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


Volume 19, Number 20

Monday, May 20, 2019


Inside this issue: (click heading to view article)
######### Off the Cuff: Ready or Not…
######### Causes and Management Outcomes of Acquired Corneal Opacity in a Preschool Age (Zero to Five Years) Group: a Hospital-Based Study
######### The Influence of Protein Deposition on Contact Lens Tear Film Stability
######### Results From the First Teleglaucoma Pilot Project in Addis Ababa, Ethiopia
######### News & Notes

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Off the Cuff: Ready or Not…

Years ago, when I lived in Great Neck on Long Island, we had a local pharmacy that had been a fixture in town well before I moved there. It seemed to be a very successful enterprise, with two busy locations on the long main shopping street. The pharmacist who owned it lived in town and took his role in the community seriously. He would even get up in the middle of the night to fill his neighbor’s emergency prescriptions when needed. When my wife was pregnant with our first child, her OB prescribed a non-standard medication. It seemed no one could fill the Rx, but this pharmacist was old-school and actually compounded it for us, and at a surprisingly reasonable price. Then CVS came to town.

You can probably predict how this story ends. In less than a year, the now frightened and despondent pharmacist took out a full-page ad in the local newspaper reminding everyone of how he got up in the middle of the night for them and how he had served the community for most of his life. Desperate, he begged for help in keeping his rapidly failing business alive. He had to shut down within a month.

At this point, I suspect I don’t need to remind you about what happened to the small, service-oriented local stationary store when Staples came to town or the hardware store that always seemed to have every odd nut and bolt you needed until Home Depot opened down the street. What I do need to share is that it’s about to be our turn.

This week, several ODs in Arizona received calls from Amazon asking to schedule a 15-minute interview to determine if we were qualified to participate in their long-anticipated entry into healthcare. From the information we have, the Amazon program is HIPAA-compliant and will use Alexa to schedule urgent care visits and prescription refills—at least initially, with more likely to come. While I love Amazon and I am a big fan of Amazon Prime, the company’s intentions are not always benign. The frightening reality is that Amazon wiped out more small businesses in America than the Great Depression did.

While I am virtually certain some doctors and groups will champ at the bit to be the first to get onboard the Amazon train, doing so may open a door that no one will be able to close. If you don’t see the wisdom of saying no to Amazon, imagine for a moment just how different things would be today if every doctor in the US let the managed care train leave the station without them.



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


Causes and Management Outcomes of Acquired Corneal Opacity in a Preschool Age (Zero to Five Years) Group: a Hospital-Based Study
This study evaluated the causes and management outcomes of acquired corneal opacity in a preschool age group (zero to five years) at a tertiary care hospital. Medical records of all cases (zero to five years) with acquired corneal opacity presenting to the cornea clinic of a tertiary eye care hospital from February 2013 to January 2014 were evaluated for age of onset, age at presentation, sex, laterality, cause of opacity, visual acuity, nutritional status and socioeconomic class of the parents. The etiology of corneal opacity and the type of intervention with outcome at three months follow-up were recorded.

A total of 106 cases were included in the study. The most common cause of corneal scarring was healed infective keratitis (35.8%). Chemical injury, mechanical trauma, and keratomalacia were the other causes, affecting 21.8%, 20.8%, and 16% of the cases, respectively. Optical iridectomy was the most commonly performed procedure (35.8%), followed by lens aspiration with intraocular lens implantation (17.9%) and penetrating keratoplasty (17%). The mean corrected visual acuity (spectacle or contact lens) at the time of presentation and at three months after treatment was 2.9 ± 0.3 (perception of light) and 2.2 ± 0.9 (hand motions) logarithm of minimum angle of resolution (logMAR) units, respectively.

Researchers wrote that chemical injury and keratomalacia were major causes of acquired corneal opacity in preschool age groups in India, and were associated with poor visual prognosis.

SOURCE: Maharana PK, Nawaz S, Singhal D, et al. Causes and management outcomes of acquired corneal opacity in a preschool age (0-5 years) group: a hospital-based study. Cornea. 2019; Apr 29. [Epub ahead of print].

