Optometric Physician



Vol. 25, #21 •   Monday, June 10, 2024


Off the Cuff: Fun with Optics

This week I was doing a contact lens check for one of my young associates' patients. The patient was a 55-year-old female wearing multifocal contact lenses. Her distance vision was good, but her computer was difficult. Being in my mid-50s myself, I knew her pain, so I tried one of the strategies I figured out since the pandemic. I cut back her distance prescription +0.50D or +0.75D, which gave her much better computer vision, highly functional indoor vision, and the multifocal worked even better for reading since we were able to use a lower add than originally prescribed. I then prescribed a pair of glasses to wear over the contacts for night driving that correct the rest of the distance power I took out. It’s probably not a popular opinion, but I'll usually refer patients to the cheap online retailers to buy these glasses since they'll just be bag riders most of the time. That seems a perfect use for those cheap online eyeglass retailers. Maybe it’s experience, maybe it’s my own presbyopia where I find myself wearing my computer glasses all day in the office, but this strategy seems to work exceptionally well for heavy computer users as well.


This got me thinking about all the other little strategies I’ve stumbled upon over the years for contact lens fitting. The most shocking one is when a distance spherical lens presbyopic patient is somehow reading, and you find they have enough uncorrected astigmatism shining through that it has an add effect. Neat trick. Wish I had done it on purpose. It makes sense though. You essentially have an uncorrected nearsighted meridian. I had never thought about astigmatism like that before. Obviously, this works if you’re working in minus cylinder—sorry OMDs. Ever since I have found, if the uncorrected astigmatism is with-the-rule, the add effect is pretty consistent.

Ocular dominance is more useful than just determining the distance correction eye for a monovision fitting. The level or severity of the ocular dominance is equally important. A strongly dominant-eyed patient does better with monovision than mildly dominant. Even in these strongly dominant patients’ eyeglass prescriptions, they won’t particularly care for a fully balanced prescription. I’ve found it’s sometimes better to leave them out of balance and slightly overminusing the dominant eye to allow it to do its thing. The nondominant lazy-kid-in-the-group-project just doesn’t contribute well, and overall quality and comfort drops if you force the balance.

Speaking of modified monovision contact lens fitting for computer users, the combinations can be far more interesting than distance/near with a distance/intermediate I was originally trained to do. The distance/intermediate on dominant with an intermediate/near on nondominant works very well or even enhancing intermediate in the dominant eye and giving the nondominant distance vision duties is also a great strategy for the work-from-home computer user. With all the lens options available to us now and the way work and computer culture has changed since the pandemic, increasing the number of people essentially indoors on their computers all day, thinking outside the box to accommodate these changed visual needs is a necessity. I would love to hear the strategies you’ve come up with, so please share so we can all learn from each other's experiences.

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.



Artificial Intelligence Based Glaucoma and Diabetic Retinopathy Detection Using MATLAB - Retrained Alexnet Convolutional Neural Network

Glaucoma and diabetic retinopathy (DR) are the leading causes of irreversible retinal damage leading to blindness. Early detection of these diseases through regular screening is especially important to prevent progression. Retinal fundus imaging serves as the principal method for diagnosing glaucoma and DR. Consequently, automated detection of eye diseases represents a significant application of retinal image analysis. Compared with classical diagnostic techniques, image classification by convolutional neural networks (CNN) exhibits potential for effective eye disease detection. This paper proposes the use of MATLAB - retrained AlexNet CNN for computerized eye diseases identification, particularly glaucoma and diabetic retinopathy, by employing retinal fundus images. The acquisition of the database was carried out through free access databases and access upon request. A transfer learning technique was employed to retrain the AlexNet CNN for non-disease (Non_D), glaucoma (Sus_G) and diabetic retinopathy (Sus_R) classification. Moreover, model benchmarking was conducted using ResNet50 and GoogLeNet architectures. A Grad-CAM analysis was also incorporated for each eye condition examined.

