Optometric Physician

Vol. 22, #22   •   Monday, June 7, 2021


Off the Cuff: Is it Finally Safe to Go Out?

For the optimistic and trusting among you who are as tired of COVID and its limitations and precautions as I am, I can tell you, you won’t like what you are about to read. I’ve been covering the COVID outbreak since its inception, hoping that each COVID piece would be the last. At this point I can tell you with some certainty that this one won’t be the last.

Despite what you are hearing from the mainstream media and US health and government sources, we are far from out of the COVID woods. As I write this, variant B.1.617.2 has now been named Delta by the WHO to better keep track of the growing number of mutations. Delta is a highly transmissible COVID variant which continues to rage in India with more than 3000 deaths a day. Delta is also ripping through parts of Asia like Taiwan, Japan and Singapore that had been largely untouched by prior strains of COVID. It has also caused an outbreak among the highly vaccinated population of the Seychelle Islands, strongly suggesting that existing vaccines are not completely effective against the new variant. The Pfizer vaccine has been reported to be 3 to 6 times less effective against it. An even more transmissible hybrid UK-Indian variant is now spreading through Vietnam.

Understanding where and how COVID originated should be helpful in predicting its course and potential severity. A letter published in the journal Science coauthored by 18 prominent researchers questioned how a bat virus with no known animal intermediary could have passed to man. This added to mounting evidence that initial transmission was not the result of a natural phenomenon, along with a growing chorus of calls for further investigation of an accidental or intentional leak from the Wuhan Institute of Virology. The recent release of Fauci’s emails strongly suggests that he was aware of the virus’ non-natural origins all along. That’s disturbing.

Once considered a conspiracy theory, the predictable economic and political consequences of an intentional leak of a weaponized virus by an aggressive and expansive world power seems increasingly plausible to many. Having visited China many times, I find it certainly possible. Regardless of how the outbreak started, the key question is how it will evolve, and how we can best manage it and its consequences until it completely abates—if it ever will.

I see little sign that our country or our profession is effectively preparing for what I fear will be an extended siege. To the contrary, we are allowing political divisiveness and wishful thinking to drive unwise policy and questionable behavior. All of us want this nightmare to be over, but no one knows when it will be.

Healthcare providers should be considering a scenario of an extended siege. For optometry, I would suggest mobilizing an interorganizational crisis management advisory group. While it will hopefully end up being a waste of time, it’s better to prepare for the worse than wishing you had when you hadn’t.

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 Observation in Chinese Children with Monocular Myelinated Retinal Nerve Fibers, Myopia and Amblyopia

The syndrome of monocular myelinated retinal nerve fibers (MRNF), myopia and amblyopia threatens visual development of infants and young children. The efficacy of part-time occlusion therapy remains controversial, and the long-term prognosis of the syndrome remains unclear. Ten children (4.40±2.22 years, 4 boys and 6 girls) with monocular MRNF, myopia and amblyopia were recruited. Both the affected eyes (treatment group) and the fellow eyes (control group) underwent routine ophthalmic examinations, including axial length (AL), cycloplegic refraction, best-spectacles-corrected distance visual acuity (BSCDVA), cover test, simultaneous perception, corneal curvature, anterior segment and fundus examinations annually from January 2004 to August 2015. Refractive error was corrected by either spectacles or rigid gas permeable (RGP) contact lenses. Part-time occlusion therapy was employed for amblyopia treatment. The retinal characteristics were examined only on the final visit with a Fourier-domain optical coherence tomography (FD-OCT).

On the final visit, six children had normal simultaneous perception, but three had strabismus. The mean AL and spherical equivalent (SE) values of the affected eyes were 28.05±1.59mm and -12.60±4.20D, respectively, while those of the fellow eyes were 23.67±1.13mm and -0.66±1.99D, respectively. AL and SE were significantly different over time and between groups (p<0.0001), but no time*group interaction effect (p>0.05) was observed. The differences in the corneal curvature, mean speed of myopia progression, axial elongation, foveal thickness and parafoveal thickness between the two groups were not significant (p>0.05). However, the perifoveal thickness in the affected eyes was significantly higher than that of the control eyes (p=0.047). In the treatment group, the occlusion dosage positively correlated with the final BSCDVA (R=0.764, p=0.016) but did not correlate with the speed of myopia progression or axial elongation (both p-values >0.05).

