Optometric Physician

Vol. 21, #9   •   Monday, March 8, 2021


Off the Cuff: When Did Insurance Coverage Become More Important Than the Doctor?

The other day, a patient in her early 90s came with her daughter-in-law for a dry eye workup. Although her face reflected her years from beneath her mask, she cogently shared her story of dry eye misery. She told me that she was happy that she had finally found someone who was as knowledgeable as I was, and explained that she had done extensive research and had watched several of my online interviews and presentations. She told me how impressive my credentials were. I thanked her.

The examination was straightforward. She had severe meibomian gland loss, and the surface of both eyes were really beaten up. Tear lipid levels were almost nonexistent and breakup times were rapid—all evidence of severe dry eye.

As I progressed through the workup, I explained what I was doing and what I was finding and finally got to the point where we discussed therapeutic options. At this point, she cautioned that there would only be this one visit and that she would not be coming back for any follow-up. I was concerned and asked why. She responded that I wasn’t on her insurance plan, and she wasn’t willing to pay for more than the initial visit and workup. I said I understood and finished up, but was surprised that we weren’t on her plan. Although you can’t judge a book by its cover any more than a patient’s financial situation by their appearance or address, I didn’t get the feeling that she wasn’t able to afford care. Even more perplexing was her willingness to forgo treatment that just moments ago seemed so important to her.

As it turned out, we did accept her AARP Advantage Medicare plan, and she did book a follow-up appointment quite happily. As I thought about it though, the encounter was a cold splash of reality. I had long ago accepted that insurance companies and our government have spent years teaching patients that they are healthcare consumers who are entitled to care. After all, they paid for or otherwise had coverage, and they were entitled to what was covered come hell or high-water. However, I didn’t think that this sense of entitlement had fully permeated all segments of society. Based on my own experience and this patient’s age, she came from a time where a doctor’s credentials, word of mouth and recommendations would have been the primary deciding factors for choosing a healthcare provider. Apparently, that’s no longer the case for most, if not all of our patients.

I know our healthcare system is broken, but sometimes I forget just how broken it really is. This was a very real reminder of how devalued the doctor-patient relationship has become. As much as I’d like to think that this is something that can be put right by legislation, time or innovation, given the current state of our union, I am not sure it is something that can be fixed. I worry that it will get even more broken.

Editor’s note: As some of you probably know our colleague and my dear friend Dr. Brian Rosenblatt had an extremely severe near fatal case of Covid-19. Thankfully he recovered but his story is extremely compelling and very much worth sharing. Please check his YouTube interview. With thanks to Dr. Alan Glazier.


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.


3D Augmented Fundus Images for Identifying Glaucoma Via Transferred Convolutional Neural Networks

Glaucoma is a chronic and irreversible retinopathy threatening the vision of millions of patients around the world. Its early diagnosis and treatment can help to prolong the period of sight deterioration from no visual impairment to blindness, whereas the screening and diagnosis of glaucoma in clinical practice remains challenging because some key assessment criteria like cup-to-disc ratio is limited by subjective analysis and intra- and interobserver variability. This paper looked at the potential of new augmented image data of the optic nerve head (ONH) combined with the latest deep learning networks to achieve better diagnosis of glaucoma. This paper explored the potential value of an additional three-dimensional topographic map of the optic nerve head proceeded by the latest deep learning approaches, i.e., convolutional neural networks to improve the diagnosis efficiency. Specifically, 3D topography maps of the ONH and RGB fundus image was used to train the transferred AlexNet and VGG-16 networks. The diagnostic performance was compared to that achieved by using the 2D fundus images only.

The 3D topographic map of ONH reconstructed from the shape from shading method provided better visualization of the structure of optic cup and disc. This new enhanced dataset was employed to train the proposed deep learning networks and finally achieve diagnostic accuracy of 94.3%, which was superior to the networks trained via 2D conventional images.

Researchers wrote that employing deep learning neural networks with augmented 3D images can increase the accuracy of automatic separating glaucoma and non-glaucoma fundus images. They added it may be used as an objective tool in developing computer assisted diagnosis systems for assessment of glaucoma.

SOURCE: Wang P, Yuan M, He Y, Sun J. 3D augmented fundus images for identifying glaucoma via transferred convolutional neural networks. Int Ophthalmol. 2021 Mar 3. [Enews ahead of print].



Side Effects of Topical Atropine 0.05% Compared to 0.01% for Myopia Control in German School Children

Based on findings of the Asian low-concentration atropine for myopia progression study, a concentration of 0.05% was proposed as a good compromise between safety and efficacy for myopia control. However, no data on side effects have been published so far in Caucasian children receiving this dose. Prior to commencement of bilateral atropine treatment with 0.05% atropine, 19 myopic children ages 5 to 15 years were treated in only one eye at bedtime, leaving the other eye as a control. Pupil size, accommodation amplitude and near visual acuity were measured at 10 a.m. the next day and compared to the untreated contralateral control eye. The results were then compared to a cohort of 18 children whose treatment with 0.01% atropine commenced in a similar fashion.

Twelve children (63%) reported visual impairment or reading difficulties. Anisocoria was 2.9 ±1.1 mm. In comparison, 0.01% atropine led to a significantly less anisocoria of 0.8 ±0.7 mm. Accommodation was decreased by -4.2 ±3.8D in 0.05% atropine treated eyes, whereas 0.01% atropine induced hypo-accommodation of -0.05 ±2.5 D. Near visual acuity was not significantly reduced in eyes treated with 0.05% atropine compared to 0.01% atropine.

