Optometric Physician



Vol. 24, #19 •   Monday, May 8, 2023


Off the Cuff: Where’s the Emergency Eye Care?

When we started Phoenix Eye Care in 2013, one of the services we implemented was emergency eye care and after-hours emergency eye care. Early on we had a patient’s wife call on a Saturday morning saying her husband had got something in his eye at work the day before. The on-site nurse gave him a bottle of tetracaine, but now there was a growing white spot on his eye. Of course this needed to be seen right away. We said we could meet them at the office in 30 minutes. Well, that wasn’t going to work for them, because they lived 3 hours away from Phoenix. What?! They had called multiple offices and places were either not open or refused to provide care because they weren’t established patients. This was unbelievable. I said well let me try for you. I called one of the big ophthalmology groups in our state who had an office only 1 hour from the patient. I got their triage nurse. “Hi, I’m Dr. Steinhauser. I have a patient with a likely infectious corneal ulcer that needs to be seen.” She asked me if the patient was an established patient of their practice and reiterated what the patient told me. After a few more frustrating phone calls, we saw the patient. He and his wife dutifully drove the 3 hrs back and forth for follow up care. Many of the patients we saw for late-night or weekend emergency care are some of our most loyal patients to this day.

Patients don’t know where to go to get emergency eye care. Urgent care centers seem to do great with your run-of-the-mill bacterial conjunctivitis and small abrasions. These urgent cares will then refer patients to optometry for follow up care. Emergency rooms don’t seem to be much better. In Phoenix there’s typically only one ophthalmologist on-call for the whole city. Most large cities have an ophthalmology residency program with residents being on-call for this type of care, but not Phoenix. Patients have relayed stories of sitting in emergency rooms for hours before being seen to ultimately be told to go see their eye doctor tomorrow. If they do manage to get seen at an urgent care or ER, the foreign bodies they “got out” are typically still there, or what was labeled a conjunctivitis and given antibiotics ends up being an iridocyclitis. This situation creates a delay in appropriate care that could have lifelong consequences.

We’re trained to advise patients to go to the emergency room if we’re unable to provide care, yet this is largely a lesson in frustration and futility. Optometry is perfectly suited to fill the gap of lacking emergency eye care if the broader medical community is amenable to working collaboratively. Having optometrists in the hospital setting be the norm rather than the exception could transform emergency eye care. Staff optometrists in an ER setting would make all providers sending eye-related emergencies know that their patients would be seen by an eye care professional. This would mean patients would be appropriately triaged so the on-call ophthalmologist would be coming in knowing that the case truly requires their care and not a rogue lost contact lens.

We as a profession know that we are the primary providers of eye care, but it doesn’t seem like patients know that especially in emergency situations. The American Optometric Association has done a good job in conveying the importance of annual eye exams and contact lens safety through its messaging. However, this may have led to the public’s perception that comprehensive eye exams are all we do. Our profession has evolved, and it is time our messaging evolves as well. Organized optometry needs to make a concerted effort to reach the general public with messaging that describes the breadth of care that optometry provides to bridge the gap between what patients think we do and the high level of care we can actually provide.

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.



The Outcomes of Postoperative Eye Patching After Cataract Surgery in Patients with Fuchs' Endothelial Corneal Dystrophy

The purpose of this investigation was to determine the influence of postoperative eye patching on corneal thickness, endothelial cell loss and visual acuity in patients diagnosed Fuchs' endothelial corneal dystrophy (FECD). This randomized controlled trial included patients with FECD undergoing routine cataract surgery in a public medical center. Patients were randomly assigned to two groups: the eye undergoing surgery was covered with a patch for 24 hours in the first group (patched group), and a plastic shield was used in the second (non-patched group). Both groups received a unique dose of a local steroid and antibiotic postoperatively. The eyes were examined pre-operatively, and on days 1, 7 and 30 post-surgery. Examination included: best corrected visual acuity (BCVA), complete slit lamp examination, intraocular pressure (IOP), anterior chamber depth (ACD), central corneal thickness (CCT) using the IOL Master 700 (Zeiss, Germany) and endothelial cell density (ECD) using Specular microscopy. Cumulative dissipated energy (CDE) and operation time were recorded for all cases.

The study included 46 eyes of 46 patients diagnosed with FECD, 23 eyes in the patched group, and 23 eyes in the non-patched group. Thirty days postoperatively, the CCT in the patched group decreased by 60 ± 38 mµ (9%) compared to 92 ± 80 mµ (13.5%) in the non-patched group. Seven days postoperatively the CCT in the patched group decreased by 31 ± 35 mµ (5%) compared to 58 ± 76 (8%) in the non-patched group, but this difference did not reach statistical significance. There was no statistically significant difference in endothelial cells loss as well as BCVA at 1, 7 and 30 days postoperatively between the study groups.

Avoiding the eye patch postoperatively after cataract surgery in patients with FECD resulted in better corneal clarity recovery and reduced corneal edema one month postoperatively. Visual acuity and endothelial cell's loss were not influenced by patching.

