Optometric Physician

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


Volume 18, Number 31

Monday, July 31, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: Are We Losing Our Humanity?
######### The Relationship Between Ocular Trauma and Substance Abuse in Emergency Department Patients
######### Use of Topical Insulin to Treat Refractory Neurotrophic Corneal Ulcers
######### A Randomized Trial of Soft Multifocal Contact Lenses for Myopia Control
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


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.

A day after beloved Arizona Senator John McCain was diagnosed with glioblastoma, Kelli Ward, who lost against him in last year’s primary, despicably demands that he step aside. Ward doesn't even try to hide that she is angling for an appointment to fill McCain’s seat rather than actually running against Arizona Senator Jeff Flake in 2018, a race she’ll almost certainly lose.

Heroes once were Salk and Sabin, John Glenn and Neil Armstrong. Today, I don’t know who most celebrities are—mostly because they’ve done nothing deserving of celebrity. In our world, doctors once were so respected that they could park at fire hydrants in NYC while they made house calls. Today, doctors are treated like more like suspected criminals rather than professionals. This sadly is the new normal.

So are we witnessing the end of civilization as we know it? Sometimes it seems that way. But I think that all of the chaos and shifting values demand more of us. My mentor, Dr. Norman Haffner, told us that we would serve as social change agents. I didn’t fully understand the depth of his words as his student, but I do now. We can either choose to accept what seems unacceptable, or refuse to accept it. Ultimately, we create and are responsible for our shared reality.


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.



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.

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.

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.

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.


Fresenius Kabi to Acquire Akorn
Fresenius Kabi has agreed to acquire Akorn for approximately $4.3 billion. The transaction is expected to close by early 2018. Fresenius Kabi specializes in sterile injectable medicines, while Akorn produces a portfolio including sterile ophthalmics among other products. Read more.

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.

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

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.



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



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.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add Optometricphysician@jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Optometric Physician.

E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

For information on advertising in this e-mail newsletter or other creative advertising opportunities with Optometric Physician, please click here for advertising information.