Investigators wrote that, compared to 0.01%, their findings indicated stronger, more relevant side effects of 0.05% topical atropine in young Caucasian children with progressive myopia as recently reported in Asian children, potentially compromising acceptance and compliance.

SOURCE: Joachimsen L, Farassat N, Bleul T, et al. Side effects of topical atropine 0.05% compared to 0.01% for myopia control in German school children: a pilot study. Int Ophthalmol. 2021; Feb 25. [Epub ahead of print].


Preoperative Vision, Gender and Operation Time Predict Visual Improvement After Epiretinal Membrane Vitrectomy

This retrospective, comparative case series included 50 patients with fovea-attached type epiretinal membrane who received micro-incision vitrectomy surgery using a non-contact wide-angle viewing system to evaluate its efficacy for fovea-attached epiretinal membrane and to report the factors influencing the outcome.

All patients were followed-up for a minimum of 12 months. Seven cases were classified as group 1A (mainly outer retinal thickening), 17 were group 1B (more tenting of outer retina and distorted inner retina) and 26 were group 1C (prominent inner retina thickening and inward tenting of outer retina). Outcome measures included operation time, recurrent rate, postoperative BCVA and CRT. The mean operative time was 26.2 minutes. The mean change of BCVA (LogMAR) was -0.43. The mean change of CRT was 135.3 μm. The mean change of CRT was significantly higher in group 1C. Worse preoperative BCVA, male gender and longer operative time can predict better postoperative BCVA found by multivariate logistic regression and multiple regression models.

Significant improvement in BCVA and CRT was noted after micro-incision vitrectomy surgery to operate fovea-attached type epiretinal membranes. Worse preoperative BCVA, male sex and longer operation time could predict better improvement. These findings may assist surgeons in better evaluating the potential of this method to help their patients with epiretinal membranes.

SOURCE: Bair H, Kung WH, Lai CT, et al. Preoperative vision, gender, and operation time predict visual improvement after epiretinal membrane vitrectomy: a retrospective study. Clin Ophthalmol. 2021; Feb 24;15:807-14.




Industry News

AAOF Announces Jill And George Mertz Fellowship Recipient Treatment

The American Academy of Optometry Foundation announced Justina Raouf Assaad, OD is the recipient of the 2021 AAOF Jill and George Mertz Fellowship. Dr. Assaad is a primary care optometry resident at the University of Houston College of Optometry. Her research goals are to establish a posterior segment imaging protocol for keratoconus patients. Read more.


Iridex Announces Strategic Collaboration with Topcon

Iridex, a provider of ophthalmic laser-based medical products for the treatment of glaucoma and retinal diseases, entered into a strategic collaboration with Topcon. The collaboration includes three main agreements under the terms of which Topcon will acquire exclusive distribution of Iridex laser systems, delivery devices and disposable probes to be sold through its networks in Asia Pacific and EMEA regions. Concurrently, Iridex will add Topcon’s PASCAL systems to its U.S. direct sales and global distribution network. Further, Iridex will acquire the design and manufacturing operation of Topcon’s PASCAL product line. Read more.

Foundation Fighting Blindness to Host Online CME (COPE) Webinar

The Foundation Fighting Blindness will jointly host an online continuing medical education (CME and COPE) course April 5 at 7 p.m. Eastern Time offering 1 CME or COPE credit. More than 40 clinical trials for emerging retinal degenerative disease therapies are underway, offering hope for patients and the opportunity for them to participate in the research. The course will:
• discuss why it’s important for patients with inherited retinal diseases such as retinitis pigmentosa, Stargardt’s disease, and age-related macular degeneration to know about clinical research;
• provide patient perspectives on clinical trials; and
• offer insights about the clinical trial process from the perspective of investigators. The course will be delivered by Alan Kimura, MD, PhD, president of and a partner at Colorado Retina. Read more.

Envision Sets Agenda for Spring Conference

Envision has finalized the agenda for its Spring 2021 Conference, a two-day event to be livestreamed on March 26 to 27. The virtual conference and Envision Conference East are multidisciplinary events focused on disseminating the latest advancements in rehabilitation techniques, research and technology surrounding low vision and low vision rehabilitation. Envision Conference East will be held August 20 to 21 at The Ohio State University College of Optometry in Columbus. Learn more.

First Insight & 4PatientCare Partner for MaximEyes.com Integration

4PatientCare, through its partnership with First Insight and latest MaximEyes.com integration, is aiming to equip eye care professionals with solutions to help with scheduling and to boost patient satisfaction. 4PatientCare’s Web Scheduler is integrated into the MaximEyes.com schedule module, empowering patients to book appointments 24 hours a day from any device. The platform also provides patients with digital fill-ahead registration forms to ensure the practice receives pre-appointment information upfront. Because 4PatientCare syncs with MaximEyes.com in near-real-time, double bookings are reduced. Learn more.

Keeler Names VanArsdale VP of Business & Channel Management

Keeler announced the promotion of Eugene R. VanArsdale to vice president of business and channel management for the Americas. He will be responsible for the strategic growth of established partnerships with group purchasing organizations, corporate accounts, optometry and ophthalmology schools, and national dealers across the Americas. Together with his team, he will also identify key opportunities to help grow Keeler’s product portfolio pipeline.





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