Optometric Physician

Vol. 22, #25   •   Monday, June 28, 2021


Off the Cuff: The Myopia Control Conundrum

Myopia control is one of the hottest topics today for good reason. Myopia is a scourge of modern man. Raging out of control, what once was a minor issue affecting a small segment of the population is now epidemic. Myopia leads to a host of problems and increased risk for even more problems.

Controlling myopia would seem to be right in the sweet spot for optometry. While I will give us an “A” for effort, and I am all for anything that can keep eyes healthy, I am still not convinced that controlling myopia will be that simple. Nature has had eons to figure out how to make myopia work; we’ve had just decades.

Humans likely started out as distance-focused animals scanning the horizon for predators or foraging for food. Accommodation and improved near vision likely came later as an advanced option to insure we were eating a banana and not our tail. Near vision was likely never designed to be more than a momentary transient function. When humans began to communicate and started to use their eyes for near tasks, the body wasn’t designed to deal with the added near point stress.

Nature does all it can to conserve energy. Myopia would seem to be a solution to the problem of seeing things up close for prolonged periods and an energy-efficient one. This tracks with environmental studies that have shown myopia increases in societies that have evolved from agrarian to industrial, with concomitant increases in near vision demands. The myopia explosion that occurred in post-World War II Japan is a prime example.

Solving the myopia issue may take more than optics. It will likely require that we find ways to reduce the energy expenditure necessary for operating in near space. We have had some success with contact lens optics and recently Essilor showed dramatic reduction in myopic progression with their Stellest™ spectacle lens. I believe that we will ultimately solve the riddle of myopia as we more fully understand what homeostatic mechanisms prompt its development. The solution may be pharmacologic, contact lens- or spectacle lens-based, or perhaps something we can’t yet imagine. One thing I think likely is that whatever the solution is, it will surprise many of us, especially Mother Nature.

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.




Enface Vitreous OCT 'Worm Holes': A Novel Finding in a Patient with Diffuse Unilateral Subacute Neuroretinitis (DUSN)

Researchers presented the clinical findings of a 37-year-old female, clinically diagnosed with diffuse unilateral subacute neuroretinitis (DUSN) after a non-invasive multimodal imaging approach that included “MultiColor” scanning laser imaging and enface vitreous OCT, which revealed a nematode body and lacunae created by worm migration, respectively.

To the researchers’ knowledge, this is the first reported case of lacunae visualized using enface vitreous optical coherence tomography (OCT), potentially marking the migration path of the nematode.

SOURCE: Sodhi SK, Golding J, Mandelcorn ED, et al. Enface vitreous OCT 'worm holes': A novel finding in a patient with diffuse unilateral subacute neuroretinitis (DUSN). Am J Ophthalmol Case Rep. 2021; May 12;23:101112.



Factors Related to Retinal Nerve Fiber Layer Thickness in Bipolar Disorder Patients and Major Depression Patients

Investigators analyzed the correlation of clinical data with retinal nerve fiber layer (RNFL) thickness and macular thickness in bipolar disorder patients and major depression patients. The aim of this study was to explore factors that affect RNFL thickness in bipolar disorder patients and major depression patients, with a view to providing a new diagnostic strategy. Eighty-two bipolar disorder patients, 35 major depression patients and 274 people who were age- and gender-matched with the patients were enrolled. Demographic information and metabolic profile of all participants were collected. Best-corrected visual acuity of each eye was recorded, intraocular pressure (IOP) measures were taken and fundus examination was performed. RNFL and macular thickness were measured by optical coherence tomography (OCT). Correlations between RNFL and macular thickness and other data were analyzed.

RNFL and macula lutea in bipolar dipolar patients and major depression patients were thinner than normal people. Triglyceride and UA levels were the highest in the bipolar disorder group, while alanine aminotransferase (ALT) and glutamic oxalacetic transaminase (AST) levels in the depression group were the highest. Age onset and ALT were positively correlated while uric acid (UA) was negatively correlated with RNFL thickness in bipolar dipolar patients. Cholesterol level was positively correlated with RNFL thickness while the duration of illness was correlated with RNFL thickness of the left eye in major depression patients.

The RNFL and macula lutea in bipolar dipolar patients and major depression patients were thinner than in normal people. In bipolar disorder patients, age-onset and ALT were potential protective factors in the progress of RNFL thinning, while UA was the pathological factor.

SOURCE: Liu Y, Tong Y, Huang L, et al. Factors related to retinal nerve fiber layer thickness in bipolar disorder patients and major depression patients. BMC Psychiatry. 2021 Jun 10;21(1):301.



