Optometric Physician



Vol. 25, #18 •   Monday, May 20, 2024


Off the Cuff: Change Under Duress

A couple weeks ago I wrote an editorial about how the internet went down in our office and subsequently took out our electronic medical records system and VoIP phone system. I wish I could say that they were able to get our internet working and all was well. In reality, Cox Communications, our internet service provider since we opened the office, ultimately couldn't get us back online. I was forced to find a new internet service provider. We are now using T-Mobile 5G for Business. My long-term relationship with Cox ended. It's not me, it's you.


I have T-Mobile Wi-Fi at home so when they offered it for small businesses last year, I tried it, but it didn't work with our VoIP provider. Last week our VoIP provider assured me they had fixed the problem, and they now worked with T-Mobile. So I pulled the trigger and the new T-Mobile router arrived. It had phenomenal Wi-Fi, but the ethernet connections weren't working, and we couldn't get the phones to work. In trying to make our old VoIP service work with our new T-Mobile Wi-Fi, T-Mobile changed all kinds of settings in the new router and ultimately made the new router non-functional. The SIMO Solis 5G mobile hotspot I bought as an internet backup truly saved the day more than once this week. Finally, a tech support person for T-Mobile recommended another VoIP provider that is truly compatible with T-Mobile called Ooma.

Ooma has just been great with exceptional customer service from beginning through setup. They got the new WiFi phones to us the next day, and Dr. Zagelbaum set it all up. I cannot thank him enough. This new system has far more features than our old service, is wildly more user friendly, and since it’s WiFi, it easily switched over to our backup hotspot when need be so we don’t lose phone service when we lose internet. All the settings our old VoIP needed, Ooma didn’t need. Once those settings were removed from the router—and strangely a content block that was preventing us from logging into our cloud-based EHR—we were up and so far, so good. Cross your fingers and toes for us.

I sound calm as I write about it now, but it’s been an incredibly stressful couple weeks. I would’ve never undertaken these big changes or this number of them at the same time to the core functionality of the office. This was forced change under duress. This has really shown me that I need to regularly look at our systems and look for areas that can be improved upon proactively rather than reactively. Ultimately though, I now have more reliable internet service at a third of the cost I was paying my previous provider. I now have a backup internet hotspot if something happens. I have an upgraded state-of-the-art phone system for half the price I was paying the last company. We can rebuild it. We have the technology. We can make it better than it was. Better, stronger, faster.

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.



Recurrent Herpetic Erosion of the Cornea: Diagnosis, Treatment and Prevention of Recurrences

A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes— herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen.

Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages. Stage I involved relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period.

After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.

SOURCE: Evg A Kasparova, E A Kasparova, N R Marchenko, A A Kasparov. Recurrent herpetic erosion of the cornea: diagnosis, treatment and prevention of recurrences. Vestn Oftalmol. 2024;140(2. Vyp. 2):102-108.




Changes in Intraocular Pressure and Biometric Parameters of the Anterior Segment After Intravitreal Injections

This study compares the changes in the parameters of the anterior chamber of the eye using anterior segment optical coherence tomography (AS-OCT) in patients with a natural and artificial lens after treatment of neovascular age-related macular degeneration (nAMD) by multiple intravitreal injections (IVI) of anti-VEGF drugs. The patients were divided into 2 groups: group 1 (control) included 30 patients (30 eyes) with a natural lens; group 2 included 30 patients (30 eyes) with an intraocular lens (IOL). AS-OCT was performed using the Revo NX tomograph (Optopol, Poland) to analyze anterior chamber depth (ACD) and the parameters of anterior chamber angle (ACA). Intraocular pressure (IOP) was measured with a contact tonometer iCare Pro.

