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


Volume 18, Number 19

Monday, May 7, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: Greatness in Our Field: Guest Author Murray Fingeret
######### Effect of a Punctal Plug on Ocular Surface Disease in Patients Using Topical Prostaglandin Analogues
######### Reduced Retinal Nerve Fiber Layer Thickness in ALS Patients: a Window to Disease Progression
######### Changes in Macular Vasculature After Uncomplicated Phacoemulsification Surgery: Optical Coherence Tomography Angiography Study
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Greatness in Our Field: Guest Author Murray Fingeret

A wonderful part of my career has been the friendships I’ve developed with individuals who have shaped our profession. I’ve long been planning to dedicate some of this space to recognizing and sharing their work and accomplishments. At the top of that list is Dr. Murray Fingeret. Most know only a small fraction of what Murray has done for our profession, but in typical fashion, when I last spoke with him, he asked if he could “borrow Optometric Physician” to focus on an individual who changed the profession and touched him. I couldn’t refuse. What follows was written by Murray Fingeret:

Dr. Mike Patella

The Humphrey Visual Field Analyzer (HFA) is one of the most important and iconic instruments used in eye care. Its development dates back to the early 1980s, not long after the introduction of automated perimetry. Several companies had introduced automated perimeters, the first being the Octopus perimeter in 1978. Automated perimetry took Goldmann perimetry, which was tedious, time consuming and dependent upon a skilled technician, and automated it. The result was improved reliability, ease of use and a dramatic advance in visual field testing.

One concern was that the original Octopus perimeter was expensive. In 1976, a company was started by Dr. Luis Alvarez, a University of California Berkeley (UCB) faculty member, to commercialize products that would use some of his optics patents, specifically the Alvarez lens. Bill Humphrey joined as technical director and hired a UCB optometry student, Michael Patella. This young student became Humphrey Instrument’s thirteenth employee and was soon involved in the development of the Humphrey Vision Analyzer. It was a device that was far ahead of its time, but it never really took off commercially.

The next project Dr. Patella was involved with was the development of the HFA perimeter. The objective was to develop a perimeter that could do everything the more expensive devices did at a fraction of the cost. Mike contacted a Swedish ophthalmologist, Anders Heijl, who had experience in building a perimeter, to provide additional consult. This team led to the introduction of the HFA perimeter, which rapidly became the gold standard for perimetery worldwide.

Perhaps the most amazing thing is that almost 40 years later, the HFA perimeter continues its place at the forefront of perimetry. Michael Patella, who at the onset was a young optometrist charged with the HFA’s development, has recently retired from Carl Zeiss Meditec. Few optometrists have had a more important role in eye care; yet few ODs realize that it was one of their brethren who led the perimeter’s development.

Mike, for years, had an optometry practice in the Bay area in addition to his role at Zeiss because he felt it important to maintain a clinical presence to understand how his products may be utilized. Mike has always championed optometry and continues to be one of its biggest advocates. I would like to congratulate Mike on a long and illustrious career and look forward to seeing what he does in his next chapter.

Murray Fingeret, OD

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.

Effect of a Punctal Plug on Ocular Surface Disease in Patients Using Topical Prostaglandin Analogues Study
Ocular surface disease (OSD) is common and can reduce treatment compliance and quality of life, researchers wrote. This study determined whether a punctal plug improved OSD and reduced IOP in patients using prostaglandin-analogue monotherapy. Sixty eligible subjects ages >18 years with symptomatic OSD from glaucoma clinics were invited to participate. Lacrimal or glaucoma surgery, lid malposition and contact lens wear were exclusion criteria. One eye received an inferior punctal plug, leaving the fellow eye as a control. Ocular surface disease index (OSDI), tear-film breakup time (TF-BUT), Oxford Cornea Score, tear osmolarity and IOP were compared at baseline and six weeks by masked investigators.

From 60 eligible, 48 (80%) participated (mean age, 69.6 years; 60% female). OSDI reduced following plug insertion. Compared with control eyes, in eyes receiving plugs: the TF-BUT increased, the Oxford Cornea Score decreased and tear osmolarity decreased. Punctal plugs resulted in a significantly lowered IOP. Sub-group analyses showed similar efficacy regardless of prostaglandin preservative status or lubricant drop use. Plugs were well-tolerated, but extrusion occurred in 8.5%, and epiphora increased in 6.5% eyes.

Punctal plug insertion improved subjective and objective measures of OSD and resulted in a reduced IOP in patients with symptomatic ocular surface disease using prostaglandin analogue monotherapy.

