A weekly e-journal by Art Epstein, OD, FAAO

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Volume 18, Number 20

Monday, May 15, 2017

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Inside this issue: (click heading to view article)
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######### Off the Cuff: Be Different Or Be Gone
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######### Long-Term Clinical Course of Normal-Tension Glaucoma: 20 Years of Experience
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######### Influence of Pilocarpine & Timolol on Meibomian Gland Epithelial Cells
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######### Retinal Nerve Fiber Layer Thickness Values and Their Associations with Ocular and Systemic Parameters in Black South Africans
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######### News & Notes
 

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Off the Cuff: Be Different or Be Gone

I’ve always been amazed at how intelligent people sometimes do really stupid things. Take the airlines for example. I am sure you’ve read about United Airline’s continuing troubles. From infamously beating a physician into bloody submission while hauling him off a flight to freezing a giant rabbit to death and then cremating evidence of the murder, UAL is in a serious tailspin. The reason is simple: United’s management is out of touch, inept and certainly overpaid.

You would think that they would have quickly figured it out, but their continuing woes prove that they haven’t learned a thing. Nor are they likely to. Sadly—especially for me as a frequent flier—that’s just part of a much more systemic problem with US airlines.

In every successful business, the devil’s in the differences. Logically, an airline would do everything possible to differentiate itself from its competitors to woo the most valuable passengers. Bizarrely, the opposite has been true. Since the merger of US Airways and American Airlines, the three remaining legacy carriers have copied each other into a down spiral of poor service, ebbing passenger loyalty and low employee morale. Truth be told, in the once proud US airline business, there is little left to be proud of.

It’s clear that change is coming to the airlines, as the current situation is unsustainable. Whether legislated by Congress or delivered as payback from pissed-off consumers, comeuppance for management hubris will come sooner than later. At least one legacy carrier airline will enter an unrecoverable spin when gas prices rise or something else disruptive happens.

So what can we as ODs learn from this? All the usual admonitions and advice apply: Treat people as you would want to be treated, see things from your patient’s perspective, etc., etc. However, the most important lesson to be learned is to make sure you are different and change while you still have a chance to. The handwriting on the wall is always easier to see just before you hit it, but by then it’s too late.

 


Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com

 

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 the editorial board, Jobson Medical Information LLC (JMI), or any other entities or individuals.

 





Long-Term Clinical Course of Normal-Tension Glaucoma: 20 Years of Experience
 
 
The purpose of this study was to investigate the long-term clinical course of NTG patients who initiated intraocular pressure (IOP)-lowering therapy. The present study included 72 normal-tension glaucoma (NTG) patients. The mean deviation (MD) was measured with visual fields. Nocturnal hypotension with weighted standard deviation (wSD) was determined by 24-hour ambulatory blood pressure monitoring. To identify risk factors for NTG progression, linear logistic regression analysis was employed.

The mean follow-up period was 21.2 ± 1.1 years. The mean MD progression rate was 0.28 ± 0.24 dB/year. The mean ocular perfusion pressure (OPP) was 52.1mm Hg  ± 5.9mm Hg. The mean wSD was 14.5 ± 2.2. In the univariate model, disc hemorrhage, IOP reduction rate and OPP were associated with glaucomatous visual field progression. However, in the multivariate model, the IOP reduction rate and OPP were detected to be significant factors associated with progression.

The mean rate of visual field progression was -0.28 dB/year in NTG patients treated with medical therapy. The IOP reduction rate and OPP were associated with glaucomatous visual field progression.


SOURCE: Jin SW, Noh SY. Long-term clinical course of normal-tension glaucoma: 20 years of experience. J Ophthalmol. 2017;2017:2651645.


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Influence of Pilocarpine & Timolol on Meibomian Gland Epithelial Cells
 
 
Investigators have discovered that topical antiglaucoma drugs may induce meibomian gland dysfunction—a response that may contribute to the dry eye disease commonly found in patients with glaucoma taking such medications, researchers wrote. This study hypothesized that drug action involved a direct effect on human meibomian gland epithelial cells (HMGECs).

