Optometric Physician



Vol. 24, #29 •   Monday, July 17, 2023


Off the Cuff: Hubble in Trouble or Are They?

All this week in my news feeds, I've been reading about a woman in New Mexico suing Hubble Contacts for the loss of her right eye. In 2020, when everyone was ordering everything online thanks to the pandemic, she ordered some Hubble contact lenses that she wore for a short period of time which led to a parade of complications and surgeries and ultimately to the placement of a prosthetic right eye. When I first learned of Hubble contacts and their known practices of switching patients' contact lens products and prescriptions to their own lenses and powers they felt were equivalent, I was hoping that poor vision and/or discomfort would be the worst complications these patients would potentially face. To hear that someone lost their eye from these shady practices is just heartbreaking.


When I looked for more information about this lawsuit, I found information about a Federal Trade Commission settlement in early 2022 against Hubble amounting to $3.5 million for deceptive practices and violations of the Contact Lens Rule. I had heard about this at the time but didn't know the details of it. Of the $3.5 million settlement, $1.9 million were refunds to consumers averaging about $63 per person. Some quick math shows that to be a little over 30,000 individuals getting refunds. $63…really?! For Hubble Contacts who reportedly have an annual revenue of $25-50 million a year, the FTC's $3.5 million is just a drop in the bucket. Due to the nature of their business of changing prescriptions and products, how is this one-time settlement fair or protecting consumers?

That got me thinking. On the other end of this Contact Lens Rule equation, if an optometrist, like you or me, fails to give or have a signed copy of a patient's contact lens prescription that we gave to them (whether they want it or not) saved in their record, there's a $50,120 civil monetary penalty for each violation. That's a far cry from $63 and nowhere on par with exposing patients to medical risk that could potentially lead to vision or life-altering complications. If the penalty for each occurrence that could be levied against an optometrist would be applied to the 2022 Hubble settlement, instead of $3.5 million it would have been closer to a $1.5 billion settlement. That definitely would have had the teeth necessary to truly protect consumers and prevent similar occurrences to what this lady in New Mexico went through. Her single settlement from Hubble could very well end up being more than the 2022 FTC slap on the wrist they received. Though the money doesn't replace what she has lost, I hope she finds justice, not only for herself, but for the countless other individuals who may have been harmed by Hubble’s deceptive practices.

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.



The Mediterranean Diet and Age-Related Eye Diseases: A Systematic Review

The Mediterranean diet (MD) is a healthy diet pattern that can prevent chronic age-related diseases, especially age-related eye diseases (AREDs) including cataract, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR) and dry eye syndrome (DES). In this study, researchers systematically reviewed studies in the literature that had reported associations between adherence to the MD and the five above-mentioned AREDs. Randomized controlled trials as well as prospective and retrospective observational studies were included; 1164 studies were identified, of which 1, 2, 9, 2 and 4 studies met eligibility criteria for cataract, glaucoma, AMD, DR, and DES, respectively.

According to these studies, higher MD adherence was associated with reduced risks of incident DR, incident AMD and progression to late AMD, but whether early and neovascular AMD could be alleviated remained to be debated. The results regarding the effects of the MD on DES were mixed, with three studies reporting associations between MD and decreased severity or incidence of DES, whereas one study reported the opposite. No significant associations were observed between the MD and cataract or glaucoma.

Researchers wrote, the evidence suggested a protective effect of the MD against AMD and DR. However, the evidence for cataract, glaucoma, and DES was less conclusive, and high-quality studies would be needed for comprehensive evaluations of the potential benefits of MD on these eye diseases, they added.

SOURCE: Yi Wu, Ye Xie, Yixiong Yuan, et al. The Mediterranean Diet and age-related eye diseases: A Systematic Review. Nutrients. 2023;15(9):2043.



Analysis of the Asymmetry in Early Diagnosis of Glaucoma Combining Retinal Images and OCT Features Into Classification Models

This study aimed to analyze the asymmetry between both eyes of the same patient for the early diagnosis of glaucoma. Two imaging modalities, retinal fundus images and optical coherence tomographies (OCTs), were considered to compare their different capabilities for glaucoma detection. From retinal fundus images, the difference between cup/disc ratio and the width of the optic rim was extracted. Analogously, the thickness of the retinal nerve fiber layer was measured in spectral-domain optical coherence tomographies. These measurements were considered as asymmetry characteristics between eyes in the modeling of decision trees and support vector machines for the classification of healthy and glaucoma patients. The main contribution of this work was the use of different classification models with imaging modalities to jointly exploit the strengths of each of these modalities for the same diagnostic purpose based on the asymmetry characteristics between the eyes of the patient.

