Optometric Physician


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

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Volume 19, Number 47

Monday, November 25, 2019

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Inside this issue: (click heading to view article)
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######### Off the Cuff: The Highs and Lows of Contact Lenses in 2019
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######### Using Icare Home Tonometry for Follow-Up of Patients with Open-Angle Glaucoma Before and After Selective Laser Trabeculoplasty
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######### Factors of Retinal Re-Detachment and Visual Outcome After Intraocular Silicone Oil Removal in Silicone Oil Filled Eyes
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######### Comparing 10-2 and 24-2 Visual Fields for Detecting Progressive Central Visual Loss in Glaucoma Eyes with Early Central Abnormalities
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######### News & Notes
 

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Off the Cuff: The Highs and Lows of Contact Lenses in 2019

This has been an epic year for contact lenses. First, Bausch + Lomb pulled a rabbit out of its hat with the Bausch + Lomb Ultra Multifocal for Astigmatism. The lens is an optical, fitting and materials science tour de force that has had patients crying tears of joy in our office—I kid you not. I am no fan of multifocal lenses, so adding the complexity of a multifocal to a toric design and coming up with a successful lens that targets a population that is more likely to drop out than return to lens wear is simply mind blowing. Bravo B+L is an understatement.

With the FDA’s approval of CooperVision's MiSight 1 day, myopia control has finally become a real thing in the US. This lens opens the door to improved vision and health for millions of American kids, and energizes a sluggish contact lens market. MiSight also creates unprecedented opportunity for eye care professionals. Congratulations to Cooper for essentially creating an entirely new therapeutic contact lens category.

Interestingly, both of these lenses have important things in common. The Bausch + Lomb Ultra Multifocal for Astigmatism and CooperVision's MiSight 1 day are cutting-edge medical devices that require extensive clinical knowledge, decent fitting ability and sufficient chair time for necessary professional care. All of these key ingredients for a successful fit require direct doctor-patient interaction. That’s not something that will be deliverable online or through the mail anytime soon.

Talking about deliverable online, in a bit of disappointing news, the ever expanding direct-to-consumer brand retailer Warby Parker appears to have transformed the Menicon Miru daily disposable into their new $440-a-year Scout lens. Apparently, money can buy everything. This excellent Bloomberg piece explains the move into contact lenses. Warby is a low cost to serve commodity seller that views contact lenses as a commodity. Their problem is that commodities fall out of favor more quickly than substantive brands, and Warby needs to reinvent itself with something new before their millennial customers realize that cheap Warby brand tortoiseshells are no longer hip.

Make no mistake, despite tripling the number of employed ODs, “Warby is hoping to push the envelope by one day letting consumers take an eye test and update their prescription using only an iPhone and a MacBook.” It will be interesting to see if Warby is successful or if this marks the beginning of a terminal down spiral. Either way, I suspect that contact lenses will still be medical devices fit by eye care professionals long after aged millennials are asking each other if they remember that ‘Warby something company’ that used to sell cheap eyeglasses and expensive contact lenses.

Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com

 

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.

 








Using Icare Home Tonometry for Follow-Up of Patients with Open-Angle Glaucoma Before and After Selective Laser Trabeculoplasty
 
 
Fourteen eyes from 14 patients diagnosed with primary open-angle glaucoma were recruited to monitor the results of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) using home rebound tonometry to evaluate the role of Icare Home tonometry. The trabecular meshwork of each eye was treated 360 degrees with a frequency doubled Q-switched Nd:YAG laser. IOP was measured four times a day for a week before and after SLT. On the day of SLT, patients were required to measure the IOP in the evening to record any IOP spikes.

Icare Home recorded a significant reduction of 5.12mmHg in the mean IOP post SLT (95% confidence interval [CI] 3.75-6.50mmHg). The maximum IOP was also reduced by 6.14mmHg (95% CI, 3.07 to 9.21) with no IOP spikes recorded post-SLT. There was a reduction in IOP fluctuation post SLT by 1.07mmHg (95% CI, 0.24 to 1.89mmHg). No adverse effects for using the Icare HOME were reported by the study participants.

Researchers wrote that this methodology could be highly useful for facilitating safe follow-up of patients residing in remote and rural areas, thus reducing healthcare costs with better information on IOP.

Editors Note: The iCare Home is an amazing device for monitoring glaucoma patients on an ongoing basis and is now a reimbursable service. Excellent technology and highly recommended!

SOURCE: Awadalla Ms, Qassim A, Craig JE, et al. Using Icare® HOME tonometry for follow-up of patients with open-angle glaucoma before and after selective laser trabeculoplasty. Clin Exp Ophthalmol. 2019; Nov 20. [Epub ahead of print].




