few innovations that will directly impact health care and health care providers.

As I look forward to the new year, I suspect 2018 will mark the start of a transformative period. Greater involvement in primary health care is virtually a certainty, as evidenced by last year’s scope changes in California. New targeted therapies will continue to emerge like the recently FDA-approved Luxturna, Spark Therapeutics' gene therapy for Leber’s congenital amaurosis, a previously incurable blinding disorder. Also expect technology to increasingly find its way into patients’ hands. For patients and doctors, this can be game changing—both good and bad—depending on how quickly we embrace these advances and how we ensure that they are used for our patients’ benefits.

Unfortunately, this won’t be as easy as it sounds. Health care, especially optometry, is conservative by nature, and we tend to hold on to beliefs and practices for too long. I can’t imagine managing glaucoma without an OCT, or keratoconus without corneal topography, but a not-insignificant number of colleagues still practice without either. Of far greater concern, there are those who would co-opt otherwise valuable advances and use them to supplant reasonable standards of professional care. Make no mistake: This will be a battle.

In our office, we are embracing technology as quickly as possible. I’ll share a recent example. Last year, Icare USA introduced the Icare Home, which we quickly adopted. The brilliant, little rebound tonometer can be used by patients to remotely monitor IOP on an ongoing basis. After a proscribed period, patients return with the device, and the stored measurements are downloaded for analysis. I don’t need to tell you that one of the most challenging problems in effective glaucoma management is occult IOP swings. With the Home able to record regular measurements, it stands to revolutionize how we manage glaucoma patients. Communicating the benefits of this kind of technology to patients will also become critical to practice success.

Differentiating your practice will be key. While Warby Parker and 1-800 will continue to try to encroach on what was once traditional optometric practice with online vision exam nonsense and autorefractor docs-on-a-stick, successful optometric practices will increasingly use technology to more effectively manage a growing population of patients in need.

Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com

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.

			Switching From BAK-Preserved to Preservative-free Latanoprost Decreases Anterior Chamber Flare in POAG Patients
			To validate the hypothesis that BAK induces low-grade inflammation in the anterior chamber, researchers designed a study to investigate whether switching from BAK-preserved to preservative-free latanoprost in patients with primary open-angle glaucoma (POAG) would reduce the flare levels. Forty-one eyes of 22 patients with primary open-angle glaucoma treated with BAK-preserved latanoprost for at least six months as monotherapy were included. Exclusion criteria included any use of topical eye drops other than latanoprost, pseudoexfoliation and pigment dispersion glaucoma, wearing of contact lenses and intraocular surgery in the past year. At the start of the study, researchers measured baseline flare values. They then switched all patients to preservative-free latanoprost. After one, two and three months, a routine ophthalmological examination was performed and flare measurement repeated. Thirty-three eyes were followed up throughout the entire three-month period. One month after the switch to preservative-free latanoprost, a statistically significant mean drop in flare of -0.96 ph/ms was observed. Mean flare decreased further by - 1.31 ph/ms after two months and by -1.25 ph/ms after three months. The switch from BAK-preserved to preservative-free latanoprost induced a statistically significant reduction in mean flare value. Whereas researchers’ previous study showed an increase in flare when initiating treatment with BAK-preserved eye drops, this study showed a decrease in flare upon cessation of BAK-preserved drugs. Researchers found that the combined evidence from the two studies strongly suggested that, in humans, BAK exerts its effects not only on the ocular surface, but also at the level of the anterior chamber.
			SOURCE: Kestelyn PA, Kestelyn PG, De Bacquer D, et al. Switch from BAK-preserved to preservative-free latanoprost decreases anterior chamber flare in POAG patients. Int Ophthalmol. 2017; Dec 22. [Epub ahead of print].

			Severe Corneal Ulcer with Progression to Endophthalmitis and High-grade Bacteremia
			Bacterial sepsis is a common consequence of many infectious processes. Authors described a case of a woman with a corneal ulcer who went on to develop group B streptococcal (GBS) endophthalmitis, bacteremia and eventual loss of the eye. A previously healthy, immunocompetent, middle-aged, contact lens-wearing female who, after freshwater boating in her contact lenses, developed a red, painful eye. She was initially prescribed an hourly topical steroid by an outside optometrist, but worsening of her condition prompted her to present to our the authors’ emergency department. Despite aggressive initial management, the patient went on to develop GBS endophthalmitis, sepsis with high-grade bacteremia and eventual loss of the eye. Authors wrote that eye care providers should exercise caution when prescribing frequent, potent corticosteroids when an infectious etiology is in the differential diagnosis.
			SOURCE: Stryjewski TP, Chodosh J, Kim IK, et al. Severe corneal ulcer with progression to endophthalmitis and high-grade bacteremia. Am J Ophthalmol Case Rep. 2017;6:30-2.

