Optometric Physician

Vol. 22, #24   •   Monday, June 21, 2021


Off the Cuff: The American Dream – P.S. We’re Not Selling

The American Dream is one of opportunity, ownership, success and prosperity. The promise of the American Dream is what brought many immigrants to these shores. In many ways, it defined the essence of American life since the country’s very beginnings. A chicken in every pot and two cars in every garage is an oft misquoted promise, but home and business ownership were perhaps among the most shared aspirations of the average American.

Today, homes are selling like hotcakes. In Arizona, rarely a week goes by where I don’t receive several calls or texts offering to buy my home. Prices continue to spiral up to what have become astronomical levels. Many homes are selling for well over asking prices. While this isn’t the first time we’ve seen a housing bubble, this time it seems different. According to the Wall Street Journal, among a chorus of other sources, a growing percentage of the homes being sold are not to individuals, but to private equity investors looking to turn these single-family homes into rentals. Entire neighborhoods are being scooped up straight from builders. Rather than owners with a financial and emotional stake in where they live, Americans are rapidly being turned into a nation of renters.

The shift in the real estate market is most visible now, but where we reside isn’t the only part of the American Dream that’s rapidly fading away. Dramatic changes in healthcare are occurring before our eyes. Many of us entered the profession with dreams of owning our own practices. Not so much anymore. New grads don’t want the responsibility of ownership. During a recent conversation with a local colleague, I was surprised to hear that many Phoenix-area practices, ones that I viewed as solid and successful, had been sold to private equity firms. Some went to larger national operations, others to a local consolidator that will no doubt sell the practices off to a larger fish when it has enough smaller fish in its pond. Optometry, as with most of the rest of medicine, is rapidly being transformed from doctor owners to doctor employees.

While prices for homes and for practices are likely to continue to rise for now, bubbles by their nature will eventually burst. Real estate prices will crash, and smaller groups—even some larger national practices—will likely go under. Timing will be critical, as the last in with the least amount of cash out will likely be left holding the bag. While some will likely be badly hurt financially when this happens, financial losses can always be recouped. Perhaps the bigger and more disturbing question is how much irreversible damage will be done to America as it is transformed into a nation of renters and employees rather than invested owners.

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.




Long-term Follow-up of Oral Mucosa Autograft Sutured to the Sclera in Severe Symblepharon

This study evaluated the clinical outcomes and complications of oral mucosa autograft (OMAU) sutured to the sclera to treat symblepharon after severe chemical or fireworks burn. The surgical technique for OMAU sutured to the sclera was presented along with clinical data and outcomes of seven symblepharon carriers. This surgical technique was performed unilaterally in all cases. An OMAU with a mean length of 3cm and 2cm wide was sutured to the bare sclera 1-3mm behind the limbus. Amniotic membrane transplant was placed covering the rectus muscles and bare sclera proximal to the limbus. The fornix was secured into the skin with deepening bolster sutures. A temporary tarsorrhaphy was performed, and a symblepharon ring was placed on top of a bandage contact lens.

There were no cases of intraoperative complications. Three years postoperatively, all patients had perfect integration of the OMAU, and there were no cases of symblepharon recurrence. Two patients developed mild superior entropion, and two patients developed mild strabismus (one esotropia and another exotropia).

Researchers wrote that OMAU sutured to the sclera after symblepharon release caused by severe ocular burns resulted in excellent cosmetic and anatomical outcomes with no recurrence.

SOURCE: Martinez-Osorio H, Schellini SA, Marin-Muñoz LS. Long-term follow up of oral mucosa autograft sutured to the sclera in severe symblepharon. Am J Ophthalmol Case Rep 2021; May 25;23:101099.



Challenges in Patients with Trisomy 21: A Review of Current Knowledge and Recommendations

A retrospective chart review, systematic literature review and international survey of the frequency of ocular abnormalities, screening schedules, and challenging aspects examining children with trisomy 21 was conducted to summarize and review the common ophthalmic anomalies in children with trisomy 21 (Down syndrome) in order to propose an update to current clinical recommendations. The chart review included patients treated at the Department of Ophthalmology at the University Hospital of Zurich over a two-year period. The international survey was submitted to the members of the Swiss Society of Ophthalmology, Slovenian Ophthalmological Society and European Pediatric Ophthalmology Society.

