Optometric Physician



Vol. 24, #31 •   Monday, July 31, 2023


Off the Cuff: New Legislation: a Template for the Future

The state of Texas passed HB1696 last month. Why should we care? It’s essentially a sweeping reform of vision plan rules and their practices that aren’t always patient or practitioner positive. Becoming effective September 1, 2023, this new legislation prevents vision plans from steering patients to practices or websites that are owned by the plan itself. Vision plans will be restricted from offering different fee structures to different providers, utilizing chargebacks, and tiering providers based on utilization of products sold to patients. Additionally, a vision plan cannot require a practice to provide a service at loss or call something “covered” if there’s no reimbursement from the plan. Remind anyone of the contact lens fitting copay that is the entire “coverage” provided by the plan? Additionally, in an audit situation, they can no longer use the “extrapolation technique” where if 1 chart of 10 doesn’t meet audit criteria, they can no longer make the assumption 10% of all our charting doesn’t meet audit criteria. This is huge. These types of reforms and the increase in transparency have been decades overdue. Huge kudos to Texas optometry for making it happen.


So I’m sure you’re thinking, “I don’t practice in Texas. That doesn’t affect me.” Actually, it will. This legislation serves as a template for each and every state to target their future legislative efforts and is progress that is worth emulating. This type of legislation ensures patients get appropriate care and services as well as makes sure our practices remain viable so we can provide those services. At a time when inflation and the cost to run a practice keep rising, but vision care plans refuse to increase reimbursement in any meaningful way, this is a welcome win that will hopefully help wrest control from the plans back to the patients and doctors they ostensibly claim to serve.

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.



Bed Bug Infestation: An Updated Review

In the past decade, there has been a global resurgence of bed bug infestations, especially in developed countries. Proper awareness and identification of bed bug infestations are essential to guide treatment and eradication. The purpose of this article is to familiarize physicians with bed bug bites so that they can effectively diagnose, treat, and address questions about bed bug bites and infestations.

Bed bug bites are often painless. Typical reactions include pruritic, erythematous maculopapules occurring in clusters or in a linear or curvilinear distribution in exposed areas of the body. A small red punctum may be visualized at the center of the bite mark. Lesions that appear three in a row and papules on the upper eyelid associated with erythema and edema are highly suggestive of bites from bed bugs. Exaggerated local reactions such as vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, and nodules may occur in previously sensitized individuals. Reactions to bed bug bites are self-limited. As such, treatment is mainly symptomatic. Topical pramoxine and oral antihistamines can be used to alleviate pruritus. Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions.

Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices (active monitors include the use of heat or carbon dioxide attractants and passive monitors include the use of sticky pads for trapping), and judicious use of nonchemical and chemical treatments known to be effective. Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture. Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils. Insecticides should be used with caution to prevent over-exposure and toxicity (in particular, cardiovascular and neurologic toxicity), especially if there are young children around. It is important to note that multiple mechanisms of insecticide resistance exist and as such, chemical treatment should only be undertaken by trained professionals who understand the current literature on resistance. Both nonchemical and chemical technologies should be combined for optimal results. Bed bug infestations may cause diverse dermal reactions, stigmatization, poor self-esteem, emotional stress, anxiety, significant adverse effect on quality of life, and substantial socioeconomic burden to society. As such, their rapid detection and eradication are of paramount importance. Consultation with a professional exterminator is recommended to fully eradicate an infestation.

SOURCE: Leung AKC, Lam JM, Barankin B, et al. Bed Bug Infestation: An Updated Review. Curr Pediatr Rev. 2023 Apr 6. Epub ahead of print.



Gut Microbiota and Metabolites in Diabetic Retinopathy: Insights into Pathogenesis for Novel Therapeutic Strategies

Diabetic retinopathy (DR) is the most common and detrimental microvascular complication of diabetes mellitus. It has become one of the top causes of blindness and visual impairment in the working-age population. However, prevention and treatment options for DR are limited, invasive, and expensive, and most are focused on advanced-stage disease. The gut microbiota is an intricate system that alters the body's microenvironment, and its dysbiosis is strongly associated with DR. Recently, more and more investigations into the relationship between microbiota and DR have enhanced our understanding of how the gut microbiota influences the occurrence, development, prevention, and treatment of DR.

In this review, the authors summarize the changes in the gut microbiota of animals and patients with DR, and the function of metabolites and anti-diabetes drugs. Furthermore, they discuss the potential use of gut microbiota as an early diagnostic marker and targeting for DR in healthy people and diabetic patients. Finally, the microbiota-gut-retina axis is presented to help understand the mechanisms underlying the effect of gut microbiota on triggering or promoting DR, with a focus on the key pathways (e.g., bacterial dysbiosis and gut barrier dysfunction) that promote inflammation, insulin resistance, retinal cell and acellular capillary damage, leading to DR.

Based on these data, researchers hope to achieve a noninvasive, inexpensive treatment for DR by modulating the gut microbiota, either by supplementation with probiotics or by fecal transplantation. Outlined are gut microbiota-targeting treatments that could prevent DR progression.

