Optometric Physician



Vol. 25, #10 •   Monday, March 11, 2024


Off the Cuff: Set It and Forget It

Last year I was diagnosed with insulin resistance. I was told because of the way insulin resistance affects the body, it makes it impossible to lose weight. So what’s the treatment? Lose weight. It was an incredibly disheartening and sick catch 22. I needed a way for my body to process insulin differently. With my family history of diabetes, I agreed to start the injectable semaglutide. Next month I will have been on this medication for a year, and it has helped me achieve a 24% weight loss.


Throughout this year I have had random symptoms pop up. Many symptoms have been reported with the use of semaglutide, so I thought it may have been the medication itself. I won’t bore you with the details, but it wasn’t the semaglutide at all. After a battery of cardiovascular tests, which were all fine, we were ultimately barking up the wrong tree. It was my thyroid medication. With the weight loss, my dose of thyroid medications wasn’t being titrated with the weight loss. It seems obvious after the fact, but at the time my thyroid levels weren’t being monitored as my weight was dropping. The dose now is nearly half of what I was taking at my heaviest, and all the symptoms have stopped.

This week I saw three different patients, who weren’t feeling very well and all had incredibly low blood pressure readings. When I reviewed their systemic medications, all three had been on the same multiple blood pressure medications for years. No changes in doses or medication classes even though the patients were older and had new health issues. It reminded me of that infomercial for the rotisserie oven, where Ron Popeil would say, “Set it, and forget it.” Common maintenance medications for blood pressure, cholesterol, and thyroid are seen as rather innocuous, and with follow-up appointments every six to twelve months, it’s easy to see how symptoms of overmedication can be overlooked by primary care and patients alike. By pointing out the concern of possible overmedication to these patients, they can have a discussion with their primary care physician that helps our patients make informed decisions and get a better handle on their own healthcare. This goes to show how optometry’s role in our patients’ healthcare is not singularly about their eyes but is truly part of overall primary care.

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.



Impact of Social Determinants of Health on Follow-Up Adherence, Testing Completion, and Outcomes Among Pediatric Glaucoma Patients at a Tertiary Care Center

The records of patients with childhood glaucoma seen from 2015 to 2021, were reviewed. to identify patient characteristics associated with visit attendance, treatment outcomes, and optical coherence tomography (OCT) testing in pediatric glaucoma patients at an urban tertiary care center. Primary outcomes were the proportion of scheduled visits completed, visual acuity and intraocular pressure (IOP) at most recent follow-up, and rates of OCT testing. Social determinants of health that were evaluated included race and ethnicity, distance of residence from clinic, insurance carrier type and residence within Baltimore City County, the latter two serving as proxies for socioeconomic status.

A total of 99 patients met inclusion criteria: 61% were male; 47%, white (non-Hispanic); 25%, black (non-Hispanic); 11%, Hispanic/Latino; and 7% Asian/Pacific Islander. Mean distance from the clinic was 45.3 miles. Mean visit completion rate was 90.4%; there was no statistically significant variation in visit completion rates by patient characteristics. IOP outcomes did not vary across patient groups, but visual acuity outcomes in affected eyes were significantly worse among Baltimore City County residents compared with non-residents. Only 22% of the cohort received ≥1 OCT per year, and patients living 0-29.9 miles from the clinic had significantly lower odds of reaching the threshold than more distant patients. Patients with state-based insurance had significantly lower odds of being ≥50th percentile for rate of OCTs received compared to patients with commercial insurance.

In children with glaucoma, residence within Baltimore City County was associated with significantly worse visual acuity outcomes, and close proximity to clinic was an independent predictor of lower rates of OCT testing, despite similar visit attendance rates and IOP outcomes across all groups.

SOURCE: Nicolas J Heckenlaible, Michelle S Attzs, Courtney L Kraus. Impact of social determinants of health on follow-up adherence, testing completion, and outcomes among pediatric glaucoma patients at a tertiary care center. J AAPOS. 2024 Mar 2:103856. Online ahead of print.



