Optometric Physician



Vol. 24, #13 •   Monday, March 27, 2023


Off the Cuff: Can’t Always Get What You Want…Sometimes You Can

During the peak of the pandemic lockdowns, I noticed an interesting trend. A large number of my eyeglass wearers wanted to try contact lenses for the first time. Why the sudden adventurous spirit? The new experience of mask wear caused their glasses to steam up and the subsequent transient vision was worth it. Conversely, a large number of my contact lens wearers wanted to update their glasses or abandoned contact lens wear altogether. For the contact lens wearers, their reasons were mostly the fact they were on computers at home all day and didn’t want to bother with them, and a smaller subset didn’t want to risk touching their eyes at all. Glasses to contacts; contacts to glasses.

I shouldn’t have been surprised when I saw the uptick of my scleral lens wearers also requesting eyeglass options. Scleral lens wearers, or any other medically necessary modality, obviously aren’t wearing those lenses because glasses are a great option for them. Last December when one of my long-time scleral patients came in asking for glasses, I refracted him and got 20/40 BCVAs. I was pretty happy. He then tells me he found if he stacks two pairs of his old glasses, he can see. I was skeptical but indulged him. He then proceeded to break out these two pairs of glasses, stack them together, put them on, and read 20/25. What the…what? I took the stacked pair and put them in a manual lensometer together. They essentially corrected one meridian the same and over-minused another. I dialed that power into the phoropter thinking it wouldn’t balance or manifest the same but he still got 20/25 acuity. I was still skeptical if they would work once made into glasses and worried he’d get headaches. At his dispense, he was thrilled and went on his merry way.

Honestly, it didn’t take a pandemic. Medically necessary contact lens wearers desire a glasses option more than any other patient type I see, whereas my cosmetic contact lens wearers could take them or leave them. I guess if you have the option, it’s not as pressing of a need, but when the glasses option is seemingly taken away, human nature dictates a new desire of wanting what we can’t have.

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.


Pupillary Parameters Effects in Pseudoexfoliation Syndrome

In this study, the authors evaluated the effects of pseudoexfoliation syndrome on dynamic, static pupillary parameters (scotopic, mesopic, photopic) and the pupil dilation speed, with automatic pupillometry. The study group included 140 eyes with clinically visible pseudoexfoliation material (PXM) of 110 patients. The study group was compared with the control group formed by including 140 eyes of 110 patients. Scotopic measurements at 0.4 lx illumination, mesopic measurements at 4 lx illumination, and photopic measurements at 40 lx illumination were performed. Dynamic measurements were made at 500 lx illumination. The mean pupil dilation speed at 10th second was calculated. In addition, the eyes (80 patients) with clinically unilateral PXM were compared with the other eyes of the patients.

The mean scotopic, mesopic, photopic and dynamic pupil diameters of eyes with clinical PXM were compared with the control group, and all values were found to be significantly lower in eyes with PXM. The mean speed of pupil dilation at the 10th second was also significantly lower in the pseudoexfoliation syndrome group. The measurement results of the patients with clinical PXM were significantly lower than the other unaffected eyes. The mean speed of pupil dilation at 10th second was also significantly lower in eyes with PXM.

Results reveal that pseudoexfoliation syndrome affects iris mechanisms. Although pseudoexfoliation syndrome is a systemic syndrome, we can say that the emergence of iris dysfunction findings is parallel with the clinical observation of PXM.

SOURCE: Yıldırım Biçer G, Zor KR. How are pupillary parameters affected in pseudoexfoliation syndrome? A quantitative study. Int Ophthalmol. 2023 Feb 28. [Epub ahead of print].



Association Between Keratoconus and Allergic Eye Diseases: A Systematic Review and Meta-Analysis

This literature review investigated the association between keratoconus (KC) and allergic eye diseases, eye rubbing, and atopy. PubMed, Web of Science, Scopus, and Cochrane databases were searched for studies investigating eye allergy, atopy, and eye rubbing as risk factors for KC up to April 2021. Two authors independently screened all titles and abstracts against the predefined inclusion and exclusion criteria. The study analyzed the prevalence of KC and its risk factors, including eye rubbing, family history of KC, atopy, and allergic eye diseases. The National Institutes of Health Study Quality Assessment Tool was used. Pooled data are presented as odds ratios (OR) and 95% confidence intervals (CI). The analysis was conducted using RevMan version 5.4 software.

