Optometric Physician



Vol. 23, #9  •   Monday, March 7, 2022


Off the Cuff: Breaking up is hard to do

A little less than ten years ago, the CBS TV news program “60 Minutes” ran a segment on Luxottica titled “Sticker Shock.” While the segment focused largely on the ever-escalating cost of eyewear and Luxottica’s market domination, it stopped just short of describing the company as a monopoly. More than a few industry insiders agreed with the piece and, after the very public exposé, expected an FTC investigation.

In 2018, Luxottica merged with Essilor. The combined EssilorLuxottica is an eyecare behemoth providing, eyewear, ophthalmic lenses and vision care insurance through EyeMed. They own a variety of eye care and optical providers throughout the US including LensCrafters, Pearle Vision, Sears and Target Opticals, Vision Source, and online retailers Clearly, Vision Direct and FramesDirect, among others.

Recently, EssilorLuxottica North America announced the creation of a management services organization (MSO) to invest in private practices and practice transitions in the US called TeamVision. The MSO assumes non-medical responsibilities of the practice, including product, inventory, staffing and marketing, enabling the doctor to focus on primary and medical eye care.

As best I can tell, and I am not yet fully aware of several important details, TeamVision appears to represent an innovative and flexible alternative to the outright purchase of a practice by equity capital consolidators. In some ways, it appears to be a clever reverse engineered take on a LensCrafters sublease.

While TeamVision isn’t something I see for our practice, EssilorLuxottica has historically played well with optometry which might make TeamVision a viable alternative for colleagues with successful practices who would prefer focusing on medical eye care while subrogating management and supply chain to a professional management team.

So, what then is the problem? With this new broad incursion into private independent eye care by EssilorLuxottica, I suspect the balance may have shifted from a dominating presence in eye care to a presence that is much more likely to be viewed as monopolistic by the US government. While I don’t have a crystal ball, if I were EssilorLuxottica I would begin exploring how best to divide the company into functional units before the FTC does it for them in a far less favorable way. Breaking up may be hard to do but we still can be friends.

Editor’s Note: I am pleased to share that Utah contact lens legislation (HB 342) did not pass this session. Congratulations to my colleagues in the state for dodging a bullet that ultimately could have halted contact lens industry innovation and harmed patients throughout the US and beyond.



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.




Dose-Dependent Effect of CBD Nanoemulsion on Ocular Surface Inflammation and Intraocular Pressure

Cannabidiol (CBD) is a phytocannabinoid that has a great clinical therapeutic potential. Few studies have been published on its efficacy in ocular inflammations while its impact on intraocular pressure (IOP), a major risk factor for glaucoma, remains unclear. Moreover, due to its lability and high lipophilicity, its formulation within a prolonged stable topical ophthalmic solution or emulsion able to penetrate the highly selective corneal barrier is challenging. Therefore, various CBD nanoemulsions (NEs) were designed and evaluated for stability in accelerated conditions. Further, the optimal formulation was tested on a murine LPS-induced keratitis inflammation model. Lastly, increasing CBD concentrations were topically applied, for two weeks, on mice eyes, for IOP measurement.

CBD NEs exhibited optimal physicochemical characteristics for ocular delivery. A specific antioxidant was required to obtain the stable final formulation. In vivo, 0.4 to 1.6% CBD w/v reduced the levels of key inflammatory cytokines, depending on the concentration applied. These concentrations decreased or did not affect the IOP.

Researchers’ results showed that a well-designed CBD ocular dosage form can be stabilized for an extended shelf life. Furthermore, the significant decrease in inflammatory cytokines levels could be exploited, provided that an adequate therapeutic dosage regimen is identified in humans.

SOURCE: Rebibo L, Frušić-Zlotkin M, Ofri R, et al. The dose-dependent effect of a stabilized cannabidiol nanoemulsion on ocular surface inflammation and intraocular pressure. Int J Pharm. 2022; Mar 1;617:121627.





Application of Mydriasis and Eye Steering in Ultrawide Field Imaging for Detecting Peripheral Retinal Lesions in Myopic Patients

220 eyes of 110 myopic patients with known peripheral retinal lesions in at least one eye under Goldmann three mirror contact lens examinations were recruited to compare mydriatic and eye-steering ultrawide field imaging (UWFI) with standard non-mydriatic UWFI examination in detecting peripheral retinal lesions in myopic patients. Non-mydriatic standard and eye-steering UWFI images were taken centrally and with eye-steering technique in upper, lower, nasal and temporal gazes under Optomap UWFI (Daytona, Optos, UK). Mydriatic standard and eye-steering UWFI were captured in the central gaze and four different peripheral gazes. The sensitivity of detecting peripheral retinal lesions under different UWFI settings was compared.