The Influence of Protein Deposition on Contact Lens Tear Film Stability
When contact lenses (CLs) are worn, they are subject to deposition of the surrounding biomolecules found in the tear film (TF) of the eye. There is a correlation between protein deposition on CLs and feelings of discomfort in patients, but it has not been well understood if these feelings of discomfort arise solely from immunogenic reactions to the protein deposits or a physical instability of the tear film on protein-fouled CLs. This study compared two hydrogel CLs: etafilcon A (polyhydroxyethylmethacrylate-based hydrogel) and senofilcon A (silicone hydrogel with internal wetting agent) to elucidate how lysozyme and mucin sorption affect the wettability of CLs and understand the potential impact on TF stability in vivo. "Wettability" is used to refer to the stability of a film of phosphate buffered saline on the CL surface. A custom-built platform was used to conduct experiments that monitored the stability of phosphate-buffered saline (PBS) and artificial tear solution (ATS) on clean and fouled CLs.

PBS was more stable (wettable) on etafilcon A than senofilcon A, and both CLs showed increased wettability after protein-fouling. However, surface wettability in PBS did not correlate with the stability of ATS on the CLs. The viscoelastic interface of ATS slowed drainage, making evaporation the primary thinning factor, in addition to the presence of a disjoining pressure that stabilized the thin film.

Researchers concluded that protein deposition increased CL wettability, but does not alter tear film stability. CL susceptibility to evaporation is a better predictor of TF stability than wettability.

SOURCE: Rabiah NI, Scales CW, Fuller GG. The influence of protein deposition on contact lens tear film stability. Colloids Surf B Biointerfaces. 2019;180:229-236.



Results From the First Teleglaucoma Pilot Project in Addis Ababa, Ethiopia
This study was conducted to analyze disease prevalence and clinical referral pathways of high-risk glaucoma patients assessed through a hospital-based teleglaucoma case finding program. A teleglaucoma case-finding model was employed in Ethiopia using a higher-risk case identification approach. Most cases could be managed medically. Patients over age 35 were referred from outpatient diabetic and hypertensive clinics. Through a teleglaucoma consultation, a glaucoma specialist provided remote diagnosis and management recommendations. Patient referral pathways were analyzed. Qualitative stakeholder feedback was also obtained.

A total of 1,002 patients (53% female) were assessed with a mean age of 51.0 years ± 11.7 years. The prevalence of glaucoma and glaucoma suspects were 7.9% (79 cases) and 13.8% (138 cases) respectively. Retinopathy was found in 9.1% with hypertensive retinopathy (2.7%) and diabetic retinopathy (2.5%) representing the majority. Age-related macular degeneration was present in 1.5% and cataract in 16%. 63% of cases were without organic eye disease. 35% of patients were referred to a general ophthalmologist, 0.7% to a glaucoma specialist (for surgery), 1.5% to a retina specialist and 17.7% to an optometrist for further care. Qualitative analysis revealed that stakeholders felt the value of teleglaucoma would be in triaging patients requiring more urgent management and identifying disease at an earlier stage.

Investigators found that there was a high prevalence of glaucoma in Ethiopian patients assessed through this teleglaucoma program. They wrote that this model and study also demonstrated various principles behind telemedicine such as development of an intelligent triage system, case-finding for a variety of diseases and consideration of optimal patient flow/referral pathways.

SOURCE: Giorgis AT, Alemu AM, Arora S, et al. Results from the first teleglaucoma pilot project in Addis Ababa, Ethiopia. J Glaucoma. 2019; May 6. [Epub ahead of print].

News & Notes
Allegro: Positive Results for Proof-of-Concept Trial with Integrin Inhibitor
Allegro Ophthalmics announced positive results of a proof-of-concept clinical trial of the new investigational ALG-1007 topical drop drug candidate in individuals with dry eye disease. The trial concluded that ALG-1007 demonstrated a dose response, indicating that the active pharmaceutical ingredient in ALG-1007 was effective in improving the signs and symptoms of DED with improvement as early as two weeks. Read more.

Ping An Completes Trials for First Intelligent OCT Retinal Disease Screening System
Ping An Insurance Company of China announced that its technology arm completed a prospective multicenter clinical trial for the world's first intelligent optical coherence tomography retinal disease screening system. The system, jointly developed with Optovue, is the first artificial intelligence imaging and screening system that integrates an OCT retinal imaging device and AI lesion detection software. Read more.

Super Optical Releases Display for Polar+Fire SV Polarized Lenses
Super Optical International, provider of optical equipment and lenses including the all-in-one FastGrind lens surfacing system, announced immediate availability of a new tabletop display stand in support of its Polar+Fire line. Polar+Fire lenses, which are polarized gray with a solid mirror front, have become the company’s most popular sunglass lenses. The company is offering a display to promote the sun lenses, in time for the summer season. Learn more.


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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