Optometric Physician



Vol. 23, #44  •   Monday, November 21, 2022


Off the Cuff: Do-It-Yourself Days

All last week, I was sick with congestion, body aches, coughing, and fatigue. After a negative in-home rapid COVID test, I had Arizona IV Medics, an IV infusion company, come to the house to load me up with vitamins, decongestants, and pain meds. These services are often thought of as hangover curatives, but they also work wonderfully for those suffering with migraines or cold and flu. This was followed by a virtual medical visit via an app called 98point6, recommended by my medical plan, which was conducted entirely via text messaging. That visit resulted in a prescription for a cough suppressant that was sent to NowRx, a same-day home delivery pharmacy. My experience last week showed me that healthcare has truly become do-it-yourself in the comfort of your own home. Was it comprehensive? No. Did I expect it to be? No. Did it serve its purpose? Yes. I'm sure you can see where I'm going with this.

The American Optometric Association in 2020 and 2022 issued warnings to patients regarding the limitations of online vision exams. I'm obviously preaching to the choir that a comprehensive eye exam catches more than just sight-threatening disease, but potentially also life-threatening systemic disease. The problem lies in the wide spectrum of what people think a vision exam entails. I'm sure I'm not the only one who has had patients jump out of the exam chair at the completion of the refraction thinking their exam is over. Then we have the polar opposite response from other patients who come to get a dilated health evaluation of their eyes because they already got a prescription done "at one of those quick eyeglass places."

What scares me about these services is largely in the nomenclature. Calling these online/virtual services "vision exams" is inaccurate; they should be referred to something along the lines of "virtual refraction." Stressing this could potentially help consumers on both ends of the spectrum understand more clearly that they're only receiving a portion of a vision exam. At home, do-it-yourself virtual/online healthcare options are only growing, so bemoaning their existence doesn't help our patients as much as properly positioning them in their overall health picture would.



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.






Development of 3D Printed Drug-Eluting Contact Lenses

The aim of this study was to introduce 3D printing technology for the design and fabrication of drug-eluting contact lenses (DECL) for the treatment of glaucoma. The researchers wrote that development of 3D printed lenses can effectively overcome drawbacks of existing approaches by using biocompatible medical grade polymers that provide sustained drug release of timolol maleate for extended periods.

Hot melt extrusion was coupled with fusion deposition modelling (FDM) to produce printable filaments of ethylene-vinyl acetate copolymer-polylactic acid blends at various ratios loaded with timolol maleate. Physicochemical and mechanical characterization of the printed filaments was used to optimize the printing of the contact lenses.

3D printed lenses with an aperture (opening) and specified dimensions could be printed using FDM technology. The lenses presented a smooth surface with good printing resolution while providing sustained release of timolol maleate over three days. The findings of this study can be used for the development of personalized DECL in the future.

SOURCE: Mohamdeen YMG, Tabriz AG, Tighsazzadeh M, et al. Development of 3D printed drug-eluting contact lenses. J Pharm Pharmacol. 2022;74(10):1467-76.






Dry Eye Following Femtosecond Laser-Assisted Cataract Surgery: A Meta-Analysis

This study investigated the dry eye effect after femtosecond laser-assisted cataract surgery (FLACS) and compared the risk of postoperative dry eye between FLACS and manual cataract surgery (MCS). The authors searched various databases between January 2000 and October 2022, and included peer-reviewed clinical studies in the review. Dry eye parameters were extracted at baseline and postoperative day one, week one, one month and three months. Parameters included were the ocular surface discomfort index (OSDI), tear secretion (tear meniscus height, Schirmer's test), microscopic ocular surface damage (fluorescein staining) and tear stability (first and average tear breakup time). Additionally, the differences of each parameter at each time point were compared between FLACS and MCS. In total, six studies of 611 eyes were included.

On postoperative day one, increased, pooled standardized mean differences (SMDs) were noted in the OSDI, tear secretion, tear film instability and microscopic damage. During postoperative week one, dry eye worsened. Fortunately, the dry eye achieved resolution afterwards and nearly returned to the baseline level at postoperative three months. When the parameters were compared between FLACS and MCS, those of FLACS had higher severities, but most were not statistically significant.

Dry eye impact was approximately the same in FLACS and MCS at postoperative three months.

SOURCE: Chen WT, Chen YY, Hung MC. Dry eye following femtosecond laser-assisted cataract surgery: a meta-analysis. J Clin Med. 2022;11(21):6228




Phacoemulsification Combined With Micropulse Cyclodiode Laser In Glaucoma Patients: Efficacy and Safety

This white paper evaluated the safety and efficacy of phacoemulsification combined with Micropulse transscleral cyclophotocoagulation (MP-TSCPC) in glaucoma patients. The participants were adult patients with diagnoses of glaucoma and cataract who required a further reduction in IOP or a reduction in the number of glaucoma drops. All consecutive patients who underwent cataract surgery (CS) combined with MP-TSCPC laser between October 2018 and July 2019, were included in the study. The effect on visual acuity (VA), intraocular pressure (IOP) and number of anti-glaucoma drops were evaluated at six and 12 months in addition to any complications that occurred during any time point of the study.

A total of 42 eyes were included in the study. Mean IOP was reduced from 19.5±5.4 mmHg by 22.5% to 15.1±4.6 at six months postoperatively and by 19.5% to 15±6.6 mm Hg at 12 months (p<0.001 at both time points). The number of anti-glaucoma medications also reduced significantly from 2.8±1.3 to 1.6±1.2 at six months and to 2.2±1.3 at 12 months (p<0.001 at both time points). The success rate was 56% at 6 months and 54% at 12 months. 54.7% of our patients who completed 12 months follow up had an improvement or unchanged vision at the last visits.

Researchers wrote that this first study evaluating the effect of cataract surgery combined with MP-TSCPC in glaucoma patients demonstrated a reduction in IOP and the number of anti-glaucoma medications at six and 12-month postoperatively. Most patients had either stable or better vision at 12 months follow-up.

SOURCE: Daas A, Sherman T, Danieliute L, et al. Phacoemulsification combined with micropulse cyclotide laser in glaucoma patients: efficacy and safety. Eye (Lond). 2022;36(11):2188-91.






Industry News

Meivertor Eyelid Eversion Tool Introduced

The Meivertor, introduced at the American Academy of Optometry annual meeting in San Diego, is an eversion tool for the upper eyelids to aid imaging of the meibomian glands, which is important for a complete assessment of meibomian gland health. Learn more.

The Relief Products Introduces Natural Eyes

The Relief Products, a provider of homeopathic OTC eye care, announced its new Natural Eyes product line featuring globally-sourced natural active ingredients with no known side effects or interactions, the company says. The company adds the product’s formulas are contact lens safe and suitable for daily use. Read more.

Visionary Optics Names Dr. Johns as Director of Clinical and Scientific Affairs

Visionary Optics appointed Lynette K. Johns, OD, FAAO, FSLS, FBLA, as director of clinical and scientific affairs. Dr. Johns has been a specialty contact lens practitioner and investigator at Massachusetts Eye and Ear, and a research associate in the Harvard Medical School Department of Ophthalmology. She is known for her work with scleral lenses for visual rehabilitation, pain management and ocular surface support. Learn more.