			A Novel Adaptive Deformable Model for Automated Optic Disc and Cup Segmentation to Aid Glaucoma Diagnosis
			This paper proposed a novel Adaptive Region-based Edge Smoothing Model (ARESM) for automatic boundary detection of the optic disc and cup to aid in automatic glaucoma diagnosis. The novelty of the approach consisted of two aspects: automatic detection of initial optimum the object boundary based on a Region Classification Model (RCM) in a pixel-level multidimensional feature space, and an Adaptive Edge Smoothing Update model (AESU) of contour points (e.g., misclassified, irregular) based on iterative force field calculations with contours obtained from the RCM by minimizing energy function—an approach that does not require predefined geometric templates to guide auto-segmentation. Such an approach also provides robustness in capturing a range of variations and shapes, investigators wrote. Investigators conducted a comprehensive comparison between their approach and state-of-the-art existing deformable models, and validated it with publicly available datasets. The experimental evaluation showed that the proposed approach significantly outperformed existing methods. Investigators suggested that the generality of the proposed approach would enable segmentation and detection of other object boundaries and provide added value in the field of medical image processing and analysis.
			SOURCE: Haleem MS, Han L, Hemert JV, et al. A novel adaptive deformable model for automated optic disc and cup segmentation to aid glaucoma diagnosis. J Med Syst. 2017;42(1):20.

News & Notes

Aerie Gets FDA Nod for Rhopressa (netarsudil ophthalmic solution) 0.02%
Aerie Pharmaceuticals announced that the U.S. Food and Drug Administration approved Rhopressa (netarsudil ophthalmic solution) 0.02% for the lowering of elevated intraocular pressure in individuals with open-angle glaucoma or ocular hypertension. The FDA approval decision was made two months ahead of the scheduled Prescription Drug User Fee Act goal date of Feb. 28. Rhopressa (netarsudil ophthalmic solution) 0.02% is a novel, once-daily eye drop believed to reduce IOP by increasing the outflow of aqueous humor through the trabecular meshwork. Read more.

Visiometrics Releases Software Update for HD Analyzer
Visiometrics released an update to its HD Analyzer system, which provides objective measurements of visual quality to improve patient outcomes in cataract diagnosis, dry eye treatment and refractive surgery. The free software update features improvements to the user experience, including accelerated exam time with one-click tests and a new auto-save feature. The simplified menu yields easier navigation, and customization options were added to tailor report management to practice protocols. One major benefit of the system’s objective reporting capabilities is as a visual aid during patient discussions. The reports offer easier review for patient education, and flexible formatting enables selected metrics to be included. Graphs are larger, and numerical range scores were added to tear film analysis. In addition, a patient history graph provides a visual progression analysis. Read more.

WCO & Academy to Host Joint Education Meeting in 2019
The World Council of Optometry and the American Academy of Optometry will co-host the 3rd World Congress of Optometry in conjunction with the Academy meeting in Orlando, Fla., at the Orange County Convention Center. The meeting, tentatively set for Oct. 23-28, 2019, will feature joint CE tracks. Information on the meeting will be available in the future. Stay tuned.

B+L Receives 510(K) Approval for Crystalsert 2.6 Injector for Crystalens AO & Trulign Toric IOLs
Bausch + Lomb announced that it received 510(k) clearance from the U.S. Food and Drug Administration for the Crystalsert 2.6 injector (CI-26). Designed for use across the entire diopter range of Crystalens AO and Trulign toric intraocular lenses, the CI-26 facilitates smooth delivery through an incision as small as 2.6 mm. The CI-26 features a smooth, oval tip shape to aid in wound entry and help prevent tissue snagging. The tip also has a straight delivery channel to reach the capsular bag without wound stretch. A haptic guide and modified plunger tip support the leading and trailing haptics during delivery. 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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