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


Volume 18, Number 28

Monday, July 10, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: The Compliance Conundrum
######### Folded Bandage Contact Lens Retention in Dry Eye Symptoms Patients
######### Correlation of Afferent Pupillary Defect with Ganglion Cell Complex
######### Long-term Evaluation of Refractive Changes in Eyes of Preterm Children
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: The Compliance Conundrum

Among the highlights of the AOA meeting was one of the most interesting and eclectic advisory boards I’ve ever participated in. Sitting around the table was a who’s who of optometry’s brightest minds in glaucoma and ocular surface disease—an interesting mix. While there is certainly overlap between the two subspecialties, this meeting was less about synergy than shared perspective about the profession, industry and the future.

Despite the broad focus, I couldn’t help but read between the lines and see some of the common problems that we struggle with daily. Among them, poor compliance is our No. 1 enemy. While a universal problem, this is especially true for glaucoma and ocular surface disease where progressive damage is usually silent, and early treatment is critical.

As the discussion turned to drug delivery and compliance challenges, I thought about my own practice and how easy it is to get lulled into a false sense of patient adherence. Truth be told, compliance is poor across the board even with life- and sight-threatening diseases. Sadly, we don’t discuss this enough and often do things that actually derail patients.

After thinking this through and discussing this with a few industry friends, I came to several realizations. First, improving patient compliance is best left to professionals. While we may be excellent at diagnosing and treating, keeping patients on the clinical straight and narrow isn’t our forte. Pharmacists are better at it and have developed numerous ways to help patients continue using prescribed medications. I know this firsthand, as I am hounded by text messages about my own refills.

I have long been a proponent of point-of-care sale of supplies. As it turns out, products sold in office have the lowest refill and compliance rate of all. That’s why companies like PRN have instituted a Patient Connect program and NovaBay has gone primarily to a pharmacy-dispensed Rx model. Refills are two to three times more prevalent through the pharmacy than the doctor’s office for prescribed products. Same with the larger companies like Shire and Allergan, which have their own novel compliance programs in place.

While starting patients with samples or starter supplies makes good clinical sense, we are increasingly leaving ongoing supply management to the professionals. I think that makes for better patient care. Something to consider.


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.


Folded Bandage Contact Lens Retention in Dry Eye Symptoms Patients
Bandage contact lenses are commonly used by ophthalmic practitioners to protect the patient's cornea. Researchers reported a case of a folded bandage contact lens retained for six-and-a-half years in the upper subtarsal space. They were not aware of any cases of retained bandage contact lenses previously reported in the literature.

A patient was applied a pair of bandage contact lenses due to persistent ocular pain secondary to dry eye symptoms. At her subsequent visit, the bandage contact lens was removed from her left eye, but none was found in the right eye. Documentation from a subsequent visit stated that the bandage contact lenses were no longer in situ. A total of 6.5 years after the lens insertion, lid eversion revealed a “foreign body” retained beneath her right upper eyelid, which was noted to be a folded, discolored bandage contact lens.

The upper fornix trap, where the contact lens may be retained by the upper tarsal edge, presents an anatomical hazard for contact lens users, researchers wrote. Moreover, they added, soft contact lenses might be more likely to retain asymptomatically and to fold onto themselves compared with hard lenses. This case report highlighted the importance of performing a thorough eye examination that includes double eversion of the upper eyelids and sweeping of the fornices with cotton buds, as well as maintaining clinical suspicion of contact lens retention.

SOURCE: Ho DK, Mathews JP. Folded bandage contact lens retention in a patient with bilateral dry eye symptoms: a case report. BMC Ophthalmol. 2017;17(1):116.

Correlation of Afferent Pupillary Defect with Ganglion Cell Complex
This study investigated the correlation between the relative afferent pupillary defect (RAPD) and retinal nerve fiber layer thickness (RNFLT) in optic neuropathy. RAPD assessment was performed using a log unit-neutral density filter bar. Spectral-domain optical coherence tomography RTVue-100 (Optovue) was used to examine the subjects. The optic nerve head pattern (ONH) was subdivided and identified for the purpose of the study into circumpapillary RNFLT (cpRNFLT) and peripheral circumpapillary RNFLT (pcpRNFLT). The cpRNFLT, pcpRNFLT and ganglion cell complex (GCC) parameters were analyzed.

Eighteen females and 23 males with asymmetric optic neuropathy and a RAPD participated. Thirty-three subjects had glaucoma and eight had optic neuropathy other than glaucoma. Significant correlations were obtained for the RAPD and the percentage difference loss for the GCC and RNFLT parameters. The grouped mean percentage difference loss for RNFLT was significantly different from that of the GCC. At a 0.6 log unit RAPD, the average mean percentage difference loss was 23% for the CRNFLT, 15% for the GCC, 12% for the global loss volume percentage and 6% for the focal loss volume (FLV) percentage.

Significant correlations between RNFLT loss for cpRNFLT, pcpRNFLT and GCC parameters with RAPD were observed. Approximately a 35% higher sensitivity was obtained using GCC compared with CRNFL parameters. The expected change in GCC average for every 0.3 log unit increment was approximately 8.49μm. The FLV% corresponded more sensitively to a RAPD but appeared to be influenced by disease severity.

SOURCE: Besada E, Frauens BJ, Makhlouf R, et al. More sensitive correlation of afferent pupillary defect with ganglion cell complex. J Optom. 2017; Jul 1. [Epub ahead of print].




Long-term Evaluation of Refractive Changes in Eyes of Preterm Children
This study investigated the longitudinal changes in refractive errors in preterm children with and without retinopathy of prematurity (ROP) in the first six years of life. Researchers included 226 preterm children with a gestational age of ≤34 weeks: 222 eyes with no ROP, 73 eyes with mild ROP and 145 eyes with severe ROP. Longitudinal cycloplegic refraction data were collected initially and yearly thereafter until six years of age.