The initial search yielded 573 articles. After screening, 21 studies were identified for qualitative analysis and 15 for quantitative synthesis. A significant association was found between KC and eye rubbing, and family history of KC and allergies. However, no significant association was found between KC and allergic eye disease, atopy, allergic rhinitis, smoking, or asthma.

In conclusion, significant associations were observed between KC and eye rubbing, family history, and allergy, but not with allergic eye disease, atopy, asthma, and allergic rhinitis.

SOURCE: Seth I, Bulloch G, Vine M, et al. The association between keratoconus and allergic eye diseases: A systematic review and meta-analysis. Clin Exp Ophthalmol. 2023 Mar 7. [Epub ahead of print].

Antibiotics Versus Placebo for Acute Bacterial Conjunctivitis

Acute bacterial conjunctivitis is an infection of the conjunctiva and is one of the most common ocular disorders in primary care. Antibiotics are generally prescribed on the basis that they may speed recovery, reduce persistence, and prevent keratitis. However, many cases of acute bacterial conjunctivitis are self-limited, resolving without antibiotic therapy. This Cochrane Review was first published in The Cochrane Library in 1999, then updated in 2006, 2012, and 2022. This report assessed the benefits and side effects of antibiotic therapy in the management of acute bacterial conjunctivitis via literature search. Two authors independently reviewed the titles and abstracts of identified studies. Twenty-one eligible randomized controlled trials were included. A total of 8805 participants were randomized. All treatments were topical in the form of drops or ointment. The trials were heterogeneous in terms of their eligibility criteria, the nature of the intervention (antibiotic drug class, which included fluoroquinolones [FQs] and non-FQs; dosage frequency; and duration of treatment), the outcomes assessed and the time points of assessment.

Based on intention-to-treat (ITT) population, antibiotics likely improved clinical cure (resolution of clinical symptoms or signs) by 26% as compared with placebo. Subgroup analysis showed no differences by antibiotic class or treatment duration. In the placebo group, 55.5% of participants had spontaneous clinical resolution by days 4 to 9 vs. 68.2% of participants treated with an antibiotic. Based on modified ITT population, in which participants were analyzed after randomization on the basis of positive microbiological culture, antibiotics likely increased microbiological cure compared with placebo at the end of therapy; there were no subgroup differences by drug class. No study evaluated the cost-effectiveness of antibiotic treatment. Patients receiving antibiotics had a lower risk of treatment incompletion than those in the placebo group and were 27% less likely to have persistent clinical infection. No evidence of serious systemic side effects was reported in the antibiotic or placebo group. When compared with placebo, fluoroquinolones but not non- fluoroquinolones may result in fewer participants with ocular side effects.

The findings of this update suggest that the use of topical antibiotics is associated with a modestly improved chance of resolution in comparison to the use of placebo. Since no evidence of serious side effects was reported, use of antibiotics may therefore be considered to achieve better clinical and microbiologic efficacy than placebo. Increasing the proportion of participants with clinical cure or increasing the speed of recovery or both are important for individual return to work or school, allowing people to regain quality of life. Future studies may examine antiseptic treatments with topical antibiotics for reasons of cost and growing antibiotic resistance.

SOURCE: Chen YY, Liu SH, Nurmatov U, et al. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. 2023 Mar 13;3:CD001211.




Industry News

ADA & Genentech Partner to Increase Eyecare Access

The American Diabetes Association and Genentech are partnering as part of the ADA’s Health Equity Now initiative to improve access to screening and treatment for eye diseases affecting the diabetes community. Read more.

Visus Completes BRIO-I Enrollment

Visus Therapeutics completed patient enrollment and the last visit in BRIO-I, a Phase III trial for its lead asset, Brimochol PF, a preservative-free topical ophthalmic solution for the treatment of presbyopia. Read more.

IDOC Receives Honor for Third Year

IDOC it received the Certified™ by Great Place to Work® for the third year in a row. The award is based entirely on what current employees say about their experience working at IDOC. Learn more about the designation.












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

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