The affected eyes have longer AL, more severe myopia and thicker perifoveal retina when compared with the fellow eyes. Both the affected and the fellow eyes have similar speed of myopia progression as well as that of axial elongation.

SOURCE: Shen Y, Zhao J, Sun L, et al. The long-term observation in Chinese children with monocular myelinated retinal nerve fibers, myopia and amblyopia. Transl Pediatr. 2021 Apr;10(4):860-9.



Effect of CPAP Therapy on 24-hour Intraocular Pressure-related Pattern from Contact Lens Sensors in Obstructive Sleep Apnea Syndrome

Twenty-two eyes of 22 newly diagnosed patients with severe OSAS were evaluated for the effect of continuous positive airway pressure (CPAP) therapy on 24-hour intraocular pressure (IOP)-related pattern from contact lens sensors (CLS) in obstructive sleep apnea syndrome (OSAS). A first 24-hour CLS measurement was performed before CPAP therapy was started, and a second 24-hour CLS monitoring was performed after beginning CPAP. Researchers analyzed the amplitude and the maximum and minimum IOP-related values (m Veq). They also analyzed IOP-related measurements at five-minute intervals throughout the first hour of nocturnal acrophase, starting from when the patient fell asleep.

The baseline measurements showed significant fluctuations in the IOP, with the highest IOP readings being recorded at night (nocturnal acrophase) in 17 of 22 patients (77.27%). Nocturnal acrophase began when the patients laid down to sleep. During CPAP therapy, the patients showed a more marked increase in IOP in the initial phase of nocturnal acrophase, with significant differences at 20, 25, 30 and 55 minutes (p<0.05).

Most patients with severe OSAS exhibited a nocturnal acrophase and the highest IOP readings at night. CPAP was associated with an additional increase in IOP-related pattern for at least the first hour of CPAP use. The results suggested that CPAP was associated with additional increase in IOP during the initial phase of nocturnal acrophase. This effect could be important in the management of patients with OSAS and glaucomatous progression.

SOURCE: Muniesa MJ, Benítez I, Ezpeleta J, et al. Effect of CPAP therapy on 24-hour intraocular pressure-related pattern from contact lens sensors in obstructive sleep apnea syndrome. Transl Vis Sci Technol. 2021 Apr 1;10(4):10.



Transepithelial Corneal Crosslinking Using a Novel Ultraviolet Light-Emitting Contact Lens Device: a Pilot Study

This study evaluated the feasibility of a novel, on-eye UVA light-emitting contact lens device driven by fiber optics for the corneal crosslinking (CXL) of patients with keratoconus. In nine corneal transplant candidates with advanced keratoconus a scleral contact lens reservoir containing 0.25% riboflavin-monophosphate preserved with 0.007% benzalkonium chloride was placed on the eye for 30 minutes. The reservoir lens was removed and replaced with the CXLens UVA light-emitting contact lens. A 375-nm UVA light at 4 mW/cm2 intensity was delivered for 30 minutes for a dose of 7.2 J/cm2. A one-sided paired T-test was used to evaluate mean differences in maximum keratometry, thinnest corneal thickness, and endothelial cell density between screening and six months after CXL. A two-sided paired T-test was used to evaluate differences in best-corrected distance visual acuity between screening and six months after CXL.

All patients received the treatment as per protocol and adhered to follow-up testing. At six months after CXL, treated eyes had an average 1.0 ± 1.6 diopters decrease in the maximum keratometry (p=0.049), a nonsignificant (2.3 ± 7.5) letter improvement in best-corrected distance visual acuity (p=0.19), a nonsignificant (-17 ± 14 µm) decrease in thinnest corneal thickness (p<0.01), and a nonsignificant (-86 ± 266 cells/mm2) decrease in endothelial cell density (p=0.20).

This pilot study demonstrated the feasibility of the novel CXL device for the treatment of keratoconus and indicated the device is ready for larger-scale studies with longer follow-up periods. The novel CXLens on-eye UVA light-emitting contact lens device offered the potential for efficient, high-throughput transepithelial corneal CXL.

SOURCE: Dackowski EK, Logroño JB, Rivera C, et al. Transepithelial corneal crosslinking using a novel ultraviolet light-emitting contact lens device: a pilot study. Transl Vis Sci Technol. 2021 Apr 29;10(5):5.