141 (64.09%) eyes had peripheral retinal lesions. The sensitivity for detecting peripheral lesions from low to high was 41.84% (95% CI 33.62% to 50.54%) under a non-mydriatic standard UWFI setting, 52.48% (95% CI 44.08% to 60.75%) under a mydriatic standard setting, 75.18% (95% CI 67.21% to 82.06%) under a non-mydriatic eye-steering setting and 86.52% (95% CI 79.76% to 91.69%) under a mydriatic eye-steering setting. Both mydriasis and the eye-steering technique increased the sensitivity of detecting peripheral lesions with statistical significance (p<0.001). By applying an eye-steering technique, sensitivity of detecting lesions located in superior and inferior quadrants witnessed a greater increase compared with other two quadrants (p<0.05). Neither spherical equivalence (p>0.05) nor axial length (p>0.05) was an independent factor for detecting peripheral lesions.

Researchers wrote that the eye-steering technique and mydriasis could efficiently improve the sensitivity of detecting peripheral retinal lesions in myopic patients. Lesions of superior and inferior quadrants benefited more from the eye-steering technique.

SOURCE: Li M, Yang D, Shen Y, et al. Application of mydriasis and eye steering in ultrawide field imaging for detecting peripheral retinal lesions in myopic patients. Br J Ophthalmol. 2022; Mar 3. [Epub ahead of print].





Use of Autologous Serum Eye Drops with Contact Lenses in the Treatment of Chemical Burn-Induced Bilateral Corneal Persistent Epithelial Defects

Investigators aimed to evaluate the clinical effect of combined topical 20% autologous serum eye drops (ASEs) along with silicone-hydrogel soft contact lenses (SCLs) in the treatment of chemical burn-induced bilateral corneal persistent epithelial defects (PEDs) and to review the literature of related studies. From January 1, 2017, to December 31, 2019, they conducted a retrospective chart review of eight patients with chemical burn-induced bilateral corneal PEDs who were unsuccessfully treated with conventional medical therapy and were then treated with combined topical 20% (v/v) ASEs and silicone-hydrogel CLs. The clinical effects and effectiveness of the combined treatment were evaluated.

The bilateral corneal PEDs healed in all 16 eyes of the eight patients within two weeks. The patients did not report any discomfort associated with the combined treatment. Improved ocular comfort/visual acuity and decreased conjunctival injection correlated with healing. No recurrent corneal epithelial breakdown was noted during the three-month post-treatment follow-up.

Investigators reported that the combined treatment of silicone-hydrogel CLs and ASEs can help to stabilize the ocular surface and successfully treat chemical burn-induced bilateral corneal PEDs. They added that the strategy may be considered as an alternative treatment method for patients with bilateral chemical burn-induced corneal PEDs with potential corneal melting.

SOURCE: Chen YM, Wang WY, Lin YC, et al. Use of autologous serum eye drops with contact lenses in the treatment of chemical burn-induced bilateral corneal persistent epithelial defects. Biomed Res Int. 2022; Feb 21. [Epub ahead of print].








Industry News

Eaglet Eye Announces New Lens Fit Algorithms

Eaglet Eye announced the global release of Prime 6.1, the latest Eye Surface Profiler (ESP) software, adding first lens fit algorithms to six new lens designs and boosting DirectConnect with nine additional labs. The ESP now features more than 60 lens algorithms from over 25 labs across scleral, orthoK, hybrid, soft and corneal GP lens designs. Learn more.

Allergy-Fighting Contact Lens Approved

Most soft contact lenses aim to be minimally disruptive to the ocular surface, but a new lens, Acuvue Theravision, takes an active role for the first time: releasing an antihistamine to fight allergy. The lens, which just received FDA approval, contains 19mcg of the antihistamine ketotifen. Patients who experience ocular itch due to allergic conjunctivitis can get relief as quickly as three minutes after insertion, with a potential effect lasting up to 12 hours, according to the company. The lens may be worn for longer than 12 hours for vision correction. Theravision is made of the etafilcon A material common to the Acuvue product line and is intended for daily disposal. It’s available in powers of -12D to +6D, with no toric component, so patients need to have no more than 1D of astigmatism. Read more.

Heru Appoints Barber as Chief Marketing Officer

Heru announced that Brandon Barber joined the company as chief marketing officer, effective February 14. Barber brings more than two decades of experience in the digital space as an entrepreneur and executive in marketing and operations, including as a former Amazon Executive. Learn about the company.

Prevent Blindness Declares March as Workplace Eye Wellness Month, Held 17th Annual Advocacy Event

Prevent Blindness declared March as Workplace Eye Wellness Month. The group is providing free resources, including an overview of proper eye protection and safety glasses for various industries, and information on the effects of extended digital screen use. Learn more.
In addition, the group held its 17th annual Eyes on Capitol Hill advocacy day virtually March 1 to 2. The program provided patients, caregivers, allied personnel and medical professionals direct access to their elected officials. Learn more.

















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

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