Metrics for validation accuracy, false positives, false negatives, precision, and recall were reported. Validation accuracies for the NetTransfer (I-V) and netAlexNet ranged from 89.7% to 94.3%, demonstrating varied effectiveness in identifying Non_D, Sus_G, and Sus_R categories, with netAlexNet achieving a 93.2% accuracy in the benchmarking of models against netResNet50 at 93.8% and netGoogLeNet at 90.4%.

This study demonstrated the efficacy of using a MATLAB-retrained AlexNet CNN for detecting glaucoma and diabetic retinopathy. It emphasizes the need for automated early detection tools, proposing CNNs as accessible solutions without replacing existing technologies.

SOURCE: Isaac Arias-Serrano, Paolo A Velásquez-López, Laura N Avila-Briones, et al. Artificial intelligence based glaucoma and diabetic retinopathy detection using MATLAB - retrained AlexNet convolutional neural network. F1000Res. 2024 Apr 3:12:14.




Analysis of the Retinal and Choroidal Vasculature Using Ultra Widefield Fundus Imaging in Mild Cognitive Impairment and Normal Cognition

This prospective cross-sectional study utilized ultra widefield (UWF) imaging to evaluate retinal and choroidal vasculature and structure in individuals with mild cognitive impairment (MCI) compared with that of controls with normal cognition. One hundred thirty-one eyes of 82 MCI patients and 230 eyes of 133 cognitively normal participants from the Eye Multimodal Imaging in Neurodegenerative Disease Study were included. A scanning laser ophthalmoscope (California, Optos) was used to obtain UWF fundus color images. Images were analyzed with the Vasculature Assessment Platform for Images of the Retina UWF (VAMPIRE-UWF 2.0, Universities of Edinburgh and Dundee) software. Imaging parameters included vessel width gradient, vessel width intercept, large vessel choroidal vascular density, vessel tortuosity, and vessel fractal dimension.

Both retinal artery and vein width gradients were less negative in MCI patients compared with controls, demonstrating decreased rates of vessel thinning at the periphery. Retinal artery and vein width intercepts, a metric that extrapolates the width of the vessel at the center of the optic disc, were smaller in MCI patients compared with that of controls. The large vessel choroidal vascular density, which quantifies the vascular area versus the total choroidal area, was greater in MCI patients compared with controls.

When compared with controls with normal cognition, MCI patients had thinner retinal vasculature manifested in both the retinal arteries and the veins. In MCI, these thinner arteries and veins attenuated at a lower rate when traveling toward the periphery. MCI patients also had increased choroidal vascular density.

SOURCE: Suzanna Joseph, Alice Haystead, Cason B Robbins, et al. Analysis of the Retinal and Choroidal Vasculature Using Ultra Widefield Fundus Imaging in Mild Cognitive Impairment and Normal Cognition. Ophthalmol Sci. 2024 Feb 1;4(4):100480.

The Pathophysiology of Keratoconus

Keratoconus is a progressive disease characterized by changes in corneal shape, resulting in loss of visual function. There remains a lack of comprehensive understanding regarding its underlying pathophysiology. This review aims to bridge this gap by exploring structural failures and inflammatory processes involved in the etiology and progression of keratoconus. A literature review was conducted using PubMed and Google Scholar databases, screening for articles published in English using the keyword combinations of "keratoconus" with "pathophysiology," "pathology," "metabolism," "inflammatory," "oxidative stress," "cytokines," "enzymes," "collagen," and "cornea." Articles published between January 1, 1970, and June 1, 2023, were queried and reviewed, with greater emphasis placed on more recent data. Fifty-six relevant studies were examined to develop a thorough review of the pathophysiological mechanisms at play in keratoconus.

