Off the Cuff: Vision and Invention

This past week I had the pleasure of speaking at Bausch + Lomb’s B+Lieve event in Denver, launching Bausch + Lomb ULTRA^® for Astigmatism Contact Lenses. I was tasked with discussing the impact of technology on the ocular surface and how modern contact lenses and materials fit into this complex equation.

As I was preparing for the presentation, I ruminated on how much digital device use has changed the way we use our eyes and how quickly this occurred. Keep in mind that the Apple II was launched in 1977 and the IBM PC in 1981.

For all the benefits of the personal computer revolution and the explosion of digital devices, we are only now starting to understand some of the unanticipated consequences. Humans are hunter-gatherers. Our eyes are designed to scan the horizon for predators and find food. The advent of digital devices and the endless hours we spend staring at them have fueled an epidemic of “dry eye” and made comfortable contact lens wear far more elusive.

Researchers looked at 21,766 persons ages ≥40 years with newly diagnosed open-angle glaucoma (OAG) between 2007 and 2011 enrolled in Medicaid or a large United States managed care network to determine whether the type of health insurance a patient possessed and/or a patient's race/ethnicity affected receipt of common tests to monitor OAG. Researchers determined the proportion of patients with newly diagnosed OAG who underwent visual field (VF) testing, fundus photography (FP), other ocular imaging (OOI) or none of these tests within the first 15 months after initial OAG diagnosis. Multivariable logistic regression was used to assess the extent by which health insurance type and race/ethnicity affected the odds of undergoing glaucoma testing.

A total of 18,372 persons with commercial health insurance and 3,394 Medicaid recipients met the study inclusion criteria. The proportions of persons with commercial health insurance with newly diagnosed OAG who underwent VF, FP and OOI were 63%, 22% and 54%, respectively, whereas the proportions were 35%, 19% and 30%, respectively, for Medicaid recipients. Compared with those with commercial health insurance, Medicaid recipients were 234% more likely to not receive any glaucoma testing in the 15 months after initial diagnosis. After adjustment for confounders, whites with OAG enrolled in Medicaid had 198% higher odds of receiving no glaucoma testing compared with whites possessing commercial health insurance. Blacks with Medicaid insurance demonstrated 291% higher odds of not receiving any glaucoma testing compared with blacks with commercial health insurance.

Irrespective of race/ethnicity, researchers determined that Medicaid recipients with OAG received substantially less glaucoma testing compared with persons with commercial health insurance. Disparities in testing were observed across all races/ethnicities but were most notable for blacks. At the same time, researchers wrote, black individuals are more likely than whites to go blind from OAG, and there are disproportionately more blacks in Medicaid. Researchers suggested that efforts were needed to improve the quality of glaucoma care for Medicaid recipients, especially racial minorities.

Dry eye is a common problem affecting mainly the adult population, and in severe cases, it can result in sterile corneal ulcer and perforation, authors wrote. They reported a rare case of a 26-year-old male, a known patient with severe dry eye who presented with sterile corneal ulcer with corneal perforation in both the eyes.

The patient was managed by applying cyanoacrylate glue, and with application of bandage contact lenses in both eyes and topical antibiotic, topical cyclosporine and preservative-free artificial tears at two hourly intervals. The patient was investigated for the systemic cause of severe dry eye, but no cause could be ascertained. On follow up, the patient reported marked relief in photophobia. On examination, both eyes showed sealed perforation with a well-formed anterior chamber.

In conclusion, authors wrote that clinicians should examine dry eye patients carefully and detect corneal ulcers and perforations in a timely way to prevent sequelae.

Primary angle-closure glaucoma (PACG) is a common eye disease and a common cause of blindness, researchers wrote. Inappropriate medical decisions severely affect the prognosis, they added. This study investigated decision-making under risk in PACG patients. Thirty patients with a first acute attack of PACG before surgery, and thirty healthy controls were included. Decision-making under risk was evaluated with the game of dice task (GDT). Results of the Eysenck Personality Questionnaire (EPQ) and GDT between PACG patients and healthy controls were compared.

Risky decisions in PACG patients were made more often than in healthy controls as measured by a mean score of GDT (12.47 ±5.72 vs. 4.33 ±3.30). A higher neuroticism score in EPQ was found in PACG patients compared with healthy controls (14.97 ±3.93 vs. 9.90 ±4.49). Neuroticism scores in EPQ were associated with decision-making performance (r=0.417).

Investigators found that neuroticism positively correlated with risky decisions, and suggested that decision-making might be influenced by neuroticism. Future studies will show whether therapy compliance will be improved by emotional management and psychological intervention in PACG patients.