Successful Treatment of Full-Thickness Macular Hole in Polypoidal Choroidal Vasculopathy with Anti-VEGF Therapy

An 86-year-old male presented with a five-month history of metamorphopsia and decreased vision in his right eye and was found to have active exudation secondary to polypoidal choroidal vasculopathy (PCV) with a concurrent full thickness macular hole (FTMH). After four treatments with intravitreal bevacizumab, the FTMH resolved without surgical intervention.

The patient's FTMH resolved with solely pharmacologic treatment as a result of treating his PCV with intravitreal bevacizumab. Researchers wrote that MH formation secondary to PCV is a rare finding, but may be successfully treated with pharmacologic therapy without surgical intervention.

SOURCE: Lindeke-Myers A, Kokame GT, Yeh S, et al. Successful Treatment of Full-Thickness Macular Hole in Polypoidal Choroidal Vasculopathy with Anti-VEGF Therapy. J Vitreoretin Dis. 2020 Oct 1;4(5):433-6.





Industry News

B+L Extends Power Range for Toric Multifocal

Presbyopic patients with higher-than-usual astigmatism have had to rely on custom-fit contact lenses if they wanted to try that modality—until now. Bausch + Lomb is expanding the cyl powers on the company’s Ultra Multifocal for Astigmatism, adding powers of -2.25D and -2.75D to the range. According to the company, the lenses have been designed for optimal comfort, clarity and stability, along with the convenience of same-day in-office fitting during the initial exam. The cylinder power parameters now include -0.75, -1.25, -1.75, -2.25 and -2.75 options. The other parameters remain unchanged: a sphere range of -6.00D to +4.00D with low and high add power varieties. The lenses are made of samfilcon A material, and have a base curve of 8.6mm and a diameter of 14.5mm. Read more.




X-Cel Introduces REMLens for Myopia Management

X-Cel Specialty Contacts introduced REMLens, a highly adjustable and easy-to-fit orthokeratology design for the management of myopia, manufactured exclusively in Boston Equalens II material. REMLens is designed to yield a Rapid Eye Molding effect for patients with low-to-moderate myopic refractive errors. REMLens can be prescribed to patients of all ages who are diagnosed with low-to-moderate myopia (up to –5.00D sphere, and up to –1.50D of astigmatism). The company says the lens offers an 89% first fit success rate. REMLens features four independently adjustable fitting zones and five diameter sizes, each with three optic zone options, and the Dynamic Edge Profile for on-eye comfort in an open and closed eye setting. Read more.



TelScreen Introduces EyeRes Diamond System Slit Lamp

TelScreen introduced the EyeRes Diamond System, which the company says provides slit-lamp imaging that is closer to human eye resolution. The digital imaging system offers a new camera with 137 million pixels per square inch, more than 3.3x the resolution of the Platinum system and within 11 percent of matching the human eye. In addition, the system creates a more efficient process, with a convenient foot pedal. Learn more.

AAOF Announces William C. Ezell Fellowship Recipients

The American Academy of Optometry Foundation announced the twelve recipients of the 2021 William C. Ezell Fellowships. View the recipients.

Prevent Blindness Announces Fireworks Safety Awareness Week

Prevent Blindness declared June 28 to July 4 Fireworks Safety Awareness Week to educate the public on the dangers of fireworks. During that week, Prevent Blindness will post messages on its social media channels, as well as offer free shareable materials including fact sheets and social media graphics. Learn more.

Dr. Link Named Chairman of Allegro’s Board of Directors

Allegro Ophthalmics announced William J. Link, PhD, was appointed chairman by the company’s board of directors and that Stephanie Yee was named vice president of finance. Dr. Link is founder and principal of Flying L. Partners and is a founder and managing director of Versant Ventures. Read more.

neurolens Partners with Cherry Optical Lab

neurolens announced Cherry Optical Lab will be the domestic lab distribution partner for neurolenses moving forward. Read more.

Marco Partners with Olleyes

Marco Ophthalmic entered into a distribution agreement with Olleyes, which offers intuitive and user-friendly virtual reality ophthalmic products. Effective immediately, Marco will add the Olleyes VisuALL S VRP (Virtual reality Platform) into its existing portfolio of ophthalmic medical devices. The VisuALL is the latest commercially available virtual reality visual field analyzer that can be used in clinical practice to detect glaucoma and to evaluate other eye diseases. Learn more.








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