Optometric Physician



Vol. 24, #11 •   Monday, March 13, 2023


Off the Cuff: Attacks on Who We Are

A few years ago, Dr. Epstein received a letter from our state board. This was not a complaint from a patient or regarding patient care. This was a complaint that on a personal website his personal bio stated that he was married to me, that I was an optometrist, and that I specialized in glaucoma management. What was the problem? He used the word “specialized.” Arizona, like many other states, has a law that states optometrists cannot advertise themselves as “specialists” or in any way that makes them appear as different from any other optometrist regardless of training, education, practice modality…any circumstance.

“A licensee may advertise that the licensee has a practice limited in some way if the licensee does not use the term ‘specialist’ or any derivative of the term ‘specialist.’

He changed the wording in his bio and all was well—but was it? These laws were put in place to protect the consumer, but does this protect the consumer if optometrists who practice full scope optometry, utilizing the full extent of their state’s laws for prescribing and procedures, cannot identify themselves as such or differentiate themselves from the optometrists who practice in an “identify-and-refer” model. One is not necessarily better than the other as long as the patients are taken care of appropriately. This is largely driven by the insurance plans we’re credentialed on, but it does represent a split in the profession and what the patient/consumer receives at one provider versus another.

In Florida, a Senate bill (SB230) has been introduced to block optometrists from being referred to as “doctor” and/or “physician.” Per a recent AOA article, similar bills are also being introduced in Connecticut and Texas. This is not a new political tactic. Whenever optometry’s scope expansions are successful, the AMA and ophthalmology try to attack who we are, threatening our degrees and Medicare physician status. Our legislators are largely lay people. They see the ads for eye exams that only show a phoropter. They are making decisions based on these limited perceptions of what we are.

Regardless of your opinion of the AOA or state optometric organization, they are the ones fighting for our profession and lobbying our legislators to give them the full picture of what optometry is, our role in healthcare, and the medical eye care we provide. With three states introducing this type of legislation, this is not the time to sit idly by and see how it plays out. Even if you’re not a member, you can contribute to your state or AOA PAC, and you can write and call your legislators. Our profession has gone through countless hard-fought battles over multiple decades to earn the right to use the title that is on our degrees. Now is the time for all of us to take action, even for the first time, to ensure we can continue to rightfully refer to ourselves as the doctors we are.


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.


Changes in the Meibomian Glands in Postmenopausal Women With Primary Acquired Nasolacrimal Duct Obstruction

Primary acquired nasolacrimal duct obstruction (PANDO) is frequently encountered in perimenopausal women, causing tear flow stagnation and resulting in a variety of ocular discomfort symptoms. However, little is known about the alterations in the meibomian gland in postmenopausal women with PANDO. Hence, this study investigated the changes in the meibomian gland and ocular surface in postmenopausal women with PANDO. This prospective study included 60 eyes of 60 postmenopausal women with PANDO (PANDO group) and 30 eyes of 30 postmenopausal women without PANDO (control group). The PANDO group was further subdivided into incomplete and complete PANDO groups, based on the degree of nasolacrimal duct obstruction. The patients' symptoms were evaluated using the ocular surface disease index questionnaire. The meibomian gland and ocular surface were assessed using the Keratograph 5 M. Other ophthalmologic examinations included the tear break-up time, corneal fluorescein staining, meibomian gland expression, and Schirmer I test. The correlations between the degree of nasolacrimal duct obstruction and other metrics were analyzed.

The loss ratio of the upper eyelid was greater in the incomplete PANDO group than in the control group. Meibomian gland distortion of the upper eyelid was more severe in the control group than in the complete PANDO group. The non-invasive tear meniscus height was greater, whereas the intensity of corneal fluorescein staining was lower in the PANDO group than in the control group. The degree of nasolacrimal duct obstruction was positively associated with the non-invasive tear meniscus height and ocular surface disease index scores. Corneal fluorescein staining and meibomian gland distortion of the upper eyelid were negatively correlated with the degree of nasolacrimal duct obstruction.

Postmenopausal women with PANDO exhibited significant morphological changes in the meibomian gland. Researchers wrote that more attention should be paid to meibomian gland loss in postmenopausal women with incomplete PANDO given its importance for identifying meibomian gland impairments in patients with PANDO.

SOURCE: Jin H, Zhang H. Changes in the meibomian glands in postmenopausal women with primary acquired nasolacrimal duct obstruction: a prospective study. BMC Ophthalmol. 2023;23(1):48.



