Optometric Physician

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


Volume 20, Number 49

Monday, November 23, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: Wet or Dry – What Are You Putting in Your Patient’s Eye?

######### A Randomized Clinical Trial of Multifocal Contact Lenses and Contact Lens Discomfort
######### Role of Topical Cenegermin in Management of a Cornea Transplant in a Functionally Monocular Patient with Neurotrophic Keratitis and Facial Nerve Palsy: a Case Report
  Update on the Use of Anti-VEGF Drugs in the Treatment of Retinopathy of Prematurity
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Wet or Dry – What Are You Putting in Your Patient’s Eye?

I just completed presenting a webinar with good friends and esteemed colleagues Paul Karpecki, Doug Devries, Damon Dierker and Ahmad Fahmy. Sponsored by Bio-Tissue, “Redefining the Standard of Care: A Consensus Guideline” revisited a number of anterior segment disorders from the perspective of improving current standards of care by integrating new research and clinical advances.

My section was corneal ulcers and infectious keratitis, an area of interest and familiarity thanks to years spent working with Drs. Eric Donnenfeld and Hank Perry, and serving as a voluntary attending in the Department of Ophthalmology at then North Shore University Hospital when I was still in New York.

I have been fascinated by amniotic membrane since sharing a patient with Dr. Scheffer Tseng, the visionary founder of Bio-Tissue, back in the 1990s. Cryopreserved amniotic membrane (CAM) tops the list of disruptive clinical innovations I have witnessed over my entire career. I’ve used it to literally save patients’ sight, taking what would have been 20/200 corneal ulcers and with appropriate antimicrobial treatment, preserved 20/20 vision.

CAM is an example of easily applied regenerative medicine, reducing inflammation and scarring, promoting healing, regenerating corneal nerves and even possessing antimicrobial properties. I consider having several Prokera bandages on hand an absolute necessity in the practice.

While I first started using CAM for microbial keratitis, with my focus on dry eye and ocular surface disease, my use has expanded over the years. I use it to treat recurrent corneal erosion, persistent epithelial defects, dense recalcitrant staining and neurotrophic keratitis sometimes prior to initiating Oxervate.

I’ve participated in a lot of webinars and panels especially since COVID hit. I focus on topics I know well. Beyond sharing what I hoped would be valuable perspective, I expected to have my thoughts about their topics reinforced by my colleagues. That’s not what happened. Paul, Doug, Damon and Ahmed were absolutely brilliant, and by the end of the webinar, I had actually expanded my thinking on how I use CAM, and will definitely integrate some of their insights and clinical pearls.

If I’ve said this once, I’ve said it a thousand times: Medical eye care is the future of optometry. Cryopreserved amniotic membrane offers a peek at what incredible power lies ahead. Embrace the future now.


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.



A Randomized Clinical Trial of Multifocal Contact Lenses and Contact Lens Discomfort

This randomized, participant-masked, crossover clinical trial fitted 84 uncomfortable soft contact lens wearers (30 to 40 years old) with single vision and multifocal contact lenses to determine how multifocal contact lenses affected contact lens discomfort. Contact lens discomfort was assessed using the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8).

No difference was found between multifocal and single vision survey scores. An interaction was found between lens type and age group. CLDEQ-8 scores with the single vision lens were less symptomatic than multifocal scores in participants <35 years old. Single vision and multifocal scores for the older age group were not different. Subjectively, those in the <35-year-old group preferred the single vision lens for intermediate, distance and overall vision. In the ≥35-year-old group, no lens was significantly preferred for vision.

Participants in the younger age group had more favorable wearing experiences with the single vision lens compared to the multifocal lens. The older age group, however, had similar wearing experiences with both lens types. Researchers concluded that, while younger contact lens wearers may prefer the wearing experience with single vision lenses, some uncomfortable contact lens wearers approaching 40 years old may benefit from wearing a multifocal contact lens sooner in life than is typically practiced.

SOURCE: Rueff EM, Jones-Jordan LA, Bailey MD. A randomised clinical trial of multifocal contact lenses and contact lens discomfort. Ophthalmic Physiol Opt. 2020; Nov 18. [Epub ahead of print.]


Role of Topical Cenegermin in Management of a Cornea Transplant in a Functionally Monocular Patient with Neurotrophic Keratitis and Facial Nerve Palsy: a Case Report

Neurotrophic keratitis (NK) is one of the most challenging ocular conditions to treat, and it can represent a devastating complication of acoustic neuroma surgery due to the profound corneal anesthesia and concomitant exposure keratopathy caused by seventh nerve palsy. In such cases, cornea surgery should be considered with extreme caution due to the high risk of devastating complications. The purpose of this study was to report the efficacy of a novel human recombinant nerve growth factor (rhNGF)-based ophthalmic treatment in a functionally monocular patient with a recurrence of severe NK on a corneal graft.

A 24-year-old woman who underwent acoustic neuroma surgery was referred for the assessment of a lagophthalmos and a paracentral corneal ulcer refractory to medical treatment. The patient presented with a large descemetocele, diagnosed as stage 3 NK that required multilayer amniotic membrane transplantation (AMT) and a following optical penetrating keratoplasty (PK). The recurrence of NK on the graft was successfully treated with a cycle of rhNGF (cenegermin 20 µg/mL) eye drops. Due to the complications of a further NK recurrence after treatment discontinuation, a second AMT and PK approach was chosen. A second cycle of treatment with cenegermin was immediately initiated after PK to prevent further recurrences. No postoperative complications were observed, and investigators reported a stable situation at one year of follow-up.