Industry News

B+L & Prevent Blindness Raising Awareness About Cataracts

Bausch + Lomb and Prevent Blindness joined forces for Cataract Awareness Month in June to educate the public and raise awareness about the symptoms and causes of, and treatment options for, cataracts. Throughout the month, Bausch + Lomb and Prevent Blindness will post content on their social media pages to share facts and information about cataracts and cataract surgery. Bausch + Lomb will donate $1 to Prevent Blindness for every Facebook “like” or “share” up to $50,000, from June 1 through June 30 to support education and advocacy work aimed at ensuring all people have access to cataract surgery and care. Visit Bausch + Lomb’s Facebook page.




Genetic Test Helps Determine Patient’s Risk of Keratoconus and Presence of Other Corneal Dystrophies

Avellino Lab announced US nationwide availability of AvaGen, The Genetic Eye Test, as the first genetic test that helps determine a patient’s risk of keratoconus and the presence of other corneal dystrophies. The test is designed to provide keratoconus patients with an earlier benefit from FDA-approved cross-linking treatment, which can halt disease progression and preserve vision. Read more.



Bausch Health and Clearside File Acceptance For Xipere

Bausch Health Companies along with Clearside Biomedical announced the FDA accepted the resubmitted New Drug Application for Xipere (triamcinolone acetonide suprachoroidal injectable suspension). The FDA determined the filing is a Class 2 resubmission and assigned a Prescription Drug User Fee Act (PDUFA) action date of October 30. Xipere is an investigational therapy with a proposed indication of treatment of macular edema associated with uveitis. Read more.

Luminopia One Offers Potential New Amblyopia Treatment

Luminopia One created an innovative therapeutic to treat amblyopia enabling kids to be treated at home by watching one hour per day of therapeutically modified content, including their favorite shows from Nickelodeon, Dreamworks and others, while wearing a VR headset. In a randomized controlled trial, findings revealed that Luminopia One may provide a new treatment alternative to patching and atropine for children with amblyopia. Luminopia One’s therapy, which has demonstrated in several clinical trials its effectiveness as an at-home treatment, is under review with the FDA. Read about some of the findings here and here. Learn more.

The Children’s Eye Foundation of AAPOS Debuts Interactive Storybook to Help Screen for Color Vision Deficiency

The Children’s Eye Foundation of AAPOS unveiled the world’s first interactive children’s book to help screen for color vision deficiency (CVD), commonly known as color blindness. The foundation posted a free digital version of at its website and published a first-run, hardcover book for its member pediatric ophthalmologists. Visit the site.

ISVA Announces Appointments Of New Executive And Advisory Board Officers

The International Sports Vision Association, an interdisciplinary group of professionals dedicated to advancing the field of vision training for athletes of all ages and levels to help them achieve peak athletic performance, announced appointments to its new Executive and Advisory Board. View the board members.

Prevent Blindness to Host 10th Annual Focus on Eye Health National Summit Virtually

Prevent Blindness will host the 10th annual Prevent Blindness Focus on Eye Health National Summit virtually July 14 to 15. This year’s Summit will include a variety of presentations related to the theme “Our Changing Vision.” During the event, Prevent Blindness will present the 2021 Jenny Pomeroy Award for Excellence in Vision and Public Health to R.V. Paul Chan, MD, MSc, MBA, FACS, professor and head, Department of Ophthalmology and Visual Sciences, the John H. Panton, MD Professor of Ophthalmology; and director, Pediatric Retina and ROP Service at the Illinois Eye and Ear Infirmary, University of Illinois at Chicago. Learn more.

ISVA and MacuHealth Offer Educational Resource on Sports Nutrition for Eyes

The International Sports Vision Association and MacuHealth launched Sports Nutrition for Your Eyes, a new educational resource on the ISVA website designed to help educate athletes about how proper nutrition can have preventive and protective benefits for overall well-being‚ improve their vision and eye health, and help enhance their sports performance. Read more.

Coburn Introduces New HFC-1 Fundus Camera

Coburn Technologies introduced the HFC-1 Non-Mydriatic Fundus Camera, a new retinal camera manufactured by Huvitz, with highly accurate autodetection technology for sharp, quick and reliable retinal imaging and measurements. Automated tracking and shooting allow the HFC-1 Fundus Camera to adjust modes quickly while measuring differing pupil sizes. Its 20-megapixel high-definition camera is designed to capture images with reduced motion artifacts and can enlarge images to study fine details. The new fundus Camera includes a variety of image modes: color, blue, red, red-free and cobalt which aid in examinations for glaucoma, RNFL, edema, pigmentary abnormalities and more. Read more.





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