The Effect of Sex and Laterality on the Phenotype of Primary Rhegmatogenous Retinal Detachment

This study is a retrospective analysis of data prospectively collected to assess the effect of sex and laterality on clinical features of primary rhegmatogenous retinal detachment (RRD). Data was extracted from two online datasets over a 7-year period of patients older than 16 years who had undergone surgery for primary RRD. Data on baseline characteristics were analyzed to compare males versus females, and right versus left eyes.

Of 8133 eyes analyzed, 4342 (53.4%) were right. The overall male predominance (63.7%) was more marked in the age range of 50-69 years. Men were more commonly pseudophakic and presented more frequently with baseline posterior vitreous detachment (PVD). Female sex was significantly associated with baseline myopia, retinal holes as causative retinal break, and isolated inferior RD. Men had more frequent foveal involvement, greater RRD extent, greater numbers and larger sized retinal tears including dialysis and giant retinal tears. Regarding laterality, foveal involvement, larger retinal breaks, isolated temporal RD and temporal retinal breaks were more common in right eyes, whereas left eyes were more myopic at baseline and presented more frequently with isolated nasal RD and nasal retinal breaks.

This study confirmed the predominance of male sex and right laterality in RRD. Sex and laterality were associated with multiple presenting features of RRD including extent, break distribution, number, size and type, as well as RD distribution.

SOURCE: Ferrara M, Song A, Al-Zubaidy M, et al; BEAVRS Retinal Detachment Outcomes Group. The effect of sex and laterality on the phenotype of primary rhegmatogenous retinal detachment. Eye (Lond). 2023 Feb 27. [Epub ahead of print].


Postoperative Complications After Successful Primary Rhegmatogenous Retinal Detachment Repair

This study aimed to evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD). The study was a retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD "pending foveal detachment" subgroup.

Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR)=4.3 times compared to macula-on RRD regardless of the surgical procedure. Macula-off status increased the risk of CME of OR=1.73 times compared to macula-on in the PPV subgroup. Combined cataract surgery and PPV increased the risk of CME by OR=3.3 times compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR=1.8 times. ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM.

Researchers wrote that the risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. They suggested that SB would be advisable in patients with RRD sparing the macula. Furthermore, they added, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.

SOURCE: Motta L, Frisina R, Ripa M, et al. Postoperative complications after successful primary rhegmatogenous retinal detachment repair. BMC Ophthalmol. 2023;23(1):77.




Industry News

Haag-Streit Launches Reliance Optometry Workplace Exam Lane

Haag-Streit announced the launch of the Reliance Optometry Workplace cost-effective exam lane solution. The equipment includes Reliance SL3 slit lamp (optimized with Haag-Streit optics), Haag-Streit AT 870 Goldmann applanation tonometer, Reliance 7900 instrument stand, Reliance 520 examination chair and Reliance 4246 examination stool. Read more.

Coburn Announces Anti-Fog Coating for Velocity Lens Coater

Coburn Technologies announced that Visgard UV Anti-Fog Coating is now available for use in its Velocity Spin Coater platform. Coburn’s latest Velocity technology, Velocity 2D, allows labs to apply two different coatings in one system, one of which can now be Visgard UV. Learn more about the company. The company also welcomed Michael Kelly to its marketing team as a new digital marketing and trade show specialist. Most recently Kelly was the multimedia designer/global corporate marketing specialist at Mirion Technologies.

Art Optical Introduces MOONLENS Identification System

Art Optical introduced a new Rx lens marking system for its MOONLENS Ortho-K/Myopia Management lenses. A unique set of numbers engraved on each lens corresponds to a matching number on the lens invoice, enabling the doctor to more easily track lens parameters during the fitting process. Read more.

Thea Data Demonstrates Positive Efficacy of Iyuzeh

Thea Pharma presented positive Phase III data on preservative-free Iyuzeh (latanoprost ophthalmic solution) 0.005% at the American Glaucoma Society annual meeting demonstrating comparable efficacy of Iyuzeh vs. Xalatan (latanoprost ophthalmic solution 0.005%; Pfizer) in patients with POAG or OHT. Read more.

TearRestore Announces Positive Clinical Trial Results

TearRestore announced positive topline results for a study conducted by the University of Colorado on the effect of warm compress therapy on dry eye disease using the TearRestore Thermal Mask. The study found:
● A 90% increase in tear break-up time
● A 51% reduction in dry eye symptoms
● A 40% increase in functional meibomian glands Learn more.

BostonSight Introduces Lensy, an Educational Ambassador

BostonSight announced that Lensy, an animated scleral lens, will be its ambassador. Read more.

IDOC Conference Sees Largest Numbers

IDOC’s national conference this year, The Connection 2023, drew more than 1,000 attendees—record-breaking attendance. Learn about the group.















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

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