Optometric Physician



Vol. 23, #17  •   Monday, May 9, 2022


Off the Cuff: Optometry’s Lack of Focus

Few things have been more professionally satisfying than watching our profession expand in ability and capability. From a completely drugless profession to the primary provider of medical eye care in the US, we have come a long way in a short time. However, despite the hard-fought state by state legislative victories, optometric scope remains an illogical hodgepodge of varying rules and regulations.

Recognizing that optometry is a legislated profession with individual practice acts and varying regulations, it’s hard to not to wonder how much more the profession could have achieved had there been greater state and national coordination when drafting scope expansion legislation.

While this wasn’t possible before the great optometric scope expansion of the 1980s and 90s gained momentum, as more and more states came on line medically, better coordination and planning, both regionally and nationally, could have ultimately led to a minimum uniform practice standard. Regularly updated, the minimum standard would have facilitated expansion throughout the US. Today, this is especially important as we enter the next chapter of optometric practice.

How can we accomplish this? First by establishing a working group that would create an accepted Uniform Optometric Minimum Practice Standard. That first step is always the hardest.


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




Peripheral Anterior Synechiae After Selective Laser Trabeculoplasty Among Chinese Patients

Peripheral anterior synechiae (PAS) have been reported as a complication after argon laser trabeculoplasty, but rarely reported after selective laser trabeculoplasty (SLT). This study aims to determine the incidence and predictors of this potential complication in phakic eyes of Chinese patients. A retrospective review of consecutive Chinese phakic patients who underwent SLT for primary open-angle glaucoma or ocular hypertension from 2011 to 2015, was analyzed for postoperative outcomes, including the development of PAS.

A total of 292 patients (509 eyes) were of Chinese ethnicity and eligible in the analysis. The four-year incidence of PAS was 13.57% for the 221 eyes with documented gonioscopy after SLT, and the time between first SLT and PAS diagnosis was 5.62 years (2052±75.2 days). After accounting for the inter-eye correlation by the mixed effect Cox regression model (AUC=0.885), the predictors of earlier PAS diagnosis were baseline intraocular pressure (≥18 vs. <18) (HR=4.6, p=0.031), baseline use of bimatoprost (HR=14.97, p=0.006), and pre-existing hypertension (HR=11.78, p=0.016). No significant association was reported between earlier PAS diagnosis with age, baseline number of medications used, or baseline use of brinzolamide.

PAS development after SLT appeared to be more common in Chinese patients, with a presumed four-year incidence of 13.6%, based on a retrospective review of eyes with subsequent documented gonioscopy findings.

SOURCE: Chan JC, Cheung RK, Wong PW, et al. Peripheral anterior synechiae after selective laser trabeculoplasty among Chinese patients. Graefes Arch Clin Exp Ophthalmol. 2022; May 7. [Epub ahead of print].


Impact of Keratoconus Stage on Outcome After Corneal Crosslinking

This study aimed to analyze if the outcome after corneal crosslinking (CXL) in progressive keratoconus patients depends on the stage at which the procedure is performed. This knowledge would help to improve success of CXL and to define surgery indications in those patients. In this retrospective study, 124 consecutive eyes of 100 patients with progressive keratoconus undergoing corneal CXL at the University Eye Hospital Tübingen were included. The eyes were graded according to modified Krumeich stages depending on induced myopia or astigmatism, corneal radii, minimum corneal thickness, and morphological changes. The observation period covered November 2008 to September 2018. Preoperatively, 12 and 24 months after CXL, the best-corrected visual acuity (BCVA) was determined, and astigmatism as well as tomographic parameters (Kmax, Kmin, central corneal thickness [CCT], minimum corneal thickness [MCT]) were measured by means of a Scheimpflug camera system.

BCVA results showed significant differences between the modified Krumeich stages at 12 months (p=0.014) and at 24 months postoperatively (p=0.032). Also, astigmatism differed significantly among the stages at 24 months after CXL. However, no significant differences regarding astigmatism were detectable after 12 months. In terms of Kmax, Kmin, CCT, and MCT, no significant differences between the Krumeich stages were observed.

BCVA showed a significantly higher improvement after CXL in the early stage of keratoconus compared to a more advanced stage. However, the post-interventional tomographic values did not differ significantly between the different modified Krumeich stages. The significantly higher improvement in BCVA after CXL in the early stage might indicate that earlier intervention provides a greater subjective benefit to the individual. Further studies with larger sample sizes are needed to confirm these findings.

SOURCE: Gassel CJ, Röck D, Konrad EM, et al. Impact of keratoconus stage on outcome after corneal crosslinking. BMC Ophthalmol. 2022; May 6. [Epub ahead of print].



