Optometric Physician



Vol. 25, #21 •   Monday, June 17, 2024


Off the Cuff: Service Contracts and Industry Standards

Last year I finally upgraded our OCT to an OCTA with angiography. I was hesitant to give up our tried-and-true Optovue iVue OCT. It was simple to operate, captured reliable and repeatable images, and was used in nearly every aspect of the practice from primary care to emergency visits, routine diabetic exams, glaucoma testing, corneal thickness monitoring for Fuchs dystrophy, keratoconus, and corneal injury patients, postoperative care for evaluating cystoid macular edema and epiretinal membranes to scleral contact lens fitting. It was our workhorse, but it was showing its age. It was time to trade it in. Upgrading was not without its headaches but after getting all the exam room computers upgraded to meet specs, we were up and running. This first year has been a learning curve figuring out its quirks and workarounds, so, frankly, I was surprised when I received notification that our one-year manufacturer warranty was up. What was surprising was that the time had flown by so quickly, but alarmingly surprising was the offered service contract price for 2 years was literally 20% of what I paid for the instrument… and this was discounted. I contacted them to see if there was a lower tier available. No. I asked why this was priced so high. I was given a perfunctory, “It’s the industry standard based on the full retail price of the instrument.” I have paid for many service contracts for many different instruments over the years and don’t recall any of them being this high.


Why does medical equipment, scratch that, expensive medical equipment have only a one-year manufacturer's warranty? Anything that would happen in that time frame would be an indication of a defective piece of equipment, which is a much bigger manufacturing problem than just a warranty. This raises the question of build quality or the implied lack thereof. If this is the quality-built item that I was told it to be, why only one year? I’ve purchased less expensive motor vehicles that are covered bumper to bumper if anything goes wrong at all for three to five years. I’ve bought used cars that still had manufacturer warranties in place that were transferred to me. These vehicle warranties foster such a sense of loyalty to the manufacturers of these vehicles. Yet, for these pieces of medical equipment that are key to the functionality of my practice and my ability to care for patients, I get only one year. This creates an adversarial relationship with the equipment manufacturer, with them holding the expensive service contract or even more expensive repair bill over your head as a threat to be able to get back to work.

If the original purchase price of the instrument had been fractionally higher and included a 3-year “bumper to bumper” warranty, the financial net to manufacturer would have been the same, but the perception of instrument quality and manufacturer reputation would have been incredibly more positive and made me far more likely to recommend and buy from them again. I realize it’s all perception, but it would seem the equipment manufacturers need to do better to stand out and not join in the swamp of the “industry standard.”

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.



The Sleep Health of Individuals with Visual Impairments

Amidst the global aging population and an increasing prevalence of visual impairment across all age groups, this study aimed to investigate the current state of research on sleep health in visually impaired populations. A scoping review was conducted to synthesize the existing literature on sleep health and visual impairment. Researchers employed conceptual mapping to identify key research topics, analyzing data from four databases: PubMed (n=290), CINAHL (n=81), Scopus (n=117), and PsycInfo (n=96). A total of 83 peer-reviewed articles, published from 1977 to August 2023, were included in the review.

The analysis identified 11 distinct eye health conditions including blindness, glaucoma, diabetic retinopathy, low vision, cataract, retinitis pigmentosa, macular degeneration, optic neuropathy, visual field defects, ocular hypertension, and retinal vein occlusion. Additionally, 8 major sleep problems were recognized: abnormal sleep duration, daytime sleepiness, insomnia, Non-24-Hour Sleep Wake Disorder, sleep apnea, sleep disorders, sleep disturbances, and sleep disordered breathing. The dominant research themes were (1) poor sleep quality in individuals with visual impairments and ophthalmic diseases, (2) high prevalence of sleep issues in patients with ophthalmic diseases, (3) sleep apnea in patients with ophthalmic conditions, and (4) circadian rhythm disruptions in blind individuals.

This review highlights research gaps that, when addressed, could greatly enhance our comprehension of the interplay between visual impairment and sleep health. Bridging these gaps promises to lead to more holistic care strategies, potentially improving vision functioning and rehabilitation outcomes for individuals with visual impairments.

SOURCE: Soyoung Choi, Grace Kim, J J Pionke. The Sleep Health of Individuals with Visual Impairments: A Scoping Review. Ophthalmic Epidemiol. 2024 Jun 12:1-19. Online ahead of print.




