Optometric Physician



Vol. 25, #11 •   Monday, March 18, 2024


Off the Cuff: Congratulations, Florida!

Florida’s SB 1112, the bill that would have limited the use of specific medical titles, otherwise known as the “not-a-doctor” bill, has failed for a second legislative cycle in a row. The amount of time, money and political capital it takes to fight off these attacks year after year is no small feat. Congratulations!


This is still not the end. In an article published by the American Optometric Association this week, it stated similar legislation was introduced in California, Connecticut, Massachusetts, Tennessee, Texas, Wisconsin and North Carolina. I had no idea this backward thinking was so pervasive. It’s unfortunate that these bills are even able to be introduced largely under the misperception of what our profession has evolved into over the last few decades. It’s also incredibly disappointing that this misperception allows this type of legislation to perpetuate year after year.

Who’s behind these obviously organized attacks? If it’s organized ophthalmology, I was always told it was older ophthalmologists who were practicing at the time we got diagnostic and therapeutic expansions in the ‘80s trying to prevent us from treading on their turf. At this point, it would be hard to believe it’s older OMDs near retirement age who are driving this. So younger ophthalmologists? Why? A lot of these doctors were trained and currently practice alongside optometry and should know exactly the type of care we provide. In any event, I believe it’s time we, as a profession, transition from a defensive position to a proactive one. It’s time to get in front of this ongoing problem rather than just reacting to it.

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.



Finite Element Analysis of Changes in Deformation of Intraocular Segments by Airbag Impact in Eyes of Various Axial Lengths

Researchers studied the kinetic phenomenon of an airbag impact on eyes with different axial lengths using finite element analysis (FEA) to sequentially determine the physical and mechanical responses of intraocular segments at various airbag deployment velocities. The human eye model created was used in simulations with the FEA program PAM-GENERISTM. The airbag was set to impact eyes with axial lengths of 21.85 mm (hyperopia), 23.85 mm (emmetropia) and 25.85 mm (myopia), at initial velocities of 20, 30, 40, 50 and 60 m/s. The deformation rate was calculated as the ratio of the length of three segments, anterior chamber, lens and vitreous, to that at the baseline from 0.2 to 2.0 minutes after the airbag impact.

Deformation rate of the anterior chamber was greater than that of other segments, especially in the early phase, 0.2-0.4 minutes after the impact, and it reached its peak, 80%, at 0.8 minutes. A higher deformation rate in the anterior chamber was found in hyperopia compared with other axial length eyes in the first half period, 0.2-0.8 minutes, followed by the rate in emmetropia. The lens deformation rate was low, its peak ranging from 40% to 75%, and exceeded that of the anterior chamber at 1.4 and 1.6 minutes after the impact. The vitreous deformation rate was lower throughout the simulation period than that of the other segments and ranged from a negative value (elongation) in the later phase.

Airbag impact on the eyeball causes evident deformation, especially in the anterior chamber. The results obtained in this study, such as the time lag of the peak deformation between the anterior chamber and lens, suggest a clue to the pathophysiological mechanism of airbag ocular injury.

SOURCE: Tomohiro Ueno, Hideaki Fujita, Aya Ikeda, et al. Finite Element Analysis of Changes in Deformation of Intraocular Segments by Airbag Impact in Eyes of Various Axial Lengths. Clin Ophthalmol. 2024 Mar 7:18:699-712.



Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Retinal Vein Occlusion

A systematic review of Clinical Practice Guidelines (CPG)s for the diagnosis and management of Retinal Vein Occlusion (RVO) was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories to assess the methodological quality of CPG for the diagnosis and management of RVO. The search update was performed in April 2022. Five CPGs published in the last 10 years in English/Spanish were selected, and 5 authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment of each CPG by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications were performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes was carried out.

The lowest score (mean 18.8%) was for domain 5 'applicability', and the highest score (mean 62%) was for domain 4 'clarity of presentation'. The 2019 American guideline (PPP) presented the best score (40.4%) in domain 3 'rigor of development'. When evaluating the overall quality of the CPGs analyzed, all CPGs could be recommended with modifications. In the meta-synthesis, anti-VEGF therapy is the first-choice therapy for macular edema associated with RVO, but there is no clear recommendation about the type of anti-VEGF therapy to choose. Recommendations for diagnosis and follow-up are similar among the CPGs appraised.

Most CPGs for the diagnosis and management of RVO have a low methodological quality assessed according to the AGREE-II. PPP has the highest score in the domain 'rigor of development'. Among the CPGs appraised, there is no clear recommendation on the type of anti-VEGF therapy to choose.

SOURCE: Jose Galvez-Olortegui, Rachid Bouchikh-El Jarroudi, Isabel Silva-Ocas, et al. Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion. Eye (Lond). 2024 Mar 11. Online ahead of print.

Quantitative Evaluation of the Topographical Maps of Three-Dimensional Choroidal Vascularity Index in Children With Different Degrees of Myopia

Investigators enrolled 274 eyes from 143 children with various severity of myopia, including emmetropia (EM), low myopia (LM), and moderate-high myopia (MHM) to study topographical maps of the three-dimensional choroidal vascularity index (3D-CVI) in children with different levels of myopia. The choroidal vessel volume (CVV), choroidal stroma volume (CSV), and 3D-CVI in different eccentricities (fovea, parafovea, and perifovea) and quadrants (nasal, temporal, superior, and inferior) were obtained from swept-source optical coherence tomography angiography (SS-OCTA) volume scans. All choroidal parameters were compared among groups, and the associated factors contributing to different 3D-CVIs were analyzed.

Compared to the less myopic group, the more myopic group showed a significant decrease in CVV and CSV (MHM < LM < EM) and a significant increase in the 3D-CVI (MHM > LM > EM) in most areas. The nasal quadrant had the greatest 3D-CVI and lowest CSV and CVV, and vice versa in the temporal quadrant. The 3D-CVIs of the EM and LM groups gradually increased from the fovea to the perifovea, whereas the 3D-CVI of the MHM group first decreased and then increased. Regression analysis showed that axial length was an independent risk factor affecting foveal and parafoveal 3D-CVIs. Restricted cubic spline analysis revealed that the 3D-CVI increased with spherical equivalent (SE) when the SE was less than threshold and decreased when the SE was greater than threshold (SE thresholds for foveal, parafoveal, and perifoveal 3D-CVIs were -5.25 D, -5.125 D, and -2.00 D, respectively; all p<0.05).

Children with myopia exhibited decreased CSV and CVV, increased 3D-CVIs, and altered 3D-CVI eccentricity characteristics (from the fovea to the perifovea). The quadratic relationship between the 3D-CVI and SE should be explored in longitudinal investigations.

SOURCE: Fang Liu, Yuhao Ye, Weiming Yang, et al. Quantitative Evaluation of the Topographical Maps of Three-Dimensional Choroidal Vascularity Index in Children With Different Degrees of Myopia. Invest Ophthalmol Vis Sci. 2024 Mar 5;65(3):14.




Industry News

NovaSight Announces Positive Findings for CureSight

NovaSight announced findings from a study demonstrating long-term vision gains achieved with CureSight. The study showed that children with various types of amblyopia showed significant improvement in both VA and steroacuity following short-term binocular treatment with Curesight; the gains were maintained for at least one year. The study was published in the American Journal of Ophthalmology. Read more.


• Neurolens announced a strategic leadership restructure to fuel continued growth and innovation. Read more.

• Surface Ophthalmics announced the appointment of Richard Lindstrom, MD, as founder and chairman. Read more.









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

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