Optometric Physician



Vol. 23, #12  •   Monday, March 28, 2022


Off the Cuff: COPE Steps Haltingly Into the Next Generation of Optometric Education

By now, virtually all readers are aware of my perspective regarding the current state of ongoing professional education. In the stark bright light of the COVID outbreak, our existing CE system was exposed as an antiquated, often-abused, ineffective, and sometimes-depreciating system that has traditionally focused more on providers and financial considerations than on education and professional advancement.

For those unaware, the Council on Optometric Education (COPE) recently released Proposed COPE Course Format Changes along with a request for comments. Here are my comments:

First, I congratulate COPE for its willingness to take on this Gordian knot, one that has been slowly strangling our profession and holding it back from achieving equity with the larger healthcare community.

COPE’s proposed new course formats bring our profession into the 21st century with greater and more rational equivalence between physical in-person CE and internet-based, educator-present CE. Many of these proposed changes reflect the perspective of an overwhelming majority of our profession, as validated by several independent polls. They also do not impede live presentations for those who prefer physical in-person education.

Unfortunately, the devil is always in the details, and it is here that COPE displays a lack of understanding of the actual optometric post-graduate educational process. Whether in-person or virtual, how the instructor interacts with the attendee should be left to the discretion of the instructor. Some educational formats don’t lend themselves to the constant interruption of questions, while others are designed by intention to be completely interactive. By locking the format, the amount of content that can be transferred may be dramatically limited. Alternatively, allowing attendees to ask questions during a synchronous presentation that can be answered asynchronously is often the best of all possible educational options.

Additionally, COPE’s outcomes measurement process completely ignores the truth that we are educating trustworthy, well-educated healthcare professionals—not children. Those who want to learn will learn and the small number who want to fall asleep in the back of a lecture hall or watch movies as a CE course runs in a minified window will do so regardless. My personal experience is that the overwhelming majority of our colleagues want to learn. I’ve had well over a thousand attendees—more than 90%—stay for non-CE credit Q&As after my Dry Eye Master Classes. Also, not everyone learns at the same rate. Many have epiphanies that come hours or days after an educational event. There are other concerns.

In the 21st century, surely there are better ways to monitor attendance, attention and learning than the overly simplistic and somewhat derisive methods proposed in the otherwise breakthrough COPE-suggested format changes. Regardless, this is a huge step in the right direction.



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.




Treatment of Epithelial Basement Membrane Dystrophy to Optimize the Ocular Surface Prior to Cataract Surgery

These researchers assessed the effectiveness of cryopreserved amniotic membrane (CAM) after debridement in treating epithelial basement membrane dystrophy (EBMD) prior to cataract surgery. This pilot study included two treatment groups: a prospective study group of nine subjects with significant EBMD who received debridement followed by self-retained CAM, and a retrospective, control group of 10 consecutive subjects who received debridement followed by a bandage contact lens (BCL). Slit-lamp photography after fluorescein staining was used to monitor healing. Corneal topography and IOL calculation were compared at baseline and one month after the procedure. Refraction and ocular surface stability were also compared after cataract surgery.

Corneal reepithelialization after debridement occurred in 4.6 ± 0.8 days in the study group and 6.8 ± 0.6 days in the control group (p<0.05). Corneal topography showed changes in curvature from 43.5 ± 1.2D at baseline to 44.6 ± 1.2D at one month in the study group and from 45.0 ± 0.6D to 45.7 ± 0.8D in the control (p=0.38). Average change in IOL calculation was 1.56D in the study group, compared to 0.95D in control (p=0.29). Post-cataract refraction in both groups was within ±0.5 Diopter of the anticipated, and the corneal surface remained stable without EBMD recurrence.

Management of ocular surface disorders prior to cataract surgery stabilized IOL calculation and reduced postoperative refractive surprises. Researchers wrote that CAM relatively accelerated healing after debridement; however, it was not better than BCL in stabilizing the ocular surface and improving visual outcome. They added that the use of CAM in cases of EBMD remains speculative.

SOURCE: Yeu E, Hashem O, Sheha H. Treatment of epithelial basement membrane dystrophy to optimize the ocular surface prior to cataract surgery. Clin Ophthalmol. 2022; Mar 15;16:785-95.