SOURCE: Gazit I, Dubinsky-Pertzov B, Or L, et al. The outcomes of postoperative eye patching after cataract surgery in patients with Fuchs' endothelial corneal dystrophy. Eur J Ophthalmol. 2023 Apr 26 [Epub ahead of print].



Comparison of Central Corneal Thickness Measurements Using Three Different Imaging Devices

The purpose of this study was to compare central corneal thickness (CCT) values and evaluate the agreement obtained with three different devices in healthy eye. A total of 120 eyes of 60 healthy individuals (36 men and 24 women) were enrolled in this retrospective study. CCT measurements were performed using an optical biometer (AL-Scan), spectral-domain optical coherence tomography (SD-OCT)(Topcon 3D) and ultrasonic pachymetry (UP)(Accupach VI), and the results were compared. Bland-Altman analysis was used to quantify the agreement between methods.

The mean patient age was 28 ± 5.73 years (18-40 years). The mean CCT values obtained by AL-Scan, UP, and SD-OCT were 532.4μm ± 29.7, 549μm ± 30.4, and 547μm ± 30.6, respectively. The mean differences in CCT were 15.30 ± 9.52μm between AL-Scan and OCT, 17.15 ± 8.42μm between AL-Scan and UP, and 1.85 ± 8.78μm between UP and OCT. All three methods of CCT measurement were closely correlated with each other.

This study’s results suggested that, despite good agreement between the three devices, AL-Scan significantly underestimated CCT compared to UP and OCT. Therefore, researchers wrote, clinicians should be aware that different results can be obtained using different devices for CCT measurements. They added that, it would be a better approach not to use them as interchangeable in clinical practice. Further, they wrote, CCT examination and follow-up should be performed using the same device, especially for patients who will undergo refractive surgery.

SOURCE: Kan E, Duran M, Yakar K. Comparison of central corneal thickness measurements using three different imaging devices. J Fr Ophtalmol. 2023 Apr 17. [Epub ahead of print].

Effects of Chewing Tobacco on Corneal Endothelium in Patients with Diabetes Mellitus

The objective of this study was to determine the impact of tobacco chewing on corneal endothelial structure in patients with diabetes mellitus (DM). Corneal endothelial parameters (endothelial cell count, ECD; coefficient of variation, CV; hexagonality, Hex, and central corneal thickness, CCT) were analyzed in 1234 eyes of 1234 patients using non-contact specular microscopy (EM 4000 Tomey Nishi-Ku, Nagoya, Aichi, Japan). A total of 948 subjects with a history of tobacco chewing, 473 with DM, was compared with an age- and gender-matched control group of 286 subjects, 139 with DM, with no history of tobacco use in any form.

Tobacco chewers had a significantly reduced ECD and Hex as compared with non-chewers. Similar results were noted in ECD and Hex in patients with DM. Tobacco chewers had a significantly decreased ECD values among males with HbA1C ≤ 7.5% and duration of DM ≤ 20 years, and significantly decreased Hex among those >50 years, who were female, with duration of DM > 20 years. The CV and CCT values were comparable between the study and the control groups. Tobacco chewers showed a significant association of ECD with age, HbA1C, and duration of DM; CV with HbA1C; Hex with age and duration of DM; and CCT with gender, age, HbA1C, and duration of DM.

Investigators concluded that tobacco chewing may negatively impact corneal health, especially when confounded by additional factors like age and DM. They suggested that these factors must be accounted for in the preoperative evaluation of such patients prior to any intraocular surgery.

SOURCE: Jha A, Verma A, Priya C. Effects of chewing tobacco on corneal endothelium in patients with diabetes mellitus. Eye (Lond). 2023 Apr 18. [Epub ahead of print].




Industry News

Lenstar Myopia Now Includes AMMC Framework

Haag-Streit announced the Lenstar Myopia now includes an Age-Matched Myopia Control (AMMC®) framework, created Prof. Dr. Hakan Kaymak, head surgeon of Breyer, Kaymak & Klabe Augenchirurgie, in Düsseldorf, Germany, to provide diagnostic support based on the eye’s axial growth. Read more.

Visus Presents Positive Topline Data from Phase III BRIO-I

Visus Therapeutics presented at ASCRS 2023 positive topline data from the Phase III BRIO-I clinical trial evaluating the safety and efficacy of Brimochol PF, a preservative-free ophthalmic solution for the treatment of presbyopia, showing Brimochol PF met its primary and secondary endpoints. Learn more.

BVI Announces Complete Enrollment of Finevision HP Study

BVI completed enrollment of its US Investigational Device Exemption clinical study for its latest hydrophobic trifocal intraocular lens Finevision HP. The hydrophobic trifocal IOL features BVI’s proprietary hydrophobic material and two novel patented CoPODize technologies enabling convolution and apodization on the entire optic surface. Read more.

Glaukos Announces FDA Accepts NDA Submission for iDose TR

Glaukos received notification from the FDA acknowledging its previously submitted New Drug Application for iDose TR (travoprost intraocular implant) is sufficiently complete to permit a substantive review. Read more.












Journal Reviews Editor:
Katherine M. Mastrota, MS, OD, FAAO

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