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


Volume 18, Number 46

Monday, November 12, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: OGS and Hope for the Future
######### Thickness Changes in the Corneal Epithelium and Bowman's Layer After Overnight Wear of Silicone Hydrogel Contact Lenses
######### Long-Term Effect of Corneoscleral Contact Lenses on Refractory Ocular Surface Diseases
######### 24-Hour Intraocular Pressure Control with Fixed-dose Combination Brinzolamide 1%/Brimonidine 0.2%: a Multicenter, Randomized Trial
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: OGS and Hope for the Future

Recently, I’ve written extensively about the mounting challenges that our profession faces. I am clearly not alone in my concern, especially among the rank and file, as well as some—but unfortunately, not all—of optometry’s leadership. Comments and conversations and even the mood at some of our meetings, including this past week’s Academy meeting in San Antonio, have borne that out. Despite this negativity, there are bright spots on the horizon.

This past Tuesday, I attended the Optometric Glaucoma Society 17th Annual Scientific Meeting. I’ve become increasingly interested in glaucoma of late, stimulated in part by Shannon’s amazing knowledge of the disorder, its comorbidity with ocular surface disease and its intriguing complexity.

When I think about the OGS, I also think of my good friend Murray Fingeret, who was instrumental in the organization’s founding. The Optometric Glaucoma Society and Murray share a unique place in optometry. While the profession has often struggled with interprofessional politics and relationships, Murray and the OGS have created strong and enduring bonds between optometry, ophthalmology and industry, based on mutual respect and common interest. These ties go beyond glaucoma, having opened doors for our profession in myriad areas.

The OGS program itself was filled with brilliant lectures by a number of well-recognized thought leaders in glaucoma and related research. Of particular personal interest was the lecture by OGS Honoree, Dr. Jay Katz who presented “Is Glaucoma a Reversible Disease?” Twenty years ago, I watched my mother slowly go blind from glaucoma, frustrated and saddened by the lack of effective treatment and no way to reverse or even slow the progressive damage.

The OGS and its membership represent some of the brightest and best in optometry today. The Society also clearly demonstrates just how much our profession can accomplish and how well we can work cooperatively with our MD colleagues at the highest levels. Perhaps, most importantly, the OGS shows us a path to a better and more productive future for our profession.

Editor’s Note: Yesterday was Veteran’s Day. We will never forget those who have served and sacrificed to protect our country, our freedom and our way of life. GBA.

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.



Thickness Changes in the Corneal Epithelium and Bowman's Layer After Overnight Wear of Silicone Hydrogel Contact Lenses
This study investigated thickness changes in the corneal epithelium and Bowman's layer after overnight silicone hydrogel contact lens (CL) wear by using ultra-high resolution optical coherence tomography (UHROCT). Eleven subjects without CL wearing history were recruited for this study. An UHROCT was used to measure the thickness of the epithelium (ET), Bowman's layer (BT), stroma (ST) and total cornea (CCT) at the center of both eyes. A silicone hydrogel CL was inserted in the right eye of each subject, and the fellow non-CL wearing left eye served as the control. The lens was inserted at 9:30pm and removed at 8am the next morning. The subjects were evaluated at 9:00pm (baseline), 9:30pm (lens insertion), 10pm (before sleep), 7am (waking), 7:30am and 8am (lens removal).

Compared to the lens insertion level, the ET of the lens-wearing eye increased by 5.73% at eye opening. The ET of the non-CL wearing eye and the BT in both eyes did not change after overnight CL wear. Compared to baseline, the CCT of the lens-wearing eye increased by 2.87% upon waking and recovered 30 minutes later. In contrast, compared to baseline, the CCT of the non-CL wearing eye did not increase upon waking (p=0.105).

By using UHROCT, researchers found that overnight CL wear induced different swelling responses in the various sublayers of the cornea.

SOURCE: Lu F, Tao A, Tao W, et al. Thickness changes in the corneal epithelium and Bowman's layer after overnight wear of silicone hydrogel contact lenses. BMC Ophthalmol 2018;18(1):286.