Prevalence of Symptomatic Dry Eye Disease With Associated Risk Factors Among Medical Students at Chiang Mai University Due to Increased Screen Time and Stress During Covid-19 Pandemic

Dry eye disease (DED) is one of the most common ophthalmological disorders, resulting from several systemic and ocular etiologies including meibomian gland dysfunction (MGD). During the COVID-19 pandemic, medical students are among the high-risk group for DED, mainly due to the increasing use of a visual display terminal (VDT) for online lectures and psychological stress from encountering several changes. This study aimed to explore the prevalence of DED using the symptoms-based definition and potential risk factors in medical students. This prospective cross-sectional study included medical students at Chiang Mai University between November 2020 and January 2021. All participants were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, the Thai version of the 10-Item Perceived Stress Scale-10 (T-PSS-10), the LipiView II interferometer, and an interview for other possible risk factors.

Overall, 528 participants were included in the study; half of the participants were female. The prevalence of DED was 70.8%. In the univariate analysis, female sex, contact lens wear, and T-PSS-10 stress scores were significantly higher in the DED group (p=0.002, 0.002, and <0.001, respectively). Moreover, participants with severe DED were likely to have higher meibomian gland tortuosity but not statistically significant. In the multivariate analysis, contact lens use and T-PSS-10 score were significant risk factors associated with the severity of DED.

In conclusion, the prevalence of DED in medical students was as high as 70.8%. Contact lens use and psychological stress evaluated using the T-PSS-10 questionnaire had a significant correlation with a risk of DED. Female gender and duration of VDT use were also associated. Most of the risk factors were modifiable and may be used as initial management in patients with DED.

SOURCE: Tangmonkongvoragul C, Chokesuwattanaskul S, Khankaeo C, et al. Prevalence of symptomatic dry eye disease with associated risk factors among medical students at Chiang Mai University due to increased screen time and stress during COVID-19 pandemic. PLoS One. 2022 Mar 23;17(3):e0265733.



Choroidal Thickness in Correlation With Axial Length and Myopia Degree

Myopia is a condition in which visual images come to focus in front of the retina of the eye. This disease is a major cause of visual disability, which is present in 108 million people globally. This study aimed to determine the relationship between the degree of myopia, the axial length, and the choroidal thickness (CT). This observational analytical study made use of a cross-sectional design. A total of 59 participants with refractive errors underwent treatment at Hasanuddin University Hospital, and 116 eyes were measured and analyzed. The choroidal thickness was measured using the Enhanced Depth Imaging OCT (EDI-OCT) tool, which is divided into nine observational areas. Furthermore, all data obtained were compared using statistical analysis, such as the one-way ANOVA and Pearson correlation test.

Researchers found a significant relationship between the choroidal thickness, axial length and myopia degree.

The thickness of the choroid decreased with an increase in the axial length and degree of myopia, which further indicated that the higher the myopia degree, the thinner the choroidal vasculature.

SOURCE: Muhiddin HS, Mayasari AR, Umar BT, et al. Choroidal thickness in correlation with axial length and myopia degree. Vision (Basel). 2022 Mar 2;6(1):16.






Industry News

Zenni and Prevent Blindness Partner on Zenni Scholarship

Online eyewear retailer Zenni and Prevent Blindness are partnering to create the Zenni Scholarship to Advance Children’s Vision program. The scholarship, which will provide professionals with free enrollment in the Prevent Blindness vision certification program, is designed to improve vision health equity by training early childcare, education and healthcare professionals to provide children’s vision screening. Zenni eyeglass vouchers will benefit children at high-risk of vision disorders. Learn more.






Alcon’s Systane Complete PF Online and in U.S. Retail Stores

Alcon’s Systane Complete Preservative-Free Lubricant Eye Drops for dry eye are now available online and in U.S. retail stores in a multi-dose bottle.

Visus Initiates Phase III Trials of Brimochol PF

Visus Therapeutics launched the first of two Phase III trials (BRIO-I and BRIO-II) for its lead asset, Brimochol PF, a preservative-free topical ophthalmic solution for the treatment of presbyopia. The double-masked, randomized, multicenter, safety and efficacy studies are expected to enroll approximately 170 emmetropic phakic and 500 pseudophakic presbyopic patients. Read more.



















Journal Reviews Editor:
Shannon Steinhauser, OD, MS, FAAO

Optometric Physician™ (OP) newsletter is owned and published by Dr. Arthur Epstein. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 19 Campus Boulevard, Newtown Square, PA 19073.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add Optometricphysician@jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Optometric Physician. HOW TO SUBMIT NEWS E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

Advertising: For information on advertising in this e-mail newsletter, please contact sales managers Michael Hoster, Michele Barrett or Jonathan Dardine.

News: To submit news or contact the editor, send an e-mail, or FAX your news to 610.492.1039