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weekly e-journal by Art Epstein, OD, FAAO
Off the Cuff: Are We Losing Our Humanity?
As a YouTube stunt, a pregnant teen mother fires a .50 caliber handgun into her boyfriend’s chest, stupidly thinking a book he was holding would stop what body armor couldn’t. Five teens in Florida watch and record a terrified man drowning while taunting and laughing at him. A gentle and beautiful 40-year-old Australian woman calls 911 afraid that someone is being assaulted in her back alley. She ends up shot to death by an incompetent and poorly trained police officer in Minneapolis.
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The Relationship Between Ocular Trauma and Substance Abuse in Emergency Department Patients | ||||
Eye injury is the second most common cause of visual impairment and a leading cause of monocular blindness in the United States, researchers wrote. There are approximately 6 million ER visits related to drug use annually, including misuse or abuse of pharmaceuticals and illicit drug use, they added. The purpose of this study was to assess the relationship between ocular trauma and substance abuse among emergency department patients and in light of demographic factors, including age and gender. This retrospective, observational study was conducted at Miami Valley Hospital, an urban hospital emergency department in Dayton, Ohio. Eligible participants included consecutive ocular trauma patients identified by the Trauma Registry from January 2014 through January 2016. Data were collected from the ER medical record including demographic information, mechanism of injury, visual acuity, slit-lamp exam findings, ER procedures, inpatient procedures, toxicology results, ER diagnosis, ER disposition and eye exams.
Among 229 patients, the mean age was 44 (range 14 to 93). Seventy-three percent of patients were male. Most patients were white (74%), followed by African American (21%), Hispanic (2%), and other (3%). Most patients arrived by ambulance (62%), followed by helicopter (30%) and walk-ins (18%). Most patients were admitted to the hospital (79%). Mechanisms of injury included motor vehicle accidents (31%) and cases of assault (28%). Most ocular traumas involved the external eye (44%), the anterior chamber (28%), the orbit (25%) and the globe (22%). The incidence of substance abuse in this patient population was high. Of the patients tested for alcohol (n=143), 49% tested positive. Among 98 patients who received a urine toxicologic screen, 63% tested positive for at least one illicit substance, including opiates (39%), cocaine (12%), benzodiazepines (25%) and/or THC (27%). There was no significant association between substance abuse and ED disposition. Mechanisms of eye injury included primarily motor vehicle accidents and assaults. Most ocular traumas involved the external eye, the anterior chamber, the orbit and the globe. Researchers concluded that the incidence of alcohol and illicit substance abuse was high among ER patients with ocular trauma. |
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SOURCE: Chang SL, Patel V, Giltner J, et al. The relationship between ocular trauma and substance abuse in emergency department patients. Am J Emerg Med. 2017; Jul 8. [Epub ahead of print]. |
Use of Topical Insulin to Treat Refractory Neurotrophic Corneal Ulcers | ||||
This retrospective chart review reported the clinical course of six patients with refractory neurotrophic corneal ulcers that were treated with topical insulin drops. Insulin drops, prepared by mixing regular insulin with artificial tears with a polyethylene glycol and propylene glycol base at a concentration of 1 unit per milliliter, were prescribed two to three times daily.
Six patients, ages two to 73 years, developed neurotrophic corneal ulcers refractory to a range of medical and surgical treatments, including bandage contact lens, amniotic membrane grafting and permanent tarsorrhaphy. Each patient was administered topical insulin drops with complete corneal reepithelialization within seven to 25 days. Investigators suggested that topical insulin might be a simple and effective treatment for refractory neurotrophic corneal ulcers. They added that further study would be required to determine the clinical efficacy and side effect profile of insulin drops. |
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SOURCE: Wang AL, Weinlander E, Metcalf BM, et al. Use of topical insulin to treat refractory neurotrophic corneal ulcers. Cornea. 2017; Jul 24. [Epub ahead of print]. |
A Randomized Trial of Soft Multifocal Contact Lenses for Myopia Control | ||||
The Bifocal Lenses in Nearsighted Kids (BLINK) study is the first soft multifocal contact lens myopia control study to compare add powers and measure peripheral refractive error in the vertical meridian, in order to provide important information about the potential mechanism of myopia control. The National Eye Institute-sponsored, double-masked, randomized clinical trial is evaluating the effects of soft multifocal contact lenses on myopia progression. This article described the subjects' baseline characteristics and study methods. Subjects were seven to 11 years old and had: -0.75 to -5.00 spherical component, less than 1.00D astigmatism, 20/25 or better logMAR distance visual acuity with manifest refraction in each eye and +2.50-D add soft bifocal contact lenses on both eyes. Children were randomly assigned to wear Biofinity single-vision, Biofinity Multifocal "D" with a +1.50-D add power, or Biofinity Multifocal "D" with a +2.50-D add power contact lenses.
Researchers examined 443 subjects at the baseline visits, and 294 (66.4%) were enrolled: 177 (60.2%) females and 200 (68%) Caucasian individuals. The mean (±SD) age was 10.3 ± 1.2 years, and 117 (39.8%) of the eligible subjects were younger than 10 years of age. The mean spherical equivalent refractive error, measured by cycloplegic autorefraction, was -2.39D ± 1.00D. The best-corrected binocular logMAR visual acuity with glasses was +0.01 ± 0.06 (20/21) at distance and -0.03 ± 0.08 (20/18) at near. Researchers wrote that the BLINK study subjects were similar to patients who would routinely be eligible for myopia control in practice, so the results would provide clinical information about soft bifocal contact lens myopia control as well as the mechanism of the treatment effect, if one occurred. |
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SOURCE: Walline JJ, Gaume Giannoni A, Sinnott LT, et al. A randomized trial of soft multifocal contact lenses for myopia control: Baseline data and methods. Optom Vis Sci. 2017; Jul 21. [Epub ahead of print]. |
News & Notes | |||||||||
World Sight Day Challenge to Be Held in October Optometry Giving Sight is again inviting individuals to support its major fundraising campaign for the year, the World Sight Day Challenge. The Challenge will run throughout October, with World Sight Day being celebrated on October 12. This year’s campaign will help raise funds for more children to receive their first pair of eyeglasses. As part of its support for Our Children’s Vision, Optometry Giving Sight will fund projects in 2017 that aid more than 1 million children. Read more.
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Fresenius Kabi to Acquire Akorn |
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Aerie Appoints of Halprin Director of Professional Affairs Aerie Pharmaceuticals appointed Richard (Rick) A. Halprin as director of professional Affairs. Halprin held leadership positions at Alcon Labs for more than 25 years, most recently as director of professional affairs and prior to that as global marketing manager, Glaucoma. Read more. |
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BioLight Reports Positive Results in Phase I/IIa Trial for Glaucoma Insert BioLight Life Sciences revealed positive results from a Phase I/IIa clinical trial demonstrating its glaucoma insert’s ability to lower intraocular pressure for a 12-week period, with a favorable safety profile. The Eye-D latanoprost insert is designed to provide sustained IOP-lowering for individuals who have difficulty taking prescribed eye drops to treat glaucoma on a continuous daily basis. This trial compared three doses of the inserts to once-daily latanoprost eye drops. Read more. |
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Optometric Physician™ (OP) newsletter is owned and published by Dr. Arthur Epstein. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073. HOW TO ADVERTISE |