Optometric Physician



Vol. 23, #43  •   Tuesday, November 14, 2022


Off the Cuff: OCT or BUST

It doesn't seem all that long ago that you would have been sitting in a continuing education lecture when the speaker would have invariably asked the question, "How many of you have an OCT in your practice?" Early on there would have been only a smattering of raised hands. Over the years when those lecturers asked that same question, you could see their visible shock when more hands went up than not. When we opened our practice in 2013, an OCT was one of the first pieces of equipment we purchased. It has become integral to how we practice—from screening at routine exams and monitoring diabetic, glaucoma, and macular degeneration patients; to fitting scleral lenses, evaluating angles, depths of corneal foreign bodies and ulcers; to documenting that the macula is indeed "on" for those coming in with flashes and floaters complaints. It was, and still is, game-changing technology for eye care.

Now that the practice has been open nearly 10 years, our beloved OCT is out of warranty and out of time. It's "no longer being serviced" by its manufacturer. The next time there's an issue, that may likely be the end of the road; it will be time to upgrade and buy a new one. The number one thing that has prevented me from preemptively buying something new, my biggest roadblock, my disconnect to upgrading to the latest and greatest, is not the cost, as some would like to think, but it's the loss of history—the ability to do change analysis and clearly demonstrate to patients their progress or decline. When I've asked about this, the sales reps seem to think starting a whole new database is perfectly fine. Frankly, it's not. Even switching manufacturers poses a problem since they each use proprietary file types.

Yes, we've got the imaging uploaded into our EHR system, but to view and compare images on there requires a flipping-back-and-forth manual process that's both time-consuming and cumbersome. I'm sure we're not the only ones to have run into this problem. Do we bite the bullet and lose the history now or slug it out until the device’s inevitable end to ultimately just lose the history later…or is there something else? The OCT that propelled our practice forward now seems to inadvertently be holding us back.

Editor’s Note: Dr. Arthur Epstein's Celebration of Life is being held this Sunday, November 13th, at 2:00 p.m. MST in Phoenix. If you would like to watch the live stream, the link will be available directly from the everloved.com website at that time.



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 Effect of Meibomian Gland Dysfunction on Laser-assisted in Situ Keratomileusis in Asymptomatic Patients

Researchers evaluated the impact of asymptomatic meibomian gland dysfunction (MGD) on laser-assisted in situ keratomileusis (LASIK) outcomes and dry eye signs and symptoms. A retrospective analysis of patients who underwent LASIK surgery between July 2017 and February 2018, at Care Vision Refractive Clinic, Tel Aviv, Israel, was done. Patients were divided into those who had preoperative asymptomatic significant MGD (MGD group) and those who did not have preoperative significant MGD (control group). Outcomes were the postoperative presence of punctate epithelial erosions, dry eye symptoms, the number of postoperative visits as a measure of adverse events, visual acuity, spherical equivalent, safety index, efficacy index, and the type of refractive error (myopia or hyperopia).

A total of 497 eyes were included in this study. Both groups had similar rates of punctate epithelial erosions, 30 (12.9%) patients vs. 39 patients (14.8%); postoperative complaints of dryness, 75 patients (32.3%) vs. 90 patients (34.2%); and postoperative number of visits, 3.15±0.75 vs. 3.12±0.54. Uncorrected visual acuity (logMAR) at one month (0.026±0.09 vs. 0.026±0.17) after surgery was similar in both groups. Mean spherical equivalent was 0.03±0.17 and -0.03±0.18 in both groups. Safety index was 1.024±0.06 in the clinically significant MGD group and 1.029±0.07 in the control group. Efficacy index was also similar in both groups. No differences were found between patients with myopia and hyperopia.

Patients with preoperative asymptomatic MGD have similar LASIK outcomes to patients without preoperative asymptomatic MGD. Accordingly, no preoperative MGD treatment or special caution is needed in these cases.

SOURCE: Spierer O, Nemet A, Bloch S, et al. The effect of meibomian gland dysfunction on laser-assisted in situ keratomileusis in asymptomatic patients. Ophthalmol Ther. 2022; Nov 8. [Epub ahead of print].