SOURCE: Sherwin JC, Ratnarajan G, Elahi B, et al. Effect of a punctal plug on ocular surface disease in patients using topical prostaglandin analogues: a randomised controlled trial. Clin Exp Ophthalmol. 2018; Apr 26. [Epub ahead of print].

Reduced Retinal Nerve Fiber Layer Thickness in ALS Patients: a Window to Disease Progression
This study population consisted of ALS patients and age- and sex-matched controls to assess retinal nerve fiber layer (RNFL) thickness in ALS patients and compare it with healthy controls, and to detect possible correlations between RNFL thickness in ALS patients, as well as disease severity and duration. Investigators used the revised ALS functional rating scale (ALSFRS-R) as a measure of disease severity. RNFL thickness in the four quadrants were measured with a spectral-domain OCT (Topcon 3D, 2015).

They evaluated 20 ALS patients (40 eyes) and 25 healthy matched controls. Average RNFL thickness in ALS patients was significantly reduced compared with controls (102.57 ± 13.46 compared twith 97.11 ± 10.76). There was a significant positive correlation between the functional abilities of the patients based on the ALSFRS-R and average RNFL thickness, and also RNFL thickness in most quadrants. A linear regression analysis proved that this correlation was independent of age. In ALS patients, RNFL thickness in the nasal quadrant of the left eyes was significantly reduced compared with the corresponding quadrant in the right eyes, even after adjustment for multiplicity (85.80 ± 23.20 compared with 96.80 ± 16.96).

RNFL thickness in ALS patients was reduced compared with healthy controls. Investigators suggested that OCT likely could serve as a marker of neurodegeneration and progression of the disease in ALS patients. In addition, they wrote that RNFL thickness was different among the right and left eyes of ALS patients, suggesting that asymmetric CNS involvement in ALS is not confined to the motor system.

SOURCE: Rohani M, Meysamie A, Zamani B, et al. Reduced retinal nerve fiber layer (RNFL) thickness in ALS patients: a window to disease progression. J Neurol. 2018; Apr 30. [Epub ahead of print].


Changes in Macular Vasculature After Uncomplicated Phacoemulsification Surgery: Optical Coherence Tomography Angiography Study
This study used optical coherence tomography (OCT) angiography and a split-spectrum amplitude-decorrelation angiography algorithm to evaluate the changes in the macular vascular system after uncomplicated phacoemulsification. Patients with senile cataracts were included. Retinal vessel density and thickness at the macular area were checked by OCT at baseline and at one week, one month and three months after cataract surgery.

Thirty-two eyes (32 patients) were included in the final analysis. There was a significant increase in retinal vessel density, a decrease in the foveal avascular zone at the macular area after the cataract surgery (all p<.05, repeated-measures analysis of variance), and an increase in full and inner macular thickness—all of which extended to the end of the follow-up period. At three months postoperatively, there was a mean 6% and 3% increase in vessel density at the parafoveal and perifoveal regions, respectively, and a mean 27% reduction in the foveal avascular zone. The mean increase in inner retinal thickness was 15%, 10% and 7% at the fovea, parafovea and perifovea, respectively. Compared with the parafovea and perifovea, the fovea had a much higher percentage of change in retinal vasculature and inner retinal thickness.

Macular vessel density and thickness increased after cataract surgery. Researchers noted that, whether these changes would persist over a longer period of time, needed to be studied.

SOURCE: Zhao Z, Wen W, Jiang C, Lu Y. Changes in macular vasculature after uncomplicated phacoemulsification surgery: Optical coherence tomography angiography study. J Cataract Refract Surg. 2018; Apr 25. [Epub ahead of print].

News & Notes
Call for Abstracts for Academy 2018 San Antonio Scientific Program
The Scientific Program Committee of the American Academy of Optometry invites the submission of abstracts for Academy 2018 San Antonio (Nov. 7 to 10). The abstract submission window will be open from through May 31. This year, the committee will present focused sessions on special topics that include extended discussion, integration of clinical topics and debate on current controversies. As a new feature this year, images can be uploaded along with abstracts (1 MB limit). First authors (excluding students and residents) of accepted papers/posters are also eligible to register for Academy 2018 San Antonio at reduced rates. Read more.


