Optometric Physician



Vol. 25, #16 •   Monday, May 13, 2024


Off the Cuff: On My Way to the AOA

This year’s American Optometric Association (AOA) meeting is being held in Nashville, TN, June 19-22, at the Music City Center convention complex. This year’s keynote is speaking on the topic of AI in healthcare and how it specifically relates to eye care. I’m excited at the possibilities that AI presents. I have always had an affinity towards new technologies, processes, and pretty much anything that could improve patient care and outcomes.


Historically, for me, the Academy meeting was all about education, and the AOA meeting was synonymous with the political side of our profession. With the House of Delegates and grassroots advocacy efforts being center focus, the AOA’s exhibit hall and continuing education classes were merely a side note. This year, though, the AOA meeting has really boosted up its education component, with over 200 hours of classes and workshops being offered. Something I read on the meeting’s website did pique my interest though. It noted some of the courses would be COPE-approved and some would be “AOA CE hours,” with an asterisk explaining that “most states” accept the AOA-approved CE hours. Be sure to check your state requirements. This was new. I hadn’t heard of this before, and I need to check to see if Arizona is one of the states that accepts these hours for license renewal.

I’m kind of excited for both the break from daily practice, and the fact that I’ve never been to Nashville before. Do I need to buy boots? Not to mention, on this year’s meeting schedule is a 5K benefiting the Optometry Cares charitable foundation and puppy yoga. Puppies. Yoga. Battlestar Galactica. Anyway, if you see me in Nashville, please stop me and say hello. I hope to see you there.

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.



Medications for Attention Deficit Hyperactivity Disorder Associated With Increased Risk of Developing Glaucoma

Attention deficit hyperactivity disorder (ADHD) therapies including atomoxetine, methylphenidate, and amphetamines are some of the most prescribed medications in North America. Due to their sympathomimetic action, these drugs are contraindicated in patients with a history of angle closure glaucoma (ACG). This study aimed to determine the risk of ACG and open angle glaucoma (OAG) among users of these treatments. This is a retrospective cohort study with a case control analysis using the PharMetrics Plus Database (IQVIA). Researchers created a cohort of new users of atomoxetine, methylphenidate, and amphetamines, followed to the first diagnosis of (1) ACG or OAG; or (2) end of follow-up. For each case, four age-matched controls were selected. A conditional logistic regression model was used to adjust for confounders and to calculate adjusted incidence-rate-ratios (aIRRs).

A total of 240,257 new users of the ADHD medications were identified. The mean age was 45.0 ± 19.4 years and 55% of the cohort was female. Regular users of atomoxetine and amphetamines had a higher aIRR for developing ACG compared with non-users (aIRR=2.55 95% CI [1.20-5.43] and 2.27 95% CI [1.42-3.63], respectively), while users of methylphenidate had a higher aIRR for developing OAG (aIRR=1.23 95% CI [1.05-1.59]).

Use of amphetamines and atomoxetine had a higher risk for ACG, while use of methylphenidate was associated with a higher risk for OAG. Given the prevalence of ADHD medication use (medically and recreationally), researchers wrote that their findings on associated risk of glaucoma have significant public health implications.

SOURCE: Rami Darwich, Mahyar Etminan, Bonnie He, Brennan D Eadie. Medications for attention deficit hyperactivity disorder associated with increased risk of developing glaucoma. Eye (Lond). 2024 May 6. Online ahead of print.




Artificial Intelligence-Assisted Prescription Determination for Orthokeratology Lens Fitting

These researchers explored the potential of artificial intelligence (AI) to assist prescription determination for orthokeratology (OK) lenses. A total of 11,502 OK lens fitting records collected from seven clinical environments covering major brands were randomly divided in a three-way data split to develop an Artificial intelligence algorithm. This was then followed by a real-world trial. Cross-validation was used to identify the most accurate algorithm, followed by an evaluation using an independent test data set. An online AI-assisted system was implemented and assessed in a real-world trial involving four junior and three senior clinicians.

