Optometric Physician



Vol. 24, #18 •   Monday, May 1, 2023


Off the Cuff: Congratulations, Dr. Lappin

Four years ago, Dr. Epstein went to lecture in Cincinnati. He would always call me once he got back to his hotel, usually regaling me with things he was working on, how the lecture went, or his travel woes. That night, though, he was excited and told me he met “an impressive young man” who was also interested in ocular surface disease and that he invited him to come see our practice. When Dr. Lappin came to Phoenix to shadow with us, it was like he was meant to be here. His residency and naturally curious mind armed him with an impressive knowledge base, and his funny, happy, and caring personality synced up perfectly with our practice vibe. He fit right in. After joining our practice, he began writing, lecturing, and assisting with our research projects and is growing a rightfully earned clinical reputation for excellence.

Dr. Lappin has been active in our state association since he arrived in the Grand Canyon State. He currently serves as a director on the board of the Arizona Optometric Association as well as serving on the membership committee. I was thrilled to learn that at the Arizona Optometric Association’s spring meeting this weekend, Dr. Cory Lappin is being awarded Arizona’s Young OD of the Year. Well deserved, and I’m confident just the beginning of all the great things that are yet to come.

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.


Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs’ Endothelial Corneal Dystrophy

Implantation of toric intraocular lenses (IOLs) in patients with Fuchs’ endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. A retrospective casecontrol study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism.

The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 (logMAR) ± 0.14 vs. 0.13 ± 0.17, respectively, and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively. The spherical equivalent in the FECD eyes compared to the control eyes was - 0.29 ± 0.43 vs. - 0.21 ± 0.50, respectively. The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85 D@93° ± 2.42° vs. 0.23 D@68° ± 2.50°, respectively, and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1 D vs. 2.28 ± 1.03 D, respectively. A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24 D@28° ± 0.57° vs. 0.03 D@127° ± 0.53°, respectively. However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31 D vs. 0.42 ± 0.31 D, respectively (D diopters).

The researchers concluded that postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52 D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

SOURCE: Blau-Most M, Levy A, Assia EI, et al. Clinical outcomes of toric intraocular lenses in patients with fuchs endothelial corneal dystrophy. Ophthalmol Ther. 2023 Apr 13. [Epub ahead of print].



Comparison of Conjunctival Sac Microbiome between Low and High Myopic Eyes

Microbial communities played a vital role in maintaining homeostasis of ocular surface. However, no studies explored the myopia-associated conjunctiva microbiota changes until now. In this study, conjunctival sac swab specimens were collected from 12 eyes of low myopia (LM) and 14 eyes of high myopia (HM) patients. The V3-V4 region of the 16S rRNA gene was amplified and then sequenced. Statistical analysis was performed to investigate differences in the taxonomy and diversity between two groups.

Compared to LM, higher Ocular Surface Disease Index (OSDI) scores were observed in HM group. The Shannon index of the HM was lower than that of the LM group (p=0.017). Principle coordinate analysis and Partial Least Squares Discrimination Analysis showed distinct microbiome composition between two groups. At the phylum level, there were higher relative abundances of Proteobacteria (68.27% vs. 38.51%) and lower abundances of Actinobacteria (3.71% vs. 9.19%) in HM, compared to LM group. At the genus level, the abundances of Acinetobacter in HM (18.16%) were significantly higher than the LM (6.52%) group. Actinobacteria levels were negatively correlated with the myopic spherical equivalent and OSDI scores. Moreover, positive correlations were found between Proteobacteria levels and OSDI scores, Acinetobacter levels were positively correlated with myopic spherical equivalent and OSDI scores.

Investigators wrote that HM patients had bacterial microbiota imbalance in the conjunctival sac compared with LM patients. They added that Proteobacteria, Actinobacteria, and Acinetobacter may play roles in the HM associated ocular surface irritation.

SOURCE: Xiao K, Chen Z, Long Q. Comparison of conjunctival sac microbiome between low and high myopic eyes. J Microbiol. 2023 Apr 21. [Epub ahead of print].


Analysis of Google Trends and Search Results for Ophthalmic Symptoms of Monkeypox

In July 2022, the World Health Organization (WHO) declared monkeypox virus's global spread a "public health emergency of international concern." About a quarter of monkeypox cases feature ophthalmic symptoms. The authors assessed trends in worldwide search interest in monkeypox ophthalmic involvement and inclusion in online search engine queries. The following keywords were searched on Google Trends from April 1, 2022, to August 12, 2022: “monkeypox + eye,” “pink eye,” “eye infection,” “eyelid,” “vision,” “blurry vision,” “vision loss,” “blindness,” “eye symptoms,” “eye problems,” “eye pain,” “eye redness,” “conjunctivitis,” “conjunctiva,” “cornea,” “keratitis,” “corneal ulcer,” and “blepharitis.” Researchers analyzed trends, correlated search interest with case count data, and compared popularity of search terms via nonparametric Mann-Whitney-U analysis. Inclusion of ophthalmic symptoms in Google search results for "monkeypox symptoms" was assessed.

"Monkeypox eye" had the highest average search interest worldwide and in the United States. Search interest peaked between mid-May and late July 2022. When compared to interest in "monkeypox rash," the most searched monkeypox symptom, the average interest in "monkeypox eye" was lower. Of the first 50 results from the Google search of "monkeypox symptoms," 10/50 (20%) mentioned ophthalmic symptoms. Six/50 (12%) mentioned the eye as a route of virus transmission.

Search interest in monkeypox ophthalmic symptoms corresponded with geographic and temporal trends, i.e., timing and location of the first reported non-endemic cases and WHO announcement. Researchers wrote that, although ophthalmic symptoms are not as widely searched currently, inclusion in public health messaging is key for diagnosis, appropriate management, and reduction of further transmission.

SOURCE: Zhu A, Mahajan J, Oydanich MK, et al. Analysis of google trends and search results for ophthalmic symptoms of monkeypox. Int Ophthalmol. 2023 Apr 18:1-7. [Epub ahead of print].




Industry News

Eye Designs Group Offers New Office Design Catalog

It contains information on space planning, optical and exam furniture, merchandising, branding, lighting, eyecare-specific artwork, etc. View the catalog.

Registration Open for NORA 2023 Conference

Registration is open for the Neuro-Optometric Rehabilitation Association, International annual conference, October 5-8, at the Portland Marriot Downtown Waterfront. The live event (no virtual attendance) for eyecare and other healthcare professionals who provide rehabilitative services to individuals who have suffered a traumatic brain injury, is themed “Brain Based Rehabilitation” and will feature up to 18 hours of CE credit. Learn more.

Prevent Blindness Declares May Ultraviolet (UV) Awareness Month

Learn more.












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

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