Idiopathic Vitreomacular Traction Managed With Initial Observation: Clinical Course and Outcomes

These authors reviewed the clinical course and outcomes of patients with idiopathic vitreomacular traction (VMT) managed initially by observation. The retrospective chart review included patients with idiopathic VMT based on clinical symptoms and findings on optical coherence tomography (OCT) between January 1, 2015, and February 15, 2021. The study included 436 eyes of 317 patients with a mean age of 72.2 years ± 8.9 at initial visit and mean follow-up time of 34 months±19.2. VMT severity grade was ascribed to each patient using previously published grading criteria. Grade 1 denoted incomplete cortical vitreous separation with attachment at the fovea and visible distortion of the foveal surface, grade 2 included intraretinal cysts or clefts along with grade 1 findings, and grade 3 included subfoveal fluid along with grade 2 traits. Researchers evaluated the rate of spontaneous release, grade at baseline compared to grade at final follow-up, and outcomes of interventions if performed.

At baseline, mean best-corrected visual acuity (BCVA) was 20/40. Baseline OCT demonstrated grade 1 VMT in 212 eyes (48.6%), grade 2 VMT in 172 eyes (39.4%), and grade 3 VMT in 52 eyes (11.9%). Among initial grade 1 eyes, 25.0% had spontaneous release of VMT (median: 290.0 days, mean: 404.5 days ± 323.9), 50.9% remained stable, and 10.4% worsened. Among initial grade 2 eyes, 14.5% had spontaneous release of VMT (median: 570 days, mean: 692.9 days ± 477.5), 55.2% remained stable, 4.7% improved, and 2.3% worsened. Among initial grade 3 eyes, 5.8% had spontaneous release of VMT (median: 790 days, mean: 839.3 days ± 246.7), 28.8% remained stable, and 5.8% improved. Of the 436 eyes, macular hole development occurred in 42 eyes (9.6%). PPV was performed in 94 of 436 eyes (21.6%), with mean BCVA prior to PPV of 20/78 and final follow-up BCVA of 20/55.

This study demonstrated the generally stable clinical course of VMT when managed initially by observation. Stable VMT grade was the most frequent outcome, and grade 1 VMT eyes were more likely to undergo spontaneous release compared to grades 2 and 3 eyes.

SOURCE: Patel V, Kiryakoza L, Chau V, et al. Idiopathic vitreomacular traction managed with initial observation: clinical course and outcomes. Ophthalmol Retina. 2022; May 4:S2468-6530(22)00214-7.





Industry News

AAOF Offers Staff Training, Calls for Applications for Bright Ideas Pitch Competition & Announces J&J Vision Award of Excellence

• The American Academy of Optometry Foundation is offering the second of six new programs, Staff Training Fundamentals: Your Foundation for Success. Optometrists have voiced the need for an online staff training program providing basic foundational education for employees new to eye care. Learn more.
• The Foundation also launched the application window for its inaugural Bright Ideas Pitch Competition. This program will aim to stimulate new ideas and innovative thinking leading to potential treatments or devices. Learn more.
• As well, the Foundation announced the 2022 Johnson & Johnson Vision Award of Excellence in Contact Lens Patient Care Grant recipients. Learn more and view the recipients.






B+L Launches as A Publicly Traded Company

Bausch + Lomb launched as a publicly traded company focused on protecting and enhancing the sight of millions of people around the world when it began trading under the "BLCO" symbol on the New York Stock Exchange and Toronto Stock Exchange. Read more.






Tarsus Announces Positive Topline Data from Saturn-2 Phase III

Tarsus Pharmaceuticals announced TP-03 (lotilaner ophthalmic solution, 0.25%) met the primary endpoint and all secondary endpoints in the Saturn-2 Phase III trial with a favorable safety profile, reinforcing its ability to resolve Demodex blepharitis. With these positive results, Tarsus plans to submit a New Drug Application to the FDA in the second half of 2022. Read more.

J&J Appoints Menziuso as Group Chairman, Named a Winner of Fast Company’s 2022 World Changing Ideas Award

Johnson & Johnson Vision appointed Peter Menziuso as Company Group Chairman. Menziuso now leads the full Johnson & Johnson Vision portfolio including brands such as Acuvue contact lenses, the Tecnis family of intraocular lenses, TearScience LipiFlow and more. Learn more.
The company was named a winner of Fast Company’s 2022 World Changing Ideas Awards for Acuvue Theravision with ketotifen. Learn more.

Prevent Blindness to Hold A.S.P.E.C.T. Patient Advocacy Summit

Prevent Blindness is holding the inaugural A.S.P.E.C.T. Patient Advocacy and Engagement Summit, May 9-11, at the Willard InterContinental Hotel in Washington, D.C. The Summit will bring together trainees, allies, and program sponsors from across the country. Read more.

Apellis Announces Results from Global Survey Revealing Emotional Burden and Impact of GA

Apellis Pharmaceuticals announced results from a global survey conducted by The Harris Poll, which found that living with geographic atrophy can cause a substantial emotional burden and impact on independence. Read more.















Journal Reviews Editor:
Shannon Steinhauser, OD, MS, FAAO

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