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


Volume 18, Number 47

Monday, November 20, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: Commonality
######### Refractive Error & Vision Correction in a General Sports-playing Population
######### Comparison of FDA Safety & Efficacy Data for Corneal Inlays
######### Protective Effect of Metformin Against Retinal Vein Occlusions in Diabetes Mellitus: A Nationwide Population-based Study
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Commonality

There are lessons to be learned from just about everything. Several years ago I received my ratings for several lectures I presented at a major educational conference. I recalled that my talks had gone extremely well and my ratings reflected that—except for one lecture. Oddly, it was the one I thought was my best. Apparently the audience didn’t agree.

The poor rating really bothered me, and I wracked my brain trying to figure out what had gone wrong. I finally recalled that during that lecture I had a heckler. I lost patience quickly and dispatched him rather unkindly. As I replayed that lecture over and over in my mind, I recalled that my snarky attitude toward the heckler was followed almost immediately by a perceptible change in the mood of the room. I finally understood. By attacking one of their own, I had lost the audience.

I’ve pondered this many times since and I’ve gained great insight from the experience. Humans thrive on commonality and are most comfortable in groups. We both seek and will spontaneously form groups and will strongly identify with its members even if they are otherwise strangers.

While I’ve learned how to avoid pissing off an audience, I’ve also learned the importance of group relationships in professional and everyday life. You may not realize it, but if you’ve done things right, your staff has formed a tightly knit group around you. In a well-run office, the group works cohesively in the best interests of the practice, each other and your patients. In the most successful practices, patients become part of a wonderful extended group and feel connected, and even protective of, you and your staff. The power of commonality is great. Use it wisely.

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.



Refractive Error & Vision Correction in a General Sports-playing Population
This study evaluated, in an amateur sports-playing population, the prevalence of refractive error, the type of vision correction used during sport and attitudes toward different kinds of vision correction used in various types of sports. A questionnaire was used for people engaging in sports, and data was collected from sport centers, gyms and universities that focused on the motor sciences.

A total of 1,573 questionnaires were collected (mean age 26.5 ± 12.9 years; 63.5% male). Nearly all (93.8%) subjects stated that their vision had been checked at least once. Fifty-three subjects (3.4%) had undergone refractive surgery. Of the remainder who did not have refractive surgery (n=1,519), 580 (38.2%) reported a defect of vision, 474 (31.2%) were myopic, 63 (4.1%) hyperopic and 241 (15.9%) astigmatic. Logistic regression analysis showed that the best predictors for myopia prevalence were gender (p<0.001) and location of sports practice (p<0.001). Sports with a higher prevalence of outdoor activity had a lower prevalence of myopia. Contact lens penetration over the study sample was 18.7%. Contact lenses were the favorite system of correction among people interviewed compared with spectacles and refractive surgery (p<0.001).

This study showed that sports were not associated with different levels of myopia prevalence in the adult population. However, subjects engaging in outdoor sports had lower rates of myopia prevalence. Penetration of contact lens use in sports was four times higher than the overall adult population. Contact lenses were the preferred system of correction in sports compared with spectacles or refractive surgery, but this preference was affected by the type of sport practiced, and by the age and level of sports activity for which the preference was required.

SOURCE: Zeri F, Pitzalis S, Di Vizio A, et al. Refractive error and vision correction in a general sports-playing population. Clin Exp Optom. 2017; Nov 9. [Epub ahead of print].

Comparison of FDA Safety & Efficacy Data for Corneal Inlays

This study provided a side-by-side analysis of the summary of safety and effectiveness data (SSED) submitted to the FDA for the Kamra and Raindrop corneal inlays for the correction of presbyopia. SSED reports submitted to the FDA for Kamra and Raindrop were compared with respect to loss of corrected distance visual acuity (CDVA), adverse event rates, induction of astigmatism, retention of contrast sensitivity, stability of manifest refractive spherical equivalent (MRSE) and achieved monocular uncorrected near visual acuity (UNVA) at 24 months.

Totally 442/508 of KAMRA patients and 344/373 Raindrop patients remained enrolled in the clinical trials at 24 months. The proportion of Kamra and Raindrop patients who lost ≥2 lines of CDVA at 24 months was 3.4% and 1%, respectively. The adverse event rate was comparable between the devices. No significant inductions of astigmatism were noted. Both technologies induced a transient myopic shift in MRSE followed by a hyperopic shift and subsequent stabilization. Totally 87% of Kamra and 98% of Raindrop patients attained a monocular UNVA of J5 (20/40) or better at 24 months, 28% of Kamra and 67% of Raindrop patients attained a monocular UNVA of J1 (20/20) or better at 24 months.

