Optometric Physician



Vol. 24, #28 •   Monday, July 10, 2023


Off the Cuff: The Fluidity of the Perception of Time

In early 2020 at the beginning of the pandemic with all the conjecture of its origin, the stories of it spreading across the world, hospitals and nursing homes being overwhelmed, the lockdowns, and the effects on every aspect of our lives, a very noticeable shift in the perception of time seemed to have occurred. At first I thought it was just me, but the more I spoke with friends and patients, it was happening to everyone of all ages. Early on I would often say that the individual days felt long but weeks seemed to just evaporate. Looking back now, 2020 through 2022 seem to have succumbed to the same fate. This year so far doesn't seem much better.


I must have mentioned it enough that my social media algorithms started showing videos on theories of why the perception of time has shifted recently. Some of these implicated emotions shifting an individuals' perception of time; it has definitely been an emotional few years. Did the collective stress of the pandemic make us all have the same perception though? That seems fairly unbelievable. Other more far-fetched videos implied our whole universe shifted to another dimension. Great for an episode of The Twilight Zone, but I'm not so sure I can hang my hat on that theory either.

Yesterday, I saw a long-time patient that I would have sworn I had seen maybe a year and a half ago, but per her records, it was actually in 2019 pre-pandemic. We were both surprised it had been that long. I even checked for an inadvertent duplicate record. She then said exactly what I have been saying, "individual days seem to be so long, but time overall seems to be moving so fast." In the last few months, I’ve had more and more patients who hadn’t been seen since pre-pandemic resurfacing for care. If you haven't experienced this oddity, more power to you. For the rest of us, we may need to take into account this shift in everyone's perception of time and set those patient recall dates out further.

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.



Racial Variation in Visual Impairment of Patients with Keratoconus at Presentation

This retrospective cohort study examined medical records of 1989 patients (3978 treatment-naive eyes) with a diagnosis of KCN seen at Wilmer Eye Institute between 2013 and 2020. It aimed to investigate racial disparities in the severity of keratoconus (KCN) at presentation, their intersection with socioeconomic variables, and other factors associated with visual impairment. A multivariable regression model adjusting for age, sex, race, insurance type, KCN family history, atopy, smoking status, and vision correction method examined factors associated with visual impairment, defined as a best available visual acuity of worse than 20/40 in the better eye.

Demographically, Asian patients were the youngest (33.4 ± 14.0 years), and Black patients had the highest median area deprivation index (the Area Deprivation Index is a mapping tool that displays the relative socioeconomic conditions of neighborhoods). Multivariable analysis showed a higher risk of visual impairment for black versus white patients. Medicaid and Medicare were also associated with a higher odds of visual impairment compared with private insurance, and active smokers were more likely to have visual impairment than those with no prior smoking history. Eyes of lack patients had the highest maximum keratometry (Kmax) (56.0 ± 11.0D) and the lowest thinnest pachymetry (463.2 ± 62.5 µm) compared with eyes of other races.

Researchers concluded that black race, government-funded insurance and active smoking were significantly associated with increased odds of visual impairment in adjusted analyses. Black race was also associated with higher Kmax and lower thinnest pachymetry, suggesting that black patients have more severe disease at presentation.

SOURCE: Nugent L, Son HS, Wang J, et al. Racial variation in visual impairment of patients with keratoconus at presentation. Cornea. 2023 Jun 9. Epub ahead of print.



Risk Factors for the Development of Fellow Eye Horseshoe Retinal Tears Following Horseshoe Retinal Tear in the Presenting Eye

This study investigated factors associated with fellow eye horseshoe retinal tear (HST) development in consecutive patients with a presenting eye HST. Medical records were reviewed for patients with initial HSTs between 2015 and 2017, and 24 factors were analyzed. Logistic regression was used to assess factors associated with fellow eye HST development.

In total, 242 patients with an HST were identified with mean follow-up of 68.3 months. Four associations with fellow eye HST development were identified: (1) presence of fellow eye lattice degeneration, (2) subsequent presenting eye HSTs, (3) fellow eye vitreous hemorrhage at presenting eye HST occurrence, and (4) OCT-determined stage 3 fellow eye posterior vitreous detachment at presenting eye HST occurrence.

Four clinical findings associated with fellow eye HST development following presenting eye HST were identified. Investigators wrote that these factors may be important considerations during management patients with HST.

SOURCE: Peng ET, Parvus MN, Yu HJ, et al. Risk factors for the development of fellow eye horseshoe retinal tears following horseshoe retinal tear in the presenting eye. Ophthalmic Surg Lasers Imaging Retina. 2023;54(6):338-45.