To test this hypothesis, researchers examined the influence of the antiglaucoma drugs pilocarpine and timolol on the morphology, survival, proliferation and differentiation of HMGECs. Immortalized (I) HMGECs (n=2 to 3 wells/treatment/experiment) were cultured with multiple concentrations of pilocarpine or timolol for up to seven days. Experiments included positive controls for proliferation (epidermal growth factor and bovine pituitary extract) and differentiation (azithromycin). Cells were enumerated using a hemocytometer, and evaluated for morphology, neutral lipid staining and lysosome accumulation.

The results demonstrated that pilocarpine and timolol caused a dose-dependent decrease in the survival of IHMGECs. The clinically used concentrations were toxic and led to cell atrophy, poor adherence or death. By contrast, drug levels that were known to accumulate within the conjunctiva, adjacent to the meibomian glands, did not influence IHMGEC survival. These latter concentrations also had no effect on IHMGEC proliferation or differentiation, and they did not interfere with the ability of azithromycin to stimulate cellular neutral lipid and lysosome accumulation. This dose of pilocarpine, though, did suppress the epidermal growth factor+bovine pituitary extract-induced proliferation of IHMGECs.

These results supported researchers’ hypothesis and demonstrated that the antiglaucoma drugs pilocarpine and timolol had a direct effect on HMGECs that might influence their morphology, survival and proliferative capacity.


SOURCE: Zhang Y, Kam WR, Liu Y, et al. Influence of pilocarpine and timolol on human meibomian gland epithelial cells. Cornea. 2017;36(6):719-724.

 

 

Retinal Nerve Fiber Layer Thickness Values and Their Associations with Ocular and Systemic Parameters in Black South Africans
 
 
Six hundred participants with healthy eyes—305 (50.83%) males and 295 (49.17%) females with a mean age of 28.15 ± 13.09 years—underwent a detailed ophthalmic examination to measure the retinal nerve fiber layer (RNFL) thickness values and investigate their associations with other parameters in healthy eyes of Black South Africans. RNFL thickness was measured by iVue SD-OCT.

The mean global RNFL thickness was 110.01µm ± 7.39µm. The RNFL was thickest inferiorly (135.06µm ± 9.66µm) and superiorly (131.72µm ± 10.46µm), thinner nasally (87.24µm ± 13.22µm) and thinnest temporally (73.63µm ± 15.66µm). Multivariate analysis showed that thicker mean global RNFL thickness was significantly associated with younger age, shorter axial length (AL) and hyperopia. Mean RNFL thickness decreased by approximately 0.11µm per year of aging life, and by 1.02µm for each 1mm of axial elongation. There was a 0.62µm RNFL thickness increase for every diopter change in spherical power towards more hyperopia.

Researchers wrote that mean RNFL thickness values and their associations established in this population may be of clinical value when assessing factors that influence this parameter and diagnosing relevant diseases.

SOURCE: Mashige KP, Oduntan OA. Retinal nerve fibre layer thickness values and their associations with ocular and systemic parameters in Black South Africans. Afr Health Sci. 2016;16(4):1188-1194.








News & Notes
 
B+L Reports Updated Results of ARMOR Study, Announces PDUFA Date for Brimonidine Tartrate Ophthalmic Solution, 0.025%
Bausch + Lomb announced updated results from the ARMOR (Antibiotic Resistance Monitoring in Ocular Microorganisms) surveillance study, the only multicenter, nationwide survey of antibiotic resistance patterns specific to eye care, at the 2017 Association for Research in Vision and Ophthalmology Annual Meeting in Baltimore. Researchers presented preliminary 2016 surveillance data on antibiotic resistance levels in addition to an eight-year trend analysis of antibiotic resistance among staphylococcal isolates. In updated surveillance data, 359 isolates were collected from eleven U.S. sites. Haemophilus influenzae isolates collected to date from 2016 were susceptible to all antibiotics tested. Although resistance among Pseudomonas aeruginosa isolates continued to be low, data indicated that non-susceptibility to fluoroquinolones (7 percent) more than doubled from 2015. Isolates of Streptococcus pneumoniae exhibited non-susceptibility to azithromycin (31 percent) and penicillin (38 percent) while remaining susceptible to fluoroquinolones and chloramphenicol. Among all staphylococci, resistance was most notable for azithromycin (47 percent to 63 percent); oxacillin/methicillin (27 percent to 43 percent); and ciprofloxacin (25 percent to 30 percent). Nonsusceptibility to three or more drug classes was observed in 24 percent of Staphylococcus aureus and 36 percent of coagulase-negative staphylococci (CoNS) isolates collected in 2016, with multidrug resistance remaining prevalent among methicillin-resistant (MR) S. aureus (70 percent) and MRCoNS (77 percent). In a second study, ARMOR researchers reported resistance trends in staphylococcal infections from January 2009 through October 2016. Read more.
In addition, Valeant Pharmaceuticals announced that the U.S. Food and Drug Administration accepted its New Drug Application for brimonidine tartrate ophthalmic solution, 0.025% (Luminesse), and set a PDUFA action date of Dec. 27, 2017. Luminesse is a topical vasoconstrictor formulation to be used over the counter as an eye drop to relieve redness of the eye due to minor eye irritations. If approved, this will be the first OTC product developed with brimonidine tartrate for the treatment of ocular redness. Read more.