Researchers concluded that both devices could be considered safe and effective; however, they added that the results of corneal inlay implantation were mixed and that long-term patient satisfaction would likely depend on subjective expectations about the capabilities of the inlays. Variability in surgical technique and postoperative care within and between the two clinical trials diminished the comparative power of this study, researchers added.

SOURCE: Moshirfar M, Desautels JD, Wallace RT, et al. Comparison of FDA safety and efficacy data for KAMRA and Raindrop corneal inlays. Int J Ophthalmol. 2017;10(9):1446-51.



Protective Effect of Metformin Against Retinal Vein Occlusions in Diabetes Mellitus: A Nationwide Population-based Study
Previous studies have found that metformin can reduce cardiovascular risk, but its association with retinal vein occlusion (RVO) is unknown, investigators wrote. In a population-based cohort study using the Taiwan National Health Insurance Research Database (NHIRD), they demonstrated the protective effect of metformin against RVO in diabetes mellitus (DM) and explored the incidence rate and factors associated with RVO development in general and diabetic populations. One million patients were randomly selected from the registry files of the NHIRD, and all their claims data were collected for the 1996-2011 period. Patients with a new diagnosis of central or branch RVO were identified using International Classification of Disease codes. DM was defined for patients with diagnoses and treatments. Factors associated with RVO development in the non-DM and DM cohorts were explored using Cox proportional regression models.

In total, 1,018 RVO patients were identified from the database. The average incidence of RVO was 9.93 and 53.5 cases per 100,000 person-years in the non-DM and DM cohorts, respectively. Older age, DM, hypertension and glaucoma were significant risk factors for RVO, whereas the prescription of anticoagulants was a significant protective factor. In the DM cohort, older age, hypertension and diabetic retinopathy were significant risk factors for RVO, whereas metformin treatment was a significant protective factor.

Investigators determined that the results confirmed the risk factors for RVO and demonstrated the protective effect of metformin against RVO in DM patients. They added that prescribing metformin for DM patients might be beneficial for reducing the incidence of RVO, along with its hypoglycemic action.

SOURCE: Lin TC, Hwang DK, Hsu CC, et al. Protective effect of metformin against retinal vein occlusions in diabetes mellitus - A nationwide population-based study. PLoS One. 2017;12(11):e0188136.


News & Notes
Bausch + Lomb: More Than 1 Million Units of CL Materials Recycled
Bausch + Lomb’s One by One Recycling Program recycled a combined total of more than one million used contact lenses, blister packs and top foils in less than one year since the launch of the program. The program, in collaboration with TerraCycle has diverted more than 7,000 pounds of waste from landfills and has helped create new post-consumer products. Eye care professionals who are registered with the One by One Recycling Program are provided custom recycling bins for collection in the office. Patients can bring in their contact lens materials from home, and the practice can collect lenses used within the office. The items are sent to TerraCycle for proper recycling using a free shipping label by Bausch + Lomb. In addition to the One by One Program supporting environmental sustainability, for every pound of waste accepted, a $1 donation is made to Optometry Giving Sight. Read more.

Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia

SECO 2018 Launches Customized Educational Content
SECO 2018, which will be held Feb. 28-March 4, 2018, in Atlanta, will feature nearly 400 hours of education options. A preliminary list of courses is available online. Attendees will have access to sessions such as: “How to Mend a Broken Cornea,” “Retina 2018” and “Seeing Stars, Concussions in Sports.” In support of Diabetes And Alzheimer’s Awareness Month, SECO will offer dedicated content for the care and management of these specialized patients. Read more.

2018 Winter Ophthalmic Conference

Paragon Hosts Myopia Symposium for Cornea & Contact Lens and Pediatric Optometry Residents
Paragon Vision Sciences hosted nearly 30 pediatric and corneal contact lens optometry residents from universities around the country and Canada at a symposium designed to provide residents with clinical expertise about the diagnosis and treatment of myopia. The event, held at the Paragon Education and Training Academy at the company’s headquarters in Gilbert, Ariz., provided a unique educational opportunity for attendees to learn about treatment options and myopia research from leading experts. Residents also received instruction on the use of topography to achieve optimal treatment outcomes, including wet lab sessions with patients being fit in orthokeratology contact lenses.

Kala Pharmaceuticals Submits NDA for Inveltys
Kala Pharmaceuticals submitted a New Drug Application to the U.S. Food and Drug Administration for Inveltys (KPI-121 1%), a topical, twice-daily corticosteroid for the treatment of inflammation and pain in individuals who have undergone ocular surgery. If approved, Kala expects Inveltys would be the first twice-daily ocular corticosteroid indicated for the treatment of postoperative ocular inflammation and pain. 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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