Long-Term Effect of Corneoscleral Contact Lenses on Refractory Ocular Surface Diseases
The medical records of 13 eyes (of nine patients) attempted for fitting with corneoscleral contact lenses (CLs) for the management of severe refractory ocular surface diseases including Stevens-Johnson syndrome (SJS; eight eyes) and chronic ocular graft-versus-host disease (GVHD; five eyes) were retrospectively reviewed. Researchers reported the therapeutic effect of CLs with a diameter of 14mm on the refractory ocular surface diseases. Lenses were fitted to improve refractory punctate epithelial erosions (PEE, 10 eyes) and persistent epithelial defect (PED, three eyes with SJS) despite the proper medical management. Short-term (one month) and long-term (12 months) changes in the best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS) score, mean wearing time and National Eye Institute's Visual Function Questionnaire-25 (VFQ-25) were evaluated.

Of the 13 eyes, 10 were successfully fitted with the corneoscleral CLs. The fitting was failed in three eyes due to small palpebral fissure and shortened fornices (two eyes) and handling difficulty (one eye). At one-month follow-up after successful fitting in 10 eyes, mean wearing time was 12.6 hours (6.5 to 17, all day long) and BCVA improved from 0.56 ± 0.59 to 0.27 ± 0.46 in logMAR. For the eight well-fitted eyes with refractory PEE, CFS score improved from 7.38 ±2 .20 to 5.13 ± 2.48. PED improved in the two eyes that were successfully fitted with corneoscleral CLs. (Of the three eyes with PED, one eye failed fitting). At 12-month follow-up, mean wearing time was 11.4 hours, and the improved BCVA and CFS score were maintained. Furthermore, no adverse events attributable to corneoscleral CLs use occurred.

The corneoscleral CLs with a diameter of 14mm were successfully fitted in 10 out of 13 eyes with severe refractory ocular surface diseases and demonstrated therapeutic benefits in the well-fitted eyes. Researchers concluded that the corneoscleral CL could be an option in the management of severe refractory ocular surface diseases.

SOURCE: Lee SM, Kim YJ, Choi SH, et al. Long-term effect of corneoscleral contact lenses on refractory ocular surface diseases. Cont Lens Anterior Eye. 2018; Oct 30. [Epub ahead of print].




24-Hour Intraocular Pressure Control with Fixed-dose Combination Brinzolamide 1%/Brimonidine 0.2%: a Multicenter, Randomized Trial
A prospective, multicenter, double-masked, parallel-group clinical trial at 16 academic and non-academic sites in the US was conducted to determine the intraocular pressure (IOP)-lowering effect of fixed-combination brinzolamide 1%/brimonidine 0.2% (BBFC) over a 24-hour period. Subjects included individuals with open-angle glaucoma (OAG) or ocular hypertension (OHT) ages ≥ 18 years, with mean baseline IOP measurements in at least one eye of ≥21 and <28 mmHg. Duplicate mean pneumatonometer IOP measurements were collected every two hours over a 24-hour period in controlled light conditions in overnight facilities. Daytime (8am to 8pm) and nocturnal (10pm to 6am) IOP measurements were collected in a sitting or supine position, respectively. Baseline 24-hour IOP was measured in untreated subjects after a washout phase (up to four weeks) and eligibility phase. Following the baseline visit, subjects were randomized 1:1 to receive masked BBFC or vehicle, one drop three times daily (8am, 3pm, 10pm) for four weeks. At week 4, IOP measurements were repeated in both groups under the same conditions.

Of 125 subjects randomized, 123 (98%; BBFC, n=62; vehicle, n=61) completed the study. No subjects randomized to BBFC discontinued from the study. At week 4, BBFC-treated eyes had significantly reduced mean 24-hour IOP vs. vehicle (least squares mean difference [95% confidence interval]: (-2.5 [-3.3, -1.7]), daytime (-3.4 [ 4.3, -2.6]) and nocturnal (-1.2 [-2.3, 0.0]) reductions were observed. A mean change from baseline was significantly different between BBFC- and vehicle-treated eyes at all daytime points and three of five nocturnal time points (10pm, 12am, 6am; secondary endpoint). The frequency of adverse events was similar between treatment groups; in the BBFC arm, ocular hyperemia, corneal abrasion and dysgeusia were the most frequently reported, consistent with events described in the drug label.

This first large, multicenter study of 24-hour IOP control with BBFC met its primary endpoint; BBFC demonstrated significantly superior 24-hour IOP-lowering efficacy vs. the vehicle following four weeks of three-times-daily treatment in subjects with OAG or OHT.

SOURCE: Weinreb RN, Bacharach J, Fechtner RD, et al. 24-Hour intraocular pressure control with fixed-dose combination brinzolamide 1%/brimonidine 0.2%: a multicenter, randomized trial. Ophthalmology 2018; Nov 4. [Epub ahead of print].