The case presented here was, to the investigators’ knowledge, the first report of a treatment with cenegermin for a NK recurrence after PK. The findings suggested that such an early medical approach could be evaluated to prevent postoperative complications.

SOURCE: Pocobelli A, Komaiha C, De Carlo L, et al. Role of topical cenegermin in management of a cornea transplant in a functionally monocular patient with neurotrophic keratitis and facial nerve palsy: a case report. Int Med Case Rep J. 2020; Nov 11;13:617-21.




Update on the Use of Anti-VEGF Drugs in the Treatment of Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is one of the many significant consequences of premature birth, and remains one of the leading causes of visual impairment in infants.

Originally, cryotherapy was used to prevent the complications of vitreous hemorrhage and retinal detachment. Subsequently, the authors wrote, laser photocoagulation, which is at least as effective and possibly safer than cryoretinopexy, was adopted as the primary treatment for type 1 ROP (stage 2 or 3 disease in zone II with plus disease, or any stage disease in zone I with plus disease, or stage 3 disease in zone I without plus disease). Laser therapy has been shown to be effective, and has a degree of permanence that is yet to be matched by alternative treatments, but can be associated with significant ocular side effects such as myopia. Treatment of type 1 ROP with anti-vascular endothelial growth factor (VEGF) agents seems to have fewer ocular side effects than laser ablation of the retina, particularly if used to treat type 1 ROP in zone I, the authors wrote. However, ROP recurrence is a real threat after anti-VEGF therapy, and long-term systemic side effects of this therapy remain under evaluation. This review focused on the ophthalmic and systemic benefits and risks of anti-VEGF therapies for ROP compared with retinal photocoagulation.

Anti-VEGF therapies have dramatically altered the management of ROP and have also been shown to be beneficial with regard to the visual prognosis of patients with ROP, but patients so treated require frequent short- and long-term follow-up to detect and manage potential complications associated with this form of treatment, the authors wrote. Such information also will allow clinicians to characterize the efficacy, side effect profile and utility of intravitreal anti-VEGF agents for this condition. The authors suggested that prospective studies would be needed to identify the optimum anti-VEGF drug and dose.

SOURCE: Seery CW, Betesh S, Guo S, et al. Update on the use of anti-VEGF drugs in the treatment of retinopathy of prematurity. J Pediatr Ophthalmol Strabismus. 2020; Nov 1;57(6):351-62.


News & Notes

Bausch Health: Investigational In Vitro Data Indicates Complete Inactivation of SARS-CoV-2 with LUMIFY And BESIVANCE
Bausch Health Companies and Bausch + Lomb announced the results of new investigational in vitro data showing that two benzalkonium chloride (BAK) preserved eye drops, LUMIFY (brimonidine tartrate ophthalmic solution 0.025%) redness reliever eye drops and BESIVANCE (besifloxacin ophthalmic suspension) 0.6%, indicated complete inactivation of Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2 or COVID-19). These data were presented at the 2020 Ocular Microbiology and Immunology Group virtual meeting on Nov. 13. In the study, researchers evaluated the in vitro antiviral activity of LUMIFY and BESIVANCE against SARS-CoV-2 using a Vero E-6 host-cell system. Both drops contain 0.01% BAK, a quaternary ammonium compound commonly used as a preservative in ophthalmic topical solutions. The activity of BAK against SARS-CoV-2 is not well- understood. Read more.


  Coburn Introduces Agility Autodeblocker
Coburn Technologies introduced a new product category to its surfacing line of products with an automatic lens deblocker, the Agility Autodeblocker. Developed for large labs seeking speed and efficiency, the system is capable of deblocking more than 200 lenses per hour. Both lenses are automatically removed from a job tray, placed onto the appropriate deblocking rings and then deblocked simultaneously using a mechanical action. Rather than using powerful water jets that displace alloy, cause alloy waste and produce contaminated water waste, Agility separates the lens from the block, without water, in one mechanical action. Contact the company to learn more.

Thyroid Eye Disease Awareness Week Launches
November 16 marked the start of the first Thyroid Eye Disease (TED) Awareness Week, established through a collaboration between Horizon Therapeutics and advocacy organizations including the American Autoimmune Related Diseases Association (AARDA), the Alliance for Eye and Vision Research (AEVR), the Graves’ Disease and Thyroid Foundation (GDATF) and Prevent Blindness. Each organization planned a variety of activities throughout the week. Learn more.


Regener-Eyes Pledges Support to Prevent Blindness
Regener-Eyes announced that Regener-Eyes is launching a campaign to support the ongoing efforts of Prevent Blindness. Now through January 15, 2021, Regener-Eyes will donate $1 to Prevent Blindness for each purchase of either Regener-Eyes LITE or Regener-Eyes Professional Strength eye drops. Regener-Eyes is a sterile biologic eye drop made of anti-inflammatory cytokines and growth factors, shown to reduce inflammation and help stimulate the ocular surface to heal, repair and regenerate. 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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