Analysis of 52 patient records during the study period revealed refractive errors (astigmatism: 54% of patients, hyperopia: 26%, and myopia: 15%) as the most common diagnosis, whereas childhood cataract was reported in 5%. This was in concordance with the literature review of 249 publications, although congenital cataracts were reported to be higher than at the researchers’ institution. The survey participants reported great challenges in taking care of these patients, despite their long professional experience (73% with over 10 years of experience).

Care and treatment of children with trisomy 21 continues to be demanding for pediatric eye care providers. Researchers recommend the following examination schedule for these patients: first, ophthalmological examination at 6-12 months of age, then once in three to six months for children under 2 years of age, once in six months for children 2 to 5 years of age, annually for children 5 to 10 years of age, and thereafter, to be decided on an individual basis depending on the presenting ocular abnormalities of the patient.

SOURCE: Robinson J, Pompe MT, Gerth-Kahlert C. Challenges in patients with trisomy 21: a review of current knowledge and recommendations. J Ophthalmol. 2021; May 26;2021:8870680.



Post Coronavirus Disease (COVID-19) Reactivation of a Quiescent Unilateral Anterior Uveitis

Coronavirus disease (COVID-19) can be associated with ophthalmic manifestations like conjunctivitis, retinal hemorrhages, retinal vascular occlusions, papillophlebitis and Adie's syndrome. Investigators reported a case of a unilateral acute anterior uveitis that was quiescent for 13 years and was reactivated post-COVID-19 infection in a 43-year-old Asian Indian male.

The patient had a past history of recurrent unilateral granulomatous anterior and intermediate uveitis in the right eye (RE), and all the investigations done 14 years ago were negative and the patient had been on treatment with topical and oral steroids. He developed cataract six months later in the RE and underwent surgery. The patient was in remission for the past 13 years. Uveitis investigations for the present episode were all negative. Topical steroids and cycloplegics helped in resolution of the uveitis.

Investigators wrote that this may be the first instance of reactivation of a quiescent unilateral anterior uveitis following COVID-19 infection.

SOURCE: Sanjay S, Mutalik D, Gowda S, et al. "Post Coronavirus Disease (COVID-19) Reactivation of a Quiescent Unilateral Anterior Uveitis". SN Compr Clin Med. 2021 Jun 7:1-5. [Epub ahead of print].





Industry News

Prevent Blindness to Present 2021 Person of Vision Award to Marc Ferrara

Prevent Blindness will present its 2021 Person of Vision Award to Marc Ferrara, CEO of Information Services, Jobson Medical Information, on Sept. 23, in conjunction with Vision Expo West. The Person of Vision event will be held at the Sands Expo & Convention Center, Las Vegas, beginning at 6:30p.m. PT. Dinner will be served at 7:30p.m., with the program and award presentation beginning at 8:30p.m. The Prevent Blindness Person of Vision Award recognizes an individual or organization whose inspired outlook champions healthy vision and its importance for a healthy life. Marc Ferrara was chosen as the 2021 Prevent Blindness Person of Vision Award recipient due to his extensive work and decades-long dedication to the vision industry. Ferrara has volunteered in several capacities at Prevent Blindness, including serving on various fundraising event committees such as the annual Prevent Blindness Swing Fore Sight golf outings and for past Person of Vision Award dinners. The Prevent Blindness Person of Vision Committee is co-chaired by Marge Axelrad, senior vice president, editorial director at Vision Monday/Jobson Optical Group, and Jim McGrann, chairman and CEO of Healthy Eyes Advantage. The 2021 Person of Vision Award event was rescheduled to be held at this year’s Vision Expo West after cancellation of Vision Expo East in New York. All proceeds from the 2021 event will go to support the sight-saving programs of Prevent Blindness. Register for the event and learn about sponsorship opportunities.




AAOF Announces Joe and Janet Barr Early Career Cornea and Contact Lens Research Award Recipient

The American Academy of Optometry Foundation announced that Gulnoza Azieva, a second-year OD/MS student at the State University of New York College of Optometry, is the recipient of the Joe and Janet Barr Early Career Cornea and Contact Lens Research Award. Read more.



Visus Announces Executive Leadership Appointments

Visus Therapeutics, a clinical-stage pharmaceutical company focused on developing ophthalmic therapies to improve vision around the world, appointed: Tim Grinstead as chief operating officer; James Burke as vice president of research; Patrick Hughes, PhD, as vice president of pharmaceutical development; Lisa Simpson as vice president of clinical operations and compliance; Dr. Guru Sharma as director of ophthalmology and clinical development; and Alex Oh as vice president of intellectual property. Read more.

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