Biomechanical structural failures in the cornea appeared to be the primary militating factors in keratoconus etiology and progression. These include disruptions in the arrangement in the collagen lamellae, a decrease in collagen levels, a decrease in natural collagen crosslinking, and changes in lysosomal enzyme activity. Immunologic changes have also been identified in keratoconus, challenging the traditional view of the condition as noninflammatory. Elevated levels of proinflammatory cytokines like IL-1b, IL-6, IL-17, and TNF-α have been observed, along with increased apoptosis of keratocytes. Researchers wrote that increased oxidative stress leads to the activation of collagenase and gelatinase enzymes.

Keratoconus is a complex condition influenced by both structural defects and inflammatory processes. Understanding these mechanisms can inform clinical management and potentially lead to more effective treatments.

SOURCE: Rita Vought, Steven A Greenstein, John Gelles, Peter S Hersh. The Pathophysiology of Keratoconus. Cornea. 2024 May 30. Online ahead of print.




Industry News

B+L Launches Blink™ NutriTears® Nutritional Supplement for Dry Eyes in the US, Announces Presentations at AOA Optometry’s Meeting

Bausch + Lomb announced the US launch of Blink NutriTears, a clinically proven over-the-counter supplement targeting the key root causes of dry eyes, promoting healthy tear production, and providing relief of eye dryness symptoms in two to four weeks. Developed in collaboration with eye care and nutritional experts, Blink NutriTears is formulated with a proprietary blend of ingredients, including lutein, zeaxanthin, curcumin, and vitamin D, and was shown to improve ocular symptom severity and tear film homeostasis, as well as clinically help tears stay on the eyes for 33% longer. Blink NutriTears will be available in the eye care aisle or online at most major retailers nationwide by the end of July. Read more.

The company also presented 12 ePosters during the American Optometric Association (AOA) Optometry’s Meeting ePoster Session, which took place virtually May 29-30, and will present three live presentations and host nine education events during the group’s in-person meeting in Nashville, June 19-22. The live presentations will include clinical data evaluating Blink NutriTears, which was selected by AOA as one of the top five abstracts. Two other presentations will showcase clinical evaluation data for Blink Triple Care Lubricating Eye Drops, the first over-the-counter eye drop with hyaluronate and a nano-emulsion lipid in the formula. Read more.

BostonSight® Launches Beyond the Fit™

BostonSight® launched Beyond the Fit™, a comprehensive consultation and fitting support program that provides BostonSight SCLERAL® lens practitioners tools for ongoing success. The company launched Beyond the Fit to ensure practitioners feel confident in fitting patients, regardless of their expertise in specialty lenses. Read more.

Azura Enrolls First Patient in Trial for AZR-MD-001 in MGD

Azura Ophthalmics, a biopharmaceutical company developing a new therapeutic class of ophthalmic keratolytics for ocular surface diseases, announced the first patient was enrolled in the ASTRO, Phase 3 clinical trial assessing the efficacy and safety of AZR-MD-001 in patients with clinical signs and symptoms of meibomian gland dysfunction. Read more.


• The Neuro-Optometric Rehabilitation Association, International (NORA) is accepting nominations for several awards, which acknowledge individuals and organizations for important contributions to the area of Neuro-Optometric Rehabilitation. Learn more.

• Hilco Vision Care Solutions division, comprising Bruder Healthcare, M&S Technologies, and Hilco Vision Ophthalmic brands, announced Brian Stafford as national account director. Read more.

• Harrow announced its ESSENCE‑2 open-label extension clinical study of Vevye (cyclosporine ophthalmic solution) 0.1% demonstrated Vevye’s sustained safety and efficacy in treating the signs and symptoms of dry eye disease. Read more.

• Latinos en Optometry appointed Sandra Juarez Fortenberry, OD, FAAO, to its board of directors. Read more.

• Nordic Pharma, a subsidiary of Nordic Group B.V., launched LACRIFILL Canalicular Gel, a therapy for dry eye in the US. The cross-linked hyaluronic acid derivative is FDA-cleared to temporarily block tear drainage by the occlusion of the canalicular system. The therapy is administered through a simple in-office procedure, reimbursed through CPT code (68761), with results lasting for six months. Read more.








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

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