Optometric Physician

Vol. 22, #23   •   Monday, June 14, 2021


Off the Cuff: Misery Loves Company

COVID has forced most of us to spend more of our time in a virtual online world. Despite the physical isolation and the disruption to my normal routines, I think I’ve used my online presence productively. I have pivoted and reached thousands of colleagues with online CE programs that I created. I have been interviewed multiple times and listened to interviews of colleagues, actually getting to know some friends better than I did before. I have taken more CE courses in more subject areas than I ever have. I have found ways to learn that I wouldn’t have had time for previously.

Since dry eye is my primary clinical focus, I frequently monitor online dry eye patient support groups. The Dry Eye Syndrome Support Community on Facebook hosted by Drs. Travis and Jenna Zigler is an especially active and well-run group. Sifting through it, I’ve learned a great deal about the disease, the patient experience and even about us as clinicians. I have also been horrified by what many patients are going through and how poorly—and, in some cases, incompetently—they have been managed. While I believe that patients should always be their own advocate regardless of the disease, some of the things written in these groups are not just cries for help, they are indictments of the way we approach managing these patients.

There really is no reason for it. It’s not like dry eye is some esoteric, arcane subspecialty in eyecare. To the contrary, it is currently an area of tremendous interest and discussion. While I have occasionally answered a question or two or offered advice, the few times I have, I have felt like Hans Brinker, the fictional little Dutch boy who tried to save Holland by plugging holes in the dike with his fingers. There are too many questions, too many crazy therapies being recommended—some by doctors, many by other patients—and too many alienated and frustrated sufferers who have lost hope because they have been let down repeatedly. Understandably, they turn to each other when they have nowhere else to turn.

While it would be easy to dismiss many of these patients as neurotic, psychosomatic nutjobs, the sad truth is that the overwhelming majority of them are suffering from real problems and have not been able to find the help they need. I find that incredibly sad.

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 Jobson Medical Information LLC (JMI), or any other entities or individuals.



Virtual Reality Visual Training in an Adult Patient with Anisometropic Amblyopia: Visual and Functional Magnetic Resonance Outcomes

A case of an adult with anisometropic amblyopia who underwent a successful vision therapy program playing video games in a virtual reality environment was described, reporting changes in conventional visual clinical data, as well as in brain activity.

The patient was a 22-year old man who never previously wore correction for anisometropia. After prescribing contact lens correction for the anisometropia and after 44 hours of virtual reality-based vision therapy over a period of 1.5 years, the best-corrected distance visual acuity (BCDVA) in the amblyopic eye improved from 0.05 to 0.5 (Sloan chart). One year after finishing the visual training, the BCDVA experienced a slight decrease to 0.4 (Sloan chart). Through the visual training, the patient gradually developed stereopsis. Likewise, changes were also detected after visual therapy on functional magnetic resonance imaging while the patient was viewing 2D and 3D stimuli.

The preliminary results of this case showed the potential of using virtual reality-based visual training as a treatment for adult amblyopia.

SOURCE: Halicka J, Bittsansky M, Sivak S, PiƱero DP, Ziak P. Virtual Reality Visual Training in an Adult Patient with Anisometropic Amblyopia: Visual and Functional Magnetic Resonance Outcomes. Vision (Basel). 2021 May 11;5(2):22. [Epub ahead of print.]



Disc Hemorrhage Following Peripapillary Retinoschisis in Glaucoma: A Case Report

Disc hemorrhage (DH) is an important factor often associated with the development and especially progression of glaucoma. In contrast, some studies have reported peripapillary retinoschisis in glaucoma, but it is not recognized as a pathognomonic finding, and opinions on the clinical significance of retinoschisis are not consistent. Researchers presented a case of DH following peripapillary retinoschisis in the same area within the same glaucomatous eye.

