Optometric Physician



Vol. 24, #26 •   Monday, June 26, 2023


Off the Cuff: When Patient Education Misses the Mark – The Final Chapter

For those of you who have followed the saga of my American Airlines seatmate, her cataract surgery complications, and her subsequent visit to see me for an additional opinion, I’m happy to report, the cystoid macular edema in her left eye I began treating for her is nearly resolved. I had started her on Prolensa and Durezol concomitantly. She said it only took a couple days before she could start to see the improvement in her vision. I love it when medicine does what it’s supposed to. Now begins the slow taper so she doesn’t get any rebound inflammation again.

It’s results like these that make it incredibly gratifying to do what we do. Cases like these exemplify how absurd these legislative attacks on optometry, the care we provide, and what we even call ourselves really are. The fact multiple states proposed similar attacks on our profession just shows how successful California’s failed bill really was. Yes, their laser privilege bill ultimately got vetoed by their governor, but it revealed to the entire country how even in our most populous state, legislators agreed that optometry’s scope needed to be expanded to better serve our patients / their constituents. Legislatively these attacks were designed only to put us in a position of defense instead of being able to proactively work off the momentum California created. Be prepared for repeat efforts because they need to keep us on the defense to prevent us from moving forward. We need to stay united as a profession to not only maintain our place in the healthcare landscape, but to continue providing the ever-evolving care patients so desperately need.

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.



Sex Differences in the Relationship Between Axial length and Dry Eye in Elderly Patients

The aim of this study was to explore the association between myopia and dry eye (DE)-related ocular parameters. A total of 460 patients (mean age, 73.6 years; 40.2% men) performed DE-related, axial length (AL) and retinal examinations. Statistical analysis revealed a significant sex difference in AL, strip meniscometry value, corneal staining score, corneal endothelial cell density, ganglion cell complex (GCC) thickness, and full macular thickness. AL was strongly age- and sex-dependent, so subsequent analyses were stratified by sex.

Among DE-related parameters, strip meniscometry value and corneal endothelial cell density were correlated with AL in women but not in men. Regarding retinal parameters, GCC thickness and full macular thickness were correlated with AL in women but not in men.

The results suggest a relationship between tear production and AL in elderly women and support the hypothesis that there may be a common upstream factor including the parasympathetic nervous system in the association between tear production and AL or DE and myopia.

SOURCE: Ayaki M, Torii H, Yotsukura E, et al. Sex differences in the relationship between axial length and dry eye in elderly patients. Front Med (Lausanne). 2023;10:1170696.



Is Demodex Blepharitis Connected with Cataract Surgery?

This study was designed to determine whether there is an increased incidence of Demodex of the eyelashes among patients following cataract extraction surgery. A cohort of patients who underwent cataract extraction surgery had several eyelashes removed preoperatively which were examined independently by the hospital laboratory for the presence of the Demodex mite. This was repeated three weeks after surgery. During several post-operative weeks, patients received the standard treatment of steroid drops alone for a period as individually required. Sixty-two patients were included in the study, 31 males and 31 females, with a mean age of 71.04 (range 47 to 87).

In the group positive for Demodex, the male to female ratio was 2:3. Demodex colonization was observed in 22.58% of samples before cataract surgery, and in 32.26% following cataract surgery and topical post-operative steroid therapy.

A statistically significant increase in Demodex colonization of eyelashes following cataract surgery and postoperative topical steroid treatment was found. Although Demodex colonization does not necessarily cause blepharitis, researcher wrote that their findings of increased colonization should raise the possibility of Demodex blepharitis in patients complaining of chronic postoperative eye discomfort following cataract surgery.

SOURCE: Feldman I, Krausz J, Levinkron O, et al. Is Demodex Blepharitis connected with cataract surgery? Am J Ophthalmol. 2023 May 29. Epub ahead of print.

Relationship Between Anterior Capsule Opening and Direction of Intraocular Lens Decentration

The purpose of this study was to compare intraocular lens (IOL) decentration between patients in whom the continuous curvilinear capsulorhexis (CCC) completely covers the IOL optic and those in whom it incompletely covers the IOL optic to determine how an incompletely covered CCC affects the IOL position. The study included 57 eyes of 57 patients (mean age 70.8±6.2 years) that underwent phacoemulsification and IOL (SN60WF; Alcon Laboratories) implantation in the bag between April 2010 and April 2015. The patients were classified based on whether the CCC completely (CC group) or incompletely (NCC group) covered the IOL optic using an anterior eye segment analysis system (EAS-1000; NIDEK). The IOL decentration of the groups was analyzed using EAS-1000 at 1 week, 1 month, 3 months, and 6 months postoperatively and compared. The relationship between the NCC location and IOL direction at 3 months postoperatively was analyzed.

The NCC group (25 eyes) had a significantly higher amount of IOL decentration than the CC group (32 eyes) at 1 week, 1 month, 3 months, and 6 months postoperatively. There was a correlation between the direction of IOL decentration and NCC location, and IOL decentration in the NCC group occurred in the opposite direction to the NCC area.

The authors of this study concluded that an anterior capsule opening that completely covers the IOL optic is important to control IOL decentration.

SOURCE: Nagata M, Hanemoto T, Matsushima H, et al. Relationship between anterior capsule opening and direction of intraocular lens decentration. J Cataract Refract Surg. 2023 Jun 8. Epub ahead of print.




Industry News

Haag-Streit Offers Premium Exam Chairs for Reliance Optometry Workplace Exam Lane

Haag-Streit USA now offers two exam chair options as part of the Reliance Optometry Workplace. Previously, the workplace solution included the Reliance 520 examination chair as standard. To further increase the exam lane's value and provide the optometrist with a broader choice, Haag-Streit USA is offering the option of adding the Reliance 6200 chair to the exam lane instead. The price for the Reliance Optometry Workplace will remain the same, regardless of the chosen chair option. Learn more.

Bruder Expands Portfolio With Distribution of AllerFocus Percutaneous Allergy Test

Bruder Healthcare announced an eyecare industry distribution agreement with AllerFocus for its Percutaneous Allergy Test, an easy-to-use, needle-free allergy screening for 78 of the most common airborne and environmental allergens. Patients suffering from eye-related allergies can experience watery eyes, itchiness, sensitivity to light, redness, and grittiness, similar to dry eye symptoms. Given that dry eye disease is a multifactorial condition, Bruder says it wanted to add diagnostic help for eye doctors. Read more.

Johnson & Johnson Vision to Partner With InfantSEE

Johnson & Johnson Vision will partner with InfantSEE, a public health program managed by Optometry Cares – the American Optometric Association Foundation, to give hands-on training to optometrists during Optometry’s Meeting of the AOA in Washington D.C., June 21-24. The company will host Healthy Vision for a Lifetime workshops June 22, 8:30 a.m. to 10 a.m. ET. The live demonstrations and trainings are designed to inform parents of the importance of eyecare to ensure early treatment of vision issues such as myopia.

Glaukos Launches iDetective

Glaukos will launch its iDetective campaign during the annual American Optometric Association Congress and American Optometric Student Association conference to educate optometrists in a fun and interactive way on the early signs—or “clues”—of keratoconus so patients can be diagnosed as early as possible. The company says early detection means earlier intervention with iLink corneal cross-linking to slow or halt disease progression. Learn more.

Prevent Blindness Declares June 28 to July 4 Fireworks Safety Awareness Week

Learn more.








Journal Reviews Editor:
Katherine M. Mastrota, MS, OD, FAAO

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