In patients with an IOL, the IOP level 1 minute after intravitreal injection (IVI) of an anti-VEGF drug was statistically lower than in the control group, on average by 17.8% during the first IVI and by 28.7% after 1 year of observation. ACD before treatment was statistically significantly higher in patients with IOL compared to patients of group 1 by an average of 39.3%. ACA from the nasal and temporal sides in the meridian 0°-180° before the start of treatment was statistically significantly wider in phakic patients than in the control group, by an average of 15.9±9.3° and 16.9±8.2°, respectively. According to AS-OCT, there was no shift of the iris-lens diaphragm in patients with an IOL after multiple IVI of an anti-VEGF drug, in contrast to the control group.

AS-OCT was used to determine for the first time the changes in the parameters of the anterior chamber of the eye in patients with a natural and artificial lens after multiple injections of an anti-VEGF drug in the treatment of nAMD.

SOURCE: Yu S Andreeva, L Alkharki, M V Budzinskaya. Changes in intraocular pressure and biometric parameters of the anterior segment of the eye after intravitreal injections. Vestn Oftalmol. 2024;140(2. Vyp. 2):7-15.

Bilateral Thermal Keratopathy Due to Plasma Skin Regeneration

A 40-year-old woman underwent periocular plasma skin regeneration, a cosmetic treatment for periorbital rejuvenation. She subsequently developed bilateral thermal keratitis, manifesting as blurred vision, irritation, and redness, with a vision decrease to 20/60 and 20/50 in her OD and OS, respectively. Examination demonstrated bilateral large, irregular corneal epithelial defects and edema, necessitating treatment with amniotic membrane grafts, bandage contact lenses, and hypertonic saline. One year post treatment, her visual acuity improved to 20/20 and 20/25, albeit with ongoing symptomatic dryness and bilateral anterior stromal haze.

This case, as only the second reported instance of ocular damage from periocular plasma skin regeneration, underscores the need for heightened awareness of potential ocular complications following plasma skin regeneration and reinforces the importance of protective measures during periocular procedures.

SOURCE: Benjamin I Meyer, Naomi E Gutkind, Marissa K Shoji, Andrew J Rong. Bilateral Thermal Keratopathy Due to Plasma Skin Regeneration. Ophthalmic Plast Reconstr Surg. 2024 May-Jun;40(3):e89-e91.




Industry News

Reichert® Tono-Vera® Tonometer Now Available in the United States

Reichert Technologies, a business of AMETEK, announced availability of the Tono-Vera® Tonometer with ActiView™ Positioning System in the United States. The new handheld tonometer offers quick, automated and reliable intraocular pressure measurements utilizing rebound tonometer technology, eliminating the need for topical anesthetic. It features the patented ActiView Positioning System, designed to rapidly guide the user to the apex of the cornea and providing a full-color view of the eye, combined with an interactive user interface. When correct alignment is achieved, Tono-Vera automatically measures, providing results in as few as three measurements taken in under one second.
Read more.

Prevent Blindness Urges Congress to Pass Legislation for Early Detection of Vision Impairments

Prevent Blindness is applauding the introduction of the “Early Detection of Vision Impairments in Children Act,” in the U.S. House of Representatives and is urging the 118th Congress to move swiftly to pass the proposed legislation. The EDVI Act, which seeks to establish grants for states and communities to improve children’s vision and eye health through coordinated systems of care, is a bipartisan proposal, co-sponsored by Congressional Vision Caucus co-chairs, U.S. Representative Gus Bilirakis (FL-12) and U.S. Representative Marc Veasey (TX-33). Companion legislation is expected to be introduced in the U.S. Senate
Read more.


STAAR Surgical, a developer of the EVO family of Implantable Collamer Lenses for myopia, astigmatism and presbyopia, announced a strategic agreement with IQ Laser Vision. IQ Laser Vision will make EVO ICL lenses a primary option for patients seeking surgical vision correction within the range of -3D to -20D, as part of its comprehensive refractive offering.
Read more.

Prevent Blindness is launching its “It Started With an Eye Exam” campaign and is asking people to share their stories of how eye care services and exams have made a positive impact on their lives. The goal of the new program is to increase awareness about the role that vision health plays in overall health and quality of life, and to educate the public about steps they can take to prepare for an eye exam.
Learn more.









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

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