Eyes in the severe ROP group showed an increase in myopia values between the one- and three-year examinations, with little change thereafter. However, the mild/no ROP group demonstrated a nonsignificant increasing myopia values throughout the six-year follow-up. Both the mild/no ROP and severe ROP groups were found to have increasing mean astigmatism values with increasing age, albeit nonsignificantly. Likewise, the stable mean values of anisometropia increased nonsignificantly during the first six years of life in the mild/no ROP and severe ROP groups. The severe ROP group had higher values regarding myopia, astigmatism and anisometropia parameters than the mild/no ROP group for all ages during the follow-up.

Researchers advised that preterm children with severe ROP should be closely monitored, and those with mild/no ROP should be carefully followed to avoid overlooking possible increases in refractive conditions.

SOURCE: Kaya M, Berk AT, Yaman A. Long-term evaluation of refractive changes in eyes of preterm children: a 6-year follow-up study. Int Ophthalmol. 2017; Jul 1. [Epub ahead of print].

News & Notes
Quidel Acquires InflammaDry & AdenoPlus Businesses
Quidel, a provider of rapid diagnostic testing solutions, cellular-based virology assays and molecular diagnostic systems, completed the acquisition from RPS Diagnostics of InflammaDry and AdenoPlus—rapid, lateral-flow based POC products for detection of infectious and inflammatory diseases and conditions of the eye. InflammaDry detects elevated levels of MMP-9, a key inflammatory marker for dry eye, while AdenoPlus differentiates viral and bacterial acute conjunctivitis infections. Both products are FDA-cleared and CLIA-waived. Read more.


IDOC Redesigns its Website
IDOC, a privately held alliance of independent optometrists in the United States, redesigned its website. The site reflects IDOC’s new brand designed to help independent optometrists run their businesses successfully at every stage and “Focus on What Matters” most. The new site was designed in conjunction with Zero Gravity Marketing & Loyalty Benefits, which also administers IDOC’s business intelligence platform. Read more.

NIDEK Offers Medmont E300 Corneal Topographer
Medmont and NIDEK announced a new partnership in which NIDEK is offering the Medmont E300 Corneal Topographer to U.S. eye care professionals and government-tendered competitions. NIDEK’s U.S. subsidiary provides ophthalmic lasers, refractive lasers and advanced diagnostic devices, while Medmont is a manufacturer of software and equipment for the ophthalmic market. Read more.

Novaliq Appoints Dr. Burian as CMO
Novaliq named Gabriela Burian, MD, MPH, Novaliq’s chief medical officer. Previously, Dr. Burian served as global program medical director at Novartis Pharma and early program leader at F. Hoffmann-La Roche. She founded and directs GB Biomed Advisors and serves as CMO for Iconic Therapeutics. Read more.

AAOF’s First Joseph T. Barr Early Research Award Recipient Named
Yuno Iwabuchi, fourth-year OD/MS student and teaching assistant at Pacific University College of Optometry, was chosen by a committee of members in the Cornea, Contact Lenses and Refractive Technologies section of the American Academy of Optometry as this year’s inaugural recipient for the Joseph T. Barr Early Cornea and Contact Lens Research Award. Of the five applicants who applied to the program, Iwabuchi presented an impressive resume of experience in clinical, volunteer service, research and lecture presentation. She will receive a $2,000 education award and a $750 travel fellowship to attend the Academy 2017 Chicago annual meeting in October. Read more.

American Academy of Optometry Releases Award Recipient Names
The 2017 American Academy of Optometry award winners will be recognized at the Academy 2017 Chicago Awards Ceremony Oct. 13 in McCormick Place. Recipients of the Section on Cornea, Contact Lenses and Refractive Technologies award recipients will be honored Oct. 11. The 2017 award recipients include:

Eli Peli, MSc, OD, FAAO
Charles F. Prentice Medal and Lecture Award

Mitchell Scheiman, OD, PhD, FAAO
Glenn A. Fry Award and Lecture
(American Academy of Optometry Foundation Award)

Ava K. Bittner, OD, PhD, FAAO

Irvin M. and Beatrice Borish Award

Luigi Bilotto, MS, OD, FAAO
AAO-Essilor Award for Outstanding International Contributions to Optometry

C. Ellis Potter, OD, FAAO
Brien Holden Humanitarian Award

Joseph Fontenot, MD, CLVT
Carel C. Koch Memorial Medal Award

Laura Goldberg, OD, MS
Celia R. Gong
Julius F. Neumueller Award in Optics
(American Academy of Optometry Foundation Award)

Richard Madonna, MA, OD, FAAO
Vincent Ellerbrock Clinician Educator Award

Harue J. Marsden, OD, MS, FAAO
Eminent Service Award

Bert C. Corwin, OD, FAAO
Avrum Richler, OD, PhD, FAAO

Life Fellow Award

Jeffrey J. Walline, OD, PhD, FAAO; Katie L. Greiner, OD, MS, FAAO; Mary Elizabeth McVey, OD, MS; and Lisa A. Jones-Jordan, PhD, FAAO
Garland W. Clay Award

Lorraine Lombardi, PhD
Michael G. Harris Award for Excellence in Optometric Education
(American Academy of Optometry Foundation Award)

Awards of the Section on Cornea, Contact Lenses & Refractive Technologies

Suzanne M.J. Fleiszig, OD, PhD, FAAO
Max Schapero Memorial Lecture Award

Lynette Johns, OD, FAAO, FSLS
Founders’ Award

Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia


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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