Potential Risk Factors for Ocular Pain in Patients Undergoing Multiple Intravitreal Injections of Anti-Vascular Endothelial Growth Factor

This prospective, observational, case series study involving patients who underwent multiple (≥3) intravitreal injections of ranibizumab or aflibercept to treat any cause of chorioretinal vascular disease assessed ocular pain in patients undergoing multiple intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) who have previous factors that may influence pain sensitivity. Ocular pain was assessed by the numerical analog scale during intravitreal injection. For this study, the main variable was ocular pain and the secondary variables included age, sex, previous history of glaucoma, primary retinal vascular disease, severe dry eye history, trigeminal pain, scleral buckle surgery, collagen diseases, fibromyalgia, severe migraine history, pars plana vitrectomy, scleral thickness measurements, and type of anti-VEGF.

In a total of 894 patients, 948 eyes (4822 intravitreal injections), 793 patients (88.6%) had ocular pain sensitivity between no pain to mild pain, 80 patients (8.9%) had moderate ocular pain, 15 patients (1.6%) had severe ocular pain, and 6 patients (0.7%) had extremely severe ocular pain. Patients with severe dry eye (p=0.01) and previous history of scleral buckle surgery (p=0.01) showed a significant correlation with ocular pain during intravitreal injection. Pars plana scleral thickness (>550 um) and diabetic neuropathy were associated with ocular pain but did not meet the criteria for statistical significance (p=0.09 and p=0.06, respectively).

Dry eye and prior scleral buckle surgery may contribute to pain associated with intravitreal injection. These issues should be taken into consideration in patients undergoing multiple intravitreal injections.

SOURCE: Nadyr A Damasceno, Juliana Angélica Estevão Oliveira, Nicolas A Yannuzzi, et al. Potential Risk Factors for Ocular Pain in Patients Undergoing Multiple Intravitreal Injections of Anti-Vascular Endothelial Growth Factor. Clin Ophthalmol. 2024 Jun 7:18:1691-1699.

Prevalence of Depression and Anxiety Disorders in Patients with Glaucoma

Glaucoma is a chronic disease with an insidious onset that often brings severe psychological burden to patients. Therefore, based on a systematic review and meta-analysis, researchers explored the prevalence and severity of depression and anxiety in glaucoma patients, and provided clinically valuable information for medical staff. Computer searches were conducted for relevant studies in PubMed, Embase, ProQuest PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, The Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure, Wanfang Database, and China VIP Database. The search date range was from the establishment of the database to December 2023. Literature was screened and data was extracted. The Cochrane risk of bias assessment tool was used to evaluate the quality of the literature, and RevMan5.4 was used for meta-analysis.

The total sample size of the 15 included studies was 24,334 cases. All included studies were of high quality. The results of the meta-analysis revealed that, compared with control patients without glaucoma, patients with glaucoma were more likely to experience depression and to have more severe depressive symptoms [RR (Relative Risk) = 5.92, 95% CI (Confidence Interval) (3.29, 10.66), p<0.01]; they were also more likely to experience anxiety and to have more severe anxiety symptoms [RR = 2.99, 95% CI (1.93, 4.64), p<0.01]. The results of the sensitivity analysis showed that two studies by Cumurcu E., 2005, and Yochim, 2012, were the sources of heterogeneity in the meta-analysis of depression; and three studies by Mabuchi 2012, Otori, 2017, and Yochim, 2012, were the sources of heterogeneity in the meta-analysis of anxiety disorders.

Researchers concluded that individuals with glaucoma were more likely to experience depression and anxiety than those without glaucoma. They suggested that eye care professionals should pay greater attention to patients' emotional problems and help patients improve their quality of life.

SOURCE: Junfei Yin, Huijun Li, Nina Guo. Prevalence of Depression and Anxiety Disorders in Patients with Glaucoma: A Systematic Review and Meta-Analysis Based on Cross-Sectional Surveys. Actas Esp Psiquiatr. 2024 Jun;52(3):325-333.




Industry News

Bausch + Lomb Introduces INFUSE® for Astigmatism SiHy Daily Disposable CLs

Bausch + Lomb announced the US introduction of INFUSE for Astigmatism daily disposable contact lenses. Engineered with a next-generation lens material infused with ProBalance Technology™ and the company’s proprietary OpticAlign® design, INFUSE for Astigmatism is designed to provide astigmatic patients clear, stable vision, all-day comfort and minimize contact lens dryness. The company expects to start shipping INFUSE for Astigmatism fitting sets to eye care professionals in July. Read more.

Oculis Announces Positive Topline Results of Phase 2b RELIEF

Oculis Holding announced positive topline results from its Phase 2b RELIEF trial with licaminlimab, a novel anti-TNFα biologic eye drop with an established dual anti-inflammatory and anti-apoptotic mechanism of action in patients with dry eye disease. Read more.


• IDOC is running a limited time promotion. New members are eligible for a rebate of up to $840 (a value of three months of membership) when they join before June 30th. Learn more.








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

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