2018 West Coast Optometric Glaucoma Symposium

News & Notes

Haag-Streit USA & Berkeley School of Optometry Announce Partnership
Haag-Streit USA, a manufacturer of ophthalmic and medical equipment, announced a new partnership with the Berkeley School of Optometry that includes a donation of equipment to the school. The partnership demonstrates Berkeley’s and Haag-Streit’s shared commitment to providing students with exemplary clinical training, and to the pursuit of new advances in eye care and research. Both Dr. Cavin and Dean Flanagan see the partnership as just the beginning of a long, mutually beneficial relationship. Read more.


Singapore National Eye Centre, Singapore Eye Research Institute & J&J Vision Aim to Halt Global Myopia Epidemic; New J&J Vision Data Highlights Potential Standards for Evidence-based Decision Making in Myopia, Measures Performance of Acuvue Oasys with Transitions Light Intelligent Technology CLs
The Singapore National Eye Centre, the Singapore Eye Research Institute and Johnson & Johnson Vision announced a $26.35 million research collaboration to tackle myopia or nearsighted vision. The first-of-its-kind public-private strategic partnership in Asia focused on myopia will create a deeper understanding of how the condition develops, how it progresses and how it may be intercepted. It will focus on developing predictive tools to identify those who may be at risk to develop high myopia, conduct research on the underlying mechanisms of myopia, progress novel therapies, and discover and validate methods to prevent the onset and progression of the condition. Due to the complexity and scale of myopia, halting the epidemic will require a multidisciplinary approach that encompasses novel clinical research as well as innovations in education and clinical care. SNEC, SERI and Johnson & Johnson Vision intend to build on these efforts and convene other stakeholders to support broad-based strategies. Read more.

In addition, Johnson & Johnson Vision announced that Noel A Brennan, PhD, the company’s Global Platform Lead for myopia control and noted researcher and specialist in the space, will present data on myopia progression and investigational methods to control it at the American Academy of Optometry annual meeting (Nov. 7-10) in San Antonio. In addition, data from two new studies on the visual effects of photochromic contact lenses will be presented. For more information about Johnson & Johnson Vision at Academy 2018, visit www.jnjvisionpro.com/academy

2018 West Coast Optometric Glaucoma Symposium


NORA & CLF Offer Educational Resource on Common Vision Problems & Symptoms Following Concussion
The Neuro-Optometric Rehabilitation Association and Concussion Legacy Foundation developed an educational resource titled “Common Vision Problems & Symptoms Following a Concussion” to assist concussion sufferers and their caregivers, as well as health care professionals. After a patient’s concussion or other TBI, there is often an interruption in communication between the eyes and the brain. Studies show that at least 50% of TBI patients suffer from visual dysfunctions, with one study finding a 90% incidence of post-trauma visual complications, such as blurred vision, sensitivity to light, reading difficulty, headaches with visual tasks and difficulties with eye movements. Visual problems are often overlooked during the initial evaluation, as some symptoms may not be present until days, weeks or even longer following the incident. Read more.

2018 Ophthalmology Update

Vital Tears Adds Mobile Phlebotomy Services to Aid ECPs & DED Patients Nationwide
Vital Tears announced the addition of mobile phlebotomy services to its system of providing autologous serum tears for dry eye therapy. By offering mobile phlebotomy services, patients can have blood drawn in the comfort and convenience of their own home or office. Autologous serum tears have long been studied and used by eye care professionals as an option for patients with ocular surface disease symptoms and dry eye. However, the cost and logistics of processing the tears made from a patient’s blood serum proved cumbersome for many. In 2015, Vital Tears introduced a system of production, delivery and billing, increasing access to the customized therapy. Read more.

B+L Presents New Scientific Data During AAO
Bausch + Lomb announced the presentation of five posters during the American Academy of Optometry meeting in San Antonio (Nov. 7-10). These presentations featured an integrated analysis from two Phase III studies evaluating the company’s investigational product, submicron loteprednol etabonate ophthalmic gel, 0.38%, as well as new data on Lumify redness reliever eye drops, Bausch + Lomb Ultra contact lenses and two analyses from the Antibiotic Resistance Monitoring in Ocular micRoorganisms study, which is the only ongoing multicenter survey of antibiotic resistance patterns specific to ocular pathogens in the United States. The company will offered a variety of educational programs and feature its current portfolio of Pharmaceuticals, Consumer Healthcare and Vision Care products in its booth #1843. Read 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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