Essilor Shareholders Approve Combination Between Essilor & Luxottica
In approving the planned combination between Essilor and Luxottica, Essilor's shareholders also appointed members of the future EssilorLuxottica board of directors, the contribution by Delfin (holding company owning approximately 62% of Luxottica shares) of all its Luxottica shares to Essilor, the contribution of almost all of Essilor's activities and equity interests into a wholly owned subsidiary; the issue of new shares in the context of the mandatory public exchange offer, to be launched by EssilorLuxottica for the remaining Luxottica shares. Final completion of the contribution by Delfin of its Luxottica shares to Essilor is expected to occur by the end of 2017. Read more.


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Dr. Lane Joins Alcon as CMO & Global Head of Franchise Clinical Strategy
Alcon appointed Stephen S. Lane, MD, as chief medical officer and global head of franchise clinical strategy. He will join the company on June 1. For the past 32 years, Dr. Lane has been a world-renowned ophthalmologist specializing in cataract surgery, cornea/external diseases, anterior segment surgery, LASIK and refractive surgery. He is a founding partner of Associated Eye Care, past president of the American Society of Cataract Surgeons, serves on the editorial boards for several ophthalmic journals, is a distinguished lecturer and has published numerous academic articles and book chapters. In addition, Dr. Lane is an adjunct professor of ophthalmology at the University of Minnesota, co-chair of the ASCRS Foundation and a visiting faculty member of ORBIS International, an Alcon partner. Read more.




Novaliq Collaborates with University Of Cologne on Neuropathic Pain Program
Novaliq GmbH announced successful application of a first-in-class ocular neuropathic pain and anti-inflammatory cannabinoid-based dry eye disease treatment approach in collaboration with the University of Cologne, Germany. The novel therapeutic approach has been proof-tested in a consecutive research program that explores the development of new dry eye therapies targeting the cannabinoid receptor system using Novaliq’s proprietary EyeSol drug delivery technology. Read more.

Slimviews Launches Stylish Reading Glasses
Slimviews, a manufacturer of contemporary eyewear, announced a new product line launch. Designed by David Colangelo, president and CEO, the reading glasses are manufactured using a lightweight, high-density TR90 material along with impact-resistant, clear transparent lenses. The glasses are available with seven power magnification levels, starting at +1.00D and progress in +.25 increments with a maximum power of +2.50D. Available in an array of contemporary colors, Slimviews are designed to be compact, lightweight, durable and offer reduced reflection for the user. The reading glasses are now available for purchase online through the company website, www.slimviews.com, and will be available through authorized Slimviews providers throughout North America. Read more.

New Technologies and Treatments in Eye Care 2017 - Orlando, Florido


   

Optometric Physician™ Editorial Board
 

Chief Medical Editor
Arthur B. Epstein, OD, FAAO

Journal Reviews
Shannon Steinhäuser, OD, FAAO


Contributing Editors
• Katherine M. Mastrota, MS, OD, FAAO
• Barry A. Weissman, OD, PhD, FAAO (Dip CL)

Editorial Board
• William Jones, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO


 

 

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