Conjunctival Microbiota and Blepharitis Symptom Scores in Patients With Ocular Rosacea

The purpose of this study was to investigate the relationship between blepharitis-related symptom scores, tear film functions, and conjunctival microbiota in patients with ocular rosacea (OR) compared with healthy controls. Consecutive 33 eyes of 33 patients with OR who were admitted from the dermatology clinic, and 30 age- and gender-matched healthy controls were included in the study. Tear breakup time (TBUT), Schirmer score, and blepharitis symptom score (BLISS) were recorded for each patient. For the bacteriological examination, bacterial culture was obtained by inoculating the samples on chocolate agar, blood agar, and fluid thioglycolate medium. The growth of different colonies of bacteria was identified using matrix-assisted laser desorption or ionization time-of-flight mass spectrometry.

Bacterial culture positivity was observed in 13 eyes (39.4%) in the patients with OR and 10 eyes (33.3%) in the controls. Patients with OR showed worse TBUT and Schirmer scores, and higher BLISSs. Patients with OR with conjunctival culture-positive results showed higher BLISSs (8.0±4.7) compared with those with negative results (4.7±2.3). The most frequent bacteria was Micrococcus luteus (18.2%) in patients with OR and Staphylococcus epidermidis (20.0%) in the controls.

This pilot study showed that patients with OR had similar conjunctival culture positivity compared with healthy controls. However, the observation of different dominant bacterial species in conjunctival microbiota and the observation of worse BLISSs in patients with OR with positive culture might suggest a potential role of conjunctival microbiota in the pathogenesis of OR.

SOURCE: Mergen B, Onal I, Gulmez A, et al. Conjunctival microbiota and blepharitis symptom scores in patients with ocular rosacea. Eye Contact Lens. 2023 Jun 26. Epub ahead of print.



Industry News

Bausch + Lomb Will Acquire Xiidra

Bausch + Lomb Corporation entered into a definitive agreement with Novartis under which Bausch + Lomb will acquire Xiidra (lifitegrast ophthalmic solution) 5%, a non-steroid eye drop approved to treat the signs and symptoms of dry-eye disease, particularly inflammation associated with dry eye. The strategic acquisition of Xiidra will complement Bausch + Lomb’s existing dry-eye portfolio, which includes eye and contact lens drops from the company’s consumer brand franchises and its pharmaceutical business featuring Miebo (perfluorohexyloctane ophthalmic solution), recently approved by the FDA as the first and only approved eye drop for DED that directly targets tear evaporation. As part of the transaction, Bausch + Lomb will also acquire libvatrep (also known as SAF312), an investigational compound being studied for the treatment of chronic ocular surface pain, and AcuStream technology, an investigational device that may have the potential to facilitate precise dosing and accurate delivery of certain topical ophthalmic medications to the eye. Read more.

Jobson Research Issues New Report on the State of Telemedicine in 2023

The adoption of telemedicine has shown an increase in eyecare, particularly during the COVID-19 pandemic. Jobson Research’s recent report, titled Telemedicine Research, focuses on the integration of telemedicine into contact lens care, summarizing recent survey data to provide insights into the current state of telemedicine usage as well as practitioners’ perspectives on the feasibility of adopting telemedicine as a vision care tool. This data is derived from a survey of eye care professionals distributed by Jobson Medical Information in 2023. The survey was created by John D. Gelles, OD, FAAO, FIAOMC, FCLSA, FSLS, FBCLA and Jennifer Waller, Director of Research & Business Analytics for Jobson Research. The survey was disseminated to Jobson’s Eye Care Profession email list. Only optometrists and ophthalmologists were qualified to take the survey. In this research, doctors were asked a variety of questions about telemedicine and responses including doctors' assessment as to their ability to diagnose various conditions based on actual patient videos. Some of the telemedicine topics covered included:
• Adoption, applications and frequency
• Usage for contact lens patients
• Concerns using telemedicine for contact lens patients
• Prescribing contact lenses via telemedicine
• Assessing contact lenses using telemedicine
• Grading eye health with contact lens grading scales
• Instructions for patients
• Types of platforms used
• Benefits and challenges of using telemedicine The survey was conducted in April 2023 and there were 313 qualified responses. Learn more.

Eyenuk Gets FDA Nod for Autonomous AI Detection of DR

Eyenuk received FDA clearance to use the Topcon NW400 retinal camera with its EyeArt AI system to autonomously detect diabetic retinopathy, adding to the already approved Canon CR-2 AF and Canon CR-2 Plus AF cameras. The company says the EyeArt v2.2.0 system makes it the first AI system FDA-cleared for use with multiple retinal cameras by different manufacturers. Read more.

RVL Launches Prescription E-commerce Platform

RVL Pharmaceuticals launched a proprietary prescription e-commerce platform, ELEVATE, for purchasing RVL products. With RVL-initiated auto refills, the platform is designed to streamline processes for providers and patients, and yield additional savings for practices. Learn more.








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

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