A 70-year-old man with high intraocular pressure (IOP) was referred to the glaucoma clinic. At the time of the baseline study, the IOP was 30mmHg, and peripapillary retinoschisis was discovered at 7 o'clock on the periphery of the optic nerve with swept-source optical coherence tomography. In addition, retinal nerve fiber layer defects were detected inferotemporally with red-free fundus photography. Under the presumption of open-angle glaucoma, researchers prescribed latanoprost ophthalmic solution. Eight months later, the patient’s IOP was 17mmHg, and the peripapillary retinoschisis had disappeared. DH was observed inferotemporally in the same direction as that of the previous peripapillary retinoschisis.

Researchers wrote that the case was the first to report on the relationship between peripapillary retinoschisis and DH. They added that future studies may reveal a direct correlation between peripapillary retinoschisis and DH.

SOURCE: Lee WJ, Seong M. Disc hemorrhage following peripapillary retinoschisis in glaucoma: a case report. BMC Ophthalmol. 2021 Jun 7;21(1):253.



Choroidal Vascularity Map in Unilateral Central Serous Chorioretinopathy: A Comparison with Fellow and Healthy Eyes

This retrospective, observational study was performed in patients with unilateral central serous chorioretinopathy (CSCR) to map the choroidal vascularity index and compare two eyes in patients with unilateral CSCR. Choroidal thickness (CT) and choroidal vascularity index (CVI) were measured and mapped in various zones according to the early treatment diabetic retinopathy (ETDRS) grid.

A total of 20 CSCR patients (20 study and 20 fellow eyes) were included in the study. Outer nasal region CT was seen to be significantly lower than central CT and inner nasal CT; outer ring CT was significantly less than central (p=0.04) and inner ring CT in CSCR eyes. On comparing all the CVI values against the corresponding CT values, a positive correlation was seen in CSCR eyes (r=0.54), which was slightly weaker in fellow eyes (r=0.3), and a negative correlation was seen in healthy eyes (r=-0.262).

Investigators wrote that the correlation between CVI and CT was altered in CSCR eyes compared to fellow and normal eyes, with increasing CVI measures toward the center of the macula and superiorly in CSCR eyes.

SOURCE: Sahoo NK, Singh SR, Beale O, et al. Choroidal vascularity map in unilateral central serous chorioretinopathy: a comparison with fellow and healthy eyes. diagnostics (Basel). 2021 May 11;11(5):861.




Industry News

ISVA, EyeCare Pro Offer Webinar on Prescribing & Selling Sports Eyewear in the Practice

The International Sports Vision Association and EyeCare Pro will hold a webinar June 24 at 7p.m. Eastern on “Prescribing and Selling Sports Eyewear in Your Practice.” Everyday dresswear eyeglasses, sunglasses and contact lenses don’t offer adequate protection to guard against potential sports-related eye injuries so ISVA Vice President – Membership Jennifer Stewart, OD, and Daniel Rostenne, CEO of EyeCarePro, will discuss safety standards in eye protection, educating patients on these standards, and how proper display and placement in the practice and online can increase optical sales. Register for the webinar.




Optomed Offers Tabletop Fundus Cameras

Optomed USA now offers two tabletop fundus imaging cameras for the U.S. market. The Optomed Polaris, a stationary device with a small footprint, has a fully automatic, non-mydriatic fundus camera. The company says it requires minimal training and provides sharp 45-degree images of the retina. The Optomed Halo, with a lightweight design and small footprint, offers a fully automatic non-mydriatic retinal camera designed for easy transporting. On the Optomed Halo, the controlling computer can locate up to 25 feet away from the camera or behind a glass wall for social distancing. Learn more.



Greg Kunst Appointed CEO of Aurion Biotech

Greg Kunst was named chief executive officer of newly launched Aurion Biotech. The company’s first candidate is a cell therapy for the treatment of corneal endothelial disease. Invented by ophthalmic surgeon and research scientist Professor Shigeru Kinoshita and his colleagues at Kyoto Prefecture University of Medicine in Japan, corneal endothelial cell therapy has demonstrated long-term efficacy in Phase II and Phase III studies in Japan. Read more.



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