Optic Nerve Cavitations in Glaucoma Suspect and Glaucoma Patients

Glaucoma is associated with structural changes of the optic nerve head such as deformation, lamina cribrosa defects, prelaminar schisis, and peripapillary retinoschisis. Researchers described optic nerve cavitations detected by routine spectral-domain optical coherence tomography (OCT).

OCT imaging showed cavitations in five eyes of four patients with an initial diagnosis of glaucoma or glaucoma suspect. The cavitations were seen as hyporeflective spaces that are sharply delineated from surrounding tissue. They were centered inferonasally, anterior to the lamina cribrosa, and at least partially within the Bruch's membrane opening (BMO). They extended from the 3 to 6 o’clock hours.

Researchers described a new OCT finding in patients with a diagnosis of glaucoma and glaucoma suspects. While previous reports have described cavitations in the choroid in patients with pathological myopia, patients in this study had minimal refractive errors, and the cavitations were located within the optic nerve. Researchers wrote that they planned to examine these patients over time to determine the impact of this finding on longitudinal changes in structure and function.

SOURCE: Hong BY, Fortune B, Kinast RM, et al. Optic nerve cavitations in glaucoma suspect and glaucoma patients. Am J Ophthalmol Case Rep. 2022; Oct 20;28:101733.




A Comparative Study on Visual Health and Physical Activity of Chinese and Japanese Children Ages 6 to 12 Years

In this study, investigators compared the visual acuity levels and physical activity participation of Chinese and Japanese children. They collected data on static visual acuity, kinetic visual acuity, axial length, intensity, frequency, duration, amount, and physical activity items of 431 children ages 6 to 12 years from Chinese and Japanese schools in the same city. The analysis examined the relationships involving age, visual function indicators, ocular biometric parameterss and extracurricular physical activity.

Investigators found the myopia rate higher in Chinese children than in Japanese children, increasing with age except in grade four; kinetic visual acuity in Chinese children was lower than in Japanese children. Axial length became longer with age in both groups, with Chinese children having a longer axial length than Japanese children. The amount of physical activity in Chinese and Japanese children ages 6 to12 years fluctuated. The frequency, duration and physical activity items were lower in Chinese children than Japanese.

Investigators reported that Chinese and Japanese children's overall static visual acuity development level showed a decreasing trend and that Japanese children had better kinetic visual acuity and physical activity participation than Chinese children. They suggested that physical activity could have an impact on visual acuity.

SOURCE: Yang G, Zhang M, Ujihara H, et al. A comparative study on visual health and physical activity of Chinese and Japanese children aged 6-12 Years. Am J Health Behav. 2022 Oct 17;46(5):567-75.







Industry News

CooperVision Adds SynergEyes

CooperVision added SynergEyes to its specialty eyecare business unit. SynergEyes has expertise in hybrid lens technologies and brands spanning the treatment of irregular cornea, presbyopia and astigmatism. Read more.

Ocuphire to Develop Eye Drops for Mydriasis, Presbyopia and Night Vision Disturbances

Ocuphire Pharma entered into an exclusive license agreement with FamyGen Life Sciences for the development and commercialization of Nyxol across three indications in the United States and other global markets. Famy will fund Nyxol development through FDA approvals, managed by Ocuphire, for all three Nyxol indications, including Nyxol+low-dose pilocarpine. Read more.

SDC Technologies Acquires Coburn

SDC Technologies, a provider of premium specialty coating solutions, acquired Coburn Technologies, a provider of ophthalmic lens processing systems and instruments for the eye care industry. For more than 65 years, Coburn has supplied optical labs and eye care professionals with products and services.

Prevent Blindness Names Board Chair, Members; Declares Thyroid Eye Disease Awareness Week

Prevent Blindness announced Jim McGrann, CEO of Professional Eyecare Associates of America, was elected chair of the Prevent Blindness board of directors. In addition, Susan A. Primo, OD, MPH, FAAO, director, Optometry and Vision Rehabilitation Services, Emory Eye Center, and professor of Ophthalmology, Emory University School of Medicine; and Susan L. Stone, founder of SLStone Consulting, were elected as board members. Read more.
In addition, the group declared November 14 to 20, its third annual Thyroid Eye Disease Awareness Week. Learn more.