Refitting Contact Lens Dropouts Into a Modern Daily Disposable Contact Lens

This was a 6-month, three-visit study that recruited subjects who discontinued contact lens (CL) wear within the past 2 years because of discomfort or dryness symptoms to determine the number of previous CL wearers who could be comfortably refitted into delefilcon A (DAILIES TOTAL1®) CLs. Subjects were required to have Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores ≤3 and to be able to wear spherical study CLs. Subjects were asked to complete a ±50 comfort visual analogue scale (VAS) at 1 month and a Likert questionnaire after 1 and 6 months of CL wear to understand the subjects' CL experience.

All 60 subjects who were fitted with the study CLs were still wearing them after 1 month, while one subject had dropped out by 6 months. Subjects had a median (interquartile range) age of 24.0 (7.0) years (71.7% female). They reported a median VAS score of 44.0 (8.0) units at the 1-month visit, with all reporting a comfortable score. At the 1-month/6-month visits, 98.3%/93.2%, 86.5%/78.0% and 93.2%/91.5% of subjects responded that they were very satisfied or satisfied with their vision, their end-of-day CL comfort and overall CL comfort, respectively. The same subjects responded that they were very likely or likely to continue to wear the study CLs at 1 (89.6%) and 6 months (80.7%) and to recommend the study CLs to a friend at 1 (98.3%) and 6 months (93.2%).

The results suggest that when encountering a CL dropout, a practitioner could educate a patient about trying an alternative CL and consider delefilcon A lenses as an option.

SOURCE: Chris Lievens, Andrew D Pucker, Elyse Rayborn , et al. Refitting contact lens dropouts into a modern daily disposable contact lens. Ophthalmic Physiol Opt. 2024 Mar 3. Online ahead of print.

Experiences of Keratoconus Patients Attending Public Eye Care Facilities in South Africa

Keratoconus (KC) is a progressive condition that usually affects young persons between their first and fourth decades. Myopia and irregular astigmatism are the common presentations that progress to corneal steepening and thinning. Keratoconus is a progressive ectasia of the cornea that presents bilaterally, although often asymmetrical. This study explored the experiences of KC patients attending public eye care facilities in the Capricorn District of Limpopo province. A descriptive qualitative phenomenology approach was used in the study to explore the lived experiences of patients diagnosed with KC, attending public eye care facilities. Purposive sampling was used to select 16 patients who were diagnosed with KC and referred for contact lens fitting. Data were collected through face-to-face, one-on-one interviews.

Patients reported developing gradual vision loss that worsened when they grew older. There was a lack of knowledge of KC amongst patients, and this was exacerbated by limited health literacy and vocabulary barriers. Patients had difficulty performing daily activities where some had dropped out of school while others worked at a slower pace and reduced working distances.

Patients with KC received inadequate information on their condition due to limited health literacy and vocabulary barriers. Researchers suggested that programs to promote practitioner and patient education would be needed to improve the perceived service level provided to KC patients. They noted that their findings may help improve the experiences of KC patients on perceived service quality received from public facilities.

SOURCE: Pheagane M W Nkoana, Percy K Mashige, Vanessa R Moodley. Experiences of keratoconus patients attending public eye care facilities in South Africa. Afr J Prim Health Care Fam Med. 2024 Feb 19;16(1):e1-e11.




Industry News

Coburn Introduces New Digital Lens Processing Platforms and Huvitz Diagnostic Technology

Coburn Technologies has introduced new technology and product offerings to kick off its 70th anniversary. The NEXUS Digital Surfacing System leverages the technology in the Cobalt Digital Lab to produce digital RX lenses. The system includes the NEXUS DGT Digital Lens Generator and DP Digital Lens Polisher. The Huvitz HT-5000 Applanation Tonometer is designed to be an easy, fast and convenient way to measures eye pressure. It processes IOP calculation virtually in real time, displays results digitally, and has a zero-delay wakeup time. Read more.

Neurolenses Demonstrate Headache Relief in New Study

Neurolens announced results of a double-masked, multi-site study in Translational Vision Science & Technology revealing that Neurolenses provided significant relief from headaches. In the study including 10 optometry practices and 195 patients, Neurolenses demonstrated a statistically significant change, based on Headache Impact Test, or HIT-6. Read more.

Vivity Reaches One Million Milestone

Alcon announced AcrySof® IQ Vivity® and Clareon® Vivity extended depth of focus (EDOF) intraocular lenses (IOLs) surpassed more than one million implants worldwide. Vivity is the most implanted EDOF IOL globally. Read more.









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

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