The primary outcome measure was the algorithm's accuracy (ACC). The ACC of the best performance of algorithms to predict the targeted reduction amplitude, lens diameter, and alignment curve of the prescription was 0.80, 0.82, and 0.83, respectively. With the assistance of the AI system, the number of trials required to determine the final prescription significantly decreased for six of the seven participating clinicians. This reduction was more significant among junior clinicians compared with consultants (0.76±0.60 vs. 0.32±0.60). Junior clinicians achieved clinical outcomes comparable to their seniors, as 93.96% (140/149) and 94.44% (119/126), respectively, of the eyes fitted achieved unaided visual acuity no worse than 0.8.

Investigators found that AI could improve prescription efficiency and reduce discrepancies in clinical outcomes among clinicians with differing levels of experience. They added that the use of AI in practice should help lessen the medical burden and improve service quality to offset the increases seen in myopia emerging worldwide.

SOURCE: Wei-Zhong Lan, He Tang, Long-Bo Wen,et al. Artificial Intelligence-Assisted Prescription Determination for Orthokeratology Lens Fitting: From Algorithm to Clinical Practice. Eye Contact Lens. 2024 May 2. Online ahead of print.

Increased Late-Onset Glaucoma Risk Following Vitrectomy for Macular Pucker or Hole

The long-term risk of developing glaucoma after vitrectomy remains uncertain. This retrospective population-based cohort study aimed to explore this risk following vitrectomy for macular pucker or hole. Utilizing Taiwan's National Health Insurance Research Database (NHIRD), researchers included patients older than 18 years who had undergone vitrectomy surgery between 2011 and 2019. Exclusions were made for patients with prior diagnoses of glaucoma, congenital or secondary glaucoma, as well as those who had received previous vitreoretinal treatments or had undergone multiple vitrectomies.

After an average follow-up period of 51 and 53 months, respectively, for the vitrectomized and non-vitrectomized group, results showed a relative risk of 1.71 for glaucoma development in the vitrectomized group. Higher adjusted hazard ratios were also observed for open-angle glaucoma and normal tension glaucoma. Increased risks were associated with male sex, obstructive sleep apnea, and migraine headaches. In the subgroup analysis, phakic eyes at baseline and those who had undergone cataract surgery post-vitrectomy were associated with a lower risk of glaucoma development during follow-up. Among all glaucoma events, pseudophakic status at baseline had the shortest interval to glaucoma development following vitrectomy.

These findings underscore the potential relationship between vitrectomy and glaucoma onset, emphasizing the need for vigilant monitoring and early detection of glaucoma in post-vitrectomy patients.

SOURCE: Yung-Sung Lee, Yu-Chi Chen, Tsung-En Huang, et al. Increased late-onset glaucoma risk following vitrectomy for macular pucker or hole. Eye (Lond). 2024 May 6. Online ahead of print.




Industry News

Bausch + Lomb Launches Zenlens® ECHO™ Scleral Lenses in US

Bausch + Lomb announced the US launch of Zenlens ECHO, a non-prosthetic, custom scleral contact lens technology designed to fit a wide variety of corneal shapes and sizes, including patients who have advanced ocular conditions such as corneal degeneration and certain postoperative conditions. Unlike impression-based or freeform lenses that can be expensive and require additional training or equipment, Zenlens ECHO can be used with a variety of technologies already available in clinical practice, including a slit lamp, optical coherence tomography scanning, profilometry or a Bi-Elevation™ fitting set. No additional training or certification is required.
Read more.

Optomed Releases First FDA-Cleared Handheld AI Fundus Camera for Detection of More Than Mild DR

Optomed introduced the Optomed Aurora AEYE, the first FDA-cleared handheld AI fundus camera. The camera provides instant detection of more than mild diabetic retinopathy, and recent clinical trials demonstrated that the camera exhibited diagnostic sensitivity in the range of 92 and 93 percent, and specificity in the range of 89 to 94 percent.
Read more.


• Prevent Blindness will host the ASPECT Patient Engagement and Advocacy Summit, May 14-16, at the Madison Hotel in Washington, D.C. Read more.









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

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