The results showed that the optimized classification models provided better performance with OCT asymmetry features between both eyes (sensitivity 80.9%, specificity 88.2%, precision 66.7%, accuracy 86.5%) than with those extracted from retinographies, although a linear relationship was found between certain asymmetry features extracted from both imaging modalities. Therefore, the resulting performance of the models based on asymmetry features showed their ability to differentiate healthy from glaucoma patients using those metrics.

The investigators wrote that models trained from fundus characteristics are a useful option as a glaucoma screening method in the healthy population, although with lower performance than those trained from the thickness of the peripapillary retinal nerve fiber layer. They added, in both imaging modalities, the asymmetry of morphological characteristics can be used as a glaucoma indicator, as noted in the study.

SOURCE: Rodríguez-Robles F, Verdú-Monedero R, Berenguer-Vidal R, et al. Analysis of the asymmetry between both eyes in early diagnosis of glaucoma combining features extracted from retinal images and OCTs into classification models. Sensors (Basel). 2023 May 14;23(10):4737.

Corneal Sensitivity in Silicone Hydrogel and Rigid Gas Permeable Contact Lens Wear

The aim of this prospective cross-sectional cohort study was to test the effect of silicone hydrogel (SH) and rigid gas permeable (RGP) contact lens (CL) wear on corneal sensitivity, applying the new Swiss Liquid Jet Aesthesiometer for Corneal Sensitivity (SLACS) and the Cochet-Bonnet (CB) aesthesiometer, based on subject feedback (psychophysical method). Participants were recruited for three equally large groups: group A (SH CL), group B (RGP CL) and group C (non-CL wearers). Inclusion criteria were healthy eyes and OSDI ≤ 13. Corneal sensory thresholds were determined twice during two visits, with aid of SLACS and CB.

Ninety-six participants completed the study (n=33 in groups A and C, n=30 in group B); average age in group A: 27.42 ± 6.83 years, group B: 36.90 ± 9.68 years and group C: 26.06 ± 6.19 years. No statistically significant difference in corneal sensitivity was observed between the three groups for either method (p=0.302 for SLACS, p=0.266 for CB; Kruskal-Wallis rank sum test). Higher CSTs were obtained for males than for females in both CL groups with SLACS, and with CB only in the RGP CL group (p=0.041 in group A, p=0.006 in Group B with SLACS; p=0.041 in Group B with CB; bootstrap analysis with age correction and gender balancing). No correlation was observed between CL comfort and corneal sensitivity for either method applied (for SLACS r=0.097 and p=0.51, for CB r=0.17 and p=0.15; robust linear mixed model).

No difference in corneal sensitivity with CL compared to non-CL wear was noted in this study. However, researchers wrote that lower levels of corneal sensitivity were observed in the male CL groups, warranting further investigation.

SOURCE: Nosch DS, Käser E, Christen A, et al. Corneal sensitivity in silicone hydrogel and rigid gas permeable contact lens wear. Cont Lens Anterior Eye 2023; Jul 6:101888.



Industry News

Bausch + Lomb Shines a Light on Dry Eye Disease During National Dry Eye Awareness Month

Bausch + Lomb kicked off a social media campaign to increase understanding of dry eye disease and the role of tear evaporation as a leading driver of the disease. The campaign, which will run throughout the month of July during National Dry Eye Awareness Month, is designed to educate eye care professionals and consumers about DED and foster physician-patient dialogue on the multifactorial disease. Read more.

Prevent Blindness to Hold 15th Annual Swing Fore Sight Golf Tournament

Learn more.


• Hilco Vision earned Drug Distributor Accreditation, establishing safeguards intended to protect the public health, from the National Association of Boards of Pharmacy for its North Las Vegas facility. Read more.








Journal Reviews Editor:
Shannon L. Steinhäuser, OD, MS, FAAO

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