Sight Sciences Initiates U.S. Trial of TearCare System for Dry Eye
Sight Sciences launched the OLYMPIA study, a trial to evaluate the safety and effectiveness of the TearCare System in individuals with dry eye disease. According to the company, the system is the world’s first and only wearable therapeutic eyelid technology that is fully customizable and allows the individual’s eyes to remain open and blinking during the procedure. Soft, flexible powered devices conform to the eyelids to deliver a sufficient level of energy for a specific period of time to liquefy meibum, the company wrote in a press release. A randomized, controlled trial will evaluate the safety and effectiveness of the system in the treatment of the signs and symptoms of dry eye disease in comparison to a daily regimen of combined warm compress therapy and lid massage. Read more.

J&J Vision Introduces AI-powered Virtual Assistant, Presents Data on Antioxidant Properties of Ultraviolet Blocker in Acuvue Contact Lenses
Johnson & Johnson Vision introduced Andy, a virtual assistant chatbot powered by artificial intelligence. Andy is designed to help guide U.S. consumers throughout their Acuvue Brand Contact Lens journey. The chatbot also provides intuitive coaching to help new wearers develop healthy contact lens habits. Andy can be found by connecting with Acuvue on the Facebook Messenger app. Read more. In addition, the company presented new data on the discovery of antioxidant properties in the ultraviolet blocker in Acuvue brand contact lenses at the Association for Research in Vision and Ophthalmology Annual Meeting in Honolulu. Two studies presented at the medical congress demonstrated that Norbloc, the UV-blocker in all of the brand’s contact lenses also behaved as an antioxidant and provided a protective effect to a tear film component that can be taken into the lens during wear. Also in this study, within the lens, Norbloc provided a protective effect from oxidation of a tear film lipid, which may support the comfort observed with the brand’s contact lenses. Read more.

B+L Introduces PreserVision AREDS 2 Formula Vitamins, Gets FDA Nod for Ultra Contact Lenses for Extended Wear and Updates ARMOR Study Results
Bausch + Lomb’s new PreserVision AREDS 2 Formula Chewable vitamins in a mixed berry flavor are designed to meet a growing consumer preference for chewable tablets. The vitamins contain the exact levels of six key nutrients recommended by the National Eye Institute, and will be available for purchase at major retailers by June 2018. Read more. In addition, the company announced that the FDA approved the Ultra family of contact lenses for extended wear of up to six nights and seven days of continuous wear. The U brand of contact lenses includes MoistureSeal technology, a patented combination of material and manufacturing process to help maintain 95 percent of lens moisture for 16 hours. The lenses are engineered to provide all-day comfort and consistently clear vision. Read more.
Lastly, the company announced results from the ninth consecutive year of the Antibiotic Resistance Monitoring in Ocular MicRoorganisms surveillance study, presented at the 2018 Association for Research in Vision and Ophthalmology Meeting in Honolulu. Researchers also presented preliminary 2017 surveillance data on antibiotic resistance levels. The nine-year trend analysis confirmed the previously noted decrease in methicillin resistance among Staphylococcus aureus (from 39 percent to 14 percent; p<0.001) but not among CoNS (p=0.455), with more than half of CoNS demonstrating continued persistence in MR. Further analysis showed decreased resistance among S. aureus to azithromycin (62 percent to 52 percent), ciprofloxacin (39 percent to 16 percent), tobramycin (24 percent to 6 percent), and chloramphenicol (6.6 percent to 4.4 percent), and among CoNS to ciprofloxacin (46% to 22 percent; p≤0.005 for all). Read more.

Registration Open for NORA Pre-conference & Annual General Conference
Registration is now open for the Neuro-Optometric Rehabilitation Association, International Clinical Skills Pre-Conference (September 20 to 21) and 27th annual General Conference (September 21 to 23) at the Hyatt Regency in St. Louis, Mo. The clinical skills program provides 12 hours of continuing education, hands-on and lecture style presentations, at three different levels that run concurrently. Read more.

MacuHealth and Med-Op Health Settle Lawsuit
Reiner Rittinghausen, president of Med-Op, and Frederic Jouhet, owner and CEO of MacuHealth, met in New York city during Vision Expo East and came to a mutual and satisfactory agreement between their respective groups. Med-Op recognized that the MacuHealth formula was different in its science and its composition. Based on this uniqueness, it was determined that Med-Op should not have compared its formula to MacuHealth's formula in its marketing materials, and would stop doing so going forward. MacuHealth was pleased to come to this understanding and wished the best to Med-Op in its current and upcoming endeavors. Both parties hinted that collaborations between the two groups were possible in the near future. Read more.

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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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