SOURCE: Cai Y, Kang Y. Gut microbiota and metabolites in diabetic retinopathy: Insights into pathogenesis for novel therapeutic strategies. Biomed Pharmacother. 2023 Aug 2023 Aug;164:114994.

Associations Between Attention-Deficit/Hyperactivity Disorder and Allergic Diseases: a Two-Sample Mendelian Randomization Study

In some observational studies, attention-deficit/hyperactivity disorder has been linked to allergic diseases, but the findings are debatable. This study aimed to determine whether attention-deficit/hyperactivity disorder (ADHD) is causally related to allergic asthma, allergic rhinitis, pollen allergy, allergic urticaria, and allergic conjunctivitis using the two-sample Mendelian Randomization (MR) approach. This study employed a two-sample Mendelian randomization (MR) study, which chose single nucleotide polymorphisms (SNPs) that are highly associated with attention-deficit/hyperactivity disorder (ADHD) levels from the Psychiatric Genomics Consortium (PGC) on 20,183 cases and 35,191 controls as instruments. Outcomes datasets included genome-wide association study (GWAS) meta-analysis (n=1,415,804). The summary statistics of outcome data were obtained from the FinnGen datasets including allergic asthma (10,877 cases and 180,942 controls), allergic rhinitis (8,430 cases and 298,829 controls), pollen allergy (4555 cases and 301,734 controls), allergic urticaria (1792 cases and 299,491 controls) and allergic conjunctivitis (15,567 cases and 293,587 controls).

The Mendelian randomization (MR) analysis indicated that ADHD in inverse variance weighted [odds ratio (OR)=1.0612; 95% confidence interval (CI):1.0192-1.1049] lightly increased the risk of allergic asthma. In MR sensitivity analyses of the weighted median, a similar association was found. But no evidence for an effect of ADHD on allergic asthma risk was found in additional methods: MR-Egger (OR=0.9592, 95% CI: 0.8384-1.0974), and weighted median (OR=1.0341, 95% CI: 0.9785-1.0929). Also, no strong evidence for an effect of ADHD on other allergic diseases (allergic rhinitis, pollen allergy, allergic urticaria, and allergic conjunctivitis) incidence was found using the inverse variance weighted (IVW) method, weighted median method, and MR-Egger regression.

Although several studies have found a link between ADHD and allergic diseases, the findings of this study did not support that ADHD could increase allergic diseases incidence. Randomized controlled trials or Mendelian randomization studies with larger samples are still needed to draw more precise conclusions.

SOURCE: Zhang X, Zhang R, Zhang Y, et al. Associations between attention-deficit/hyperactivity disorder and allergic diseases: a two-sample Mendelian randomization study. Front Psychiatry. 2023 Jul 5;14:1185088.



Industry News

Tarsus Announces FDA Approves Xdemvy 0.25% for Treatment of Demodex Blepharitis

Tarsus Pharmaceuticals announced that the FDA approval of Xdemvy (lotilaner ophthalmic solution) 0.25% for the treatment of Demodex blepharitis. Xdemvy, formerly known as TP-03, is the first and only FDA approved treatment to directly target Demodex mites, the root cause of Demodex blepharitis. Read more.


• The American Academy of Optometry named David Elliott, PhD, FCOptom, FAAO, as the new editor-in-chief of Optometry and Vision Science. Dr. Elliott, who succeeds Michael Twa, OD, PhD, FAAO, comes to OVS after 11 years leading the Ophthalmic & Physiological Optics journal. Read more.
• BostonSight announced election of Pamela Anderson, Esq., as chairperson of the BostonSight board of directors and Donna Desmond, MBA, CPA as a board director. Read more.

Verséa Launches Tear-based POC Quantitative Testing Platform

Verséa Ophthalmics initiated shipments of its T-POC TOTAL IgE Immunoassay and Lateral Flow Readers. The company focuses on delivering tear-based point-of-care testing and biologic solutions designed to optimize diagnosis, treatment and management of various eye care conditions including ocular surface disease and pterygium surgery. Read more.

Celularity and Verséa Announce Commercialization Agreement

Celularity and Verséa Ophthalmics announced an exclusive U.S. commercialization agreement in which Verséa Ophthalmics will distribute Celularity’s Biovance and Biovance 3L Ocular products to support the treatment of ocular surface disease and ocular surgical applications. Read more.

Dietary Oral Zeaxanthin Decreased Progression of Wet AMD

A recent study confirmed an earlier comparative trial and two-year randomized clinical trial finding that 20 mg of dietary zeaxanthin daily decreased the chances of developing neovascular age-related macular degeneration in the second eye. View the study.









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

Optometric Physician™ (OP) newsletter is owned and published by Dr. Shannon L. Steinhäuser. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 19 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. HOW TO SUBMIT NEWS E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

Advertising: For information on advertising in this e-mail newsletter, please contact sales managers Michael Hoster, Michele Barrett or Jonathan Dardine.

News: To submit news or contact the editor, send an e-mail, or FAX your news to 610.492.1039