Factors of Retinal Re-Detachment and Visual Outcome After Intraocular Silicone Oil Removal in Silicone Oil Filled Eyes
 
 
This study aimed to evaluate the risk factors of retinal re-detachment and visual outcome after silicone oil removal (SOR) in silicone oil-filled eyes. A total of 57 patients who underwent pars plana vitrectomy (PPV) and silicone oil injection for retinal detachment (RD), and subsequently underwent a silicone oil removal procedure were included. Preoperative examinations were performed to determine the best-corrected visual acuity (BCVA) using the Snellen chart, while Icare was used to determine the intraocular pressure (IOP). In addition, slit-lamp examination of the anterior segment and lens, fundus pre-set lens examination for the posterior segment, color fundus photography, anterior segment photography and type B-ultrasonic scans were performed.

In five of 57 patients (8.77%), the retina re-detached following the removal of silicone oil. The factors for re-detachment were proliferative vitreoretinopathy (PVR) (two cases), formation of new retinal breaks (two cases) and incomplete membrane peeling (one case). The rate of retinal re-detachment (reRD) was statistically independent of the duration of silicone oil endotamponade. BCVA significantly improved following the removal of silicone oil. The duration of the silicone oil tamponade was significant in the development of cataract (27 eyes, 47.3%), emulsified oil in the anterior chamber (13 eyes, 22.8%) and glaucoma (seven eyes, 12.2%).

The improvement of visual acuity was discovered following the removal of the intraocular silicone oil. Investigators found that, although the duration of the intraocular silicone oil endotamponade had no effect on the rate of retinal attachment, a longer duration of silicone oil endotamponade could lead to the development of complications, such as cataract, emulsified oil in the anterior chamber and glaucoma, suggesting that the earlier removal of oil should be performed.


SOURCE: Hu S-Q, Jin H-Y, Zhu L-P. Factors of retinal re-detachment and visual outcome after intraocular silicone oil removal in silicone oil filled eyes. Curr Eye Res 2019; Nov 19. [Online ahead of print].

 

 

Comparing 10-2 and 24-2 Visual Fields for Detecting Progressive Central Visual Loss in Glaucoma Eyes with Early Central Abnormalities
 
 
To compare the ability of 10-2 visual field tests and central 12 locations of the 24-2 tests (C24-2) to detect central visual field progression in glaucoma eyes with early central visual field abnormalities, participants with both 10-2 and 24-2 tests performed on ≥3 visits over ≥1-year period were evaluated to estimate the longitudinal variability of 10-2 and C24-2 visual field mean deviation (MD). The variability estimates were then used to reconstruct real-world visual field results by computer simulations in a scenario where eyes had a baseline 10-2, and C24-2 MD was -2dB and exhibited various rates of change (-0.25, -0.50, -0.75 and -1.00dB/year); the time to detect these changes were evaluated using trend-based analyses.

Overall, the time to detect central visual field progression was reduced by 7-9% using the 10-2 compared with C24-2 MD values, equivalent to a total reduction of 0.1 to 0.3dB lost. For example, 90% of eyes with a central 10-2 or C24-2 MD loss of -0.50dB/year would be detected after 5 and 5.5 years of semi-annual testing respectively, or after 3.4 and 3.7 years respectively for eyes with a -1.00dB/year loss.

Trend-based analyses using 10-2 MD resulted in a mild reduction (7-9%) in the time to detect central visual field progression compared to C24-2 MD in glaucoma eyes with early central visual field abnormalities. Researchers wrote that further studies would be needed to determine whether other progression analyses can better exploit the increased sampling of 10-2 tests. They added that these findings provided evidence-based guidance on the potential value-add of 10-2 testing in the clinical management of glaucoma patients.


SOURCE: Wu Z, Medeiros FA, Weinreb RN, et al. Comparing 10-2 and 24-2 visual fields for detecting progressive central visual loss in glaucoma eyes with early central abnormalities. Ophthalmol Glaucoma. 2019;2(2):95-102.





News & Notes
 
CooperVision MiSight 1 Day Contact Lens for Childhood Myopia Coming to US in 2020
CooperVision announced it received FDA approval of its MiSight 1 day contact lens. The daily-wear, single-use contact lens is the first and only FDA-approved product clinically proven to slow the progression of myopia (nearsightedness or short-sightedness) when initially prescribed for children eight to 12 years old. CooperVision's research into MiSight 1 day's effectiveness was shown as part of a prospective, multi-center, double-masked, randomized multi-year study that enrolled 144 myopic children ages eight to 12 years from Singapore, Canada, the United Kingdom and Portugal, which accounts for the FDA's approved age range for initial fitting. Three-year peer-reviewed results published in Optometry and Vision Science in August 2019 indicated that use of MiSight 1 day was shown to slow myopia progression: 59% as measured by mean cycloplegic spherical equivalent (SE) and 52% as measured by mean axial elongation of the eye. MiSight 1 day will launch in the US, as part of a CooperVision myopia management initiative beginning in March 2020. Read more.



Aerie to Commence Phase IIb Study in Dry Eye Subjects in Late 2020
Aerie Pharmaceuticals announced the signing of an agreement for the acquisition of Avizorex Pharma, a Spanish ophthalmic pharmaceutical company developing therapeutics for the treatment of dry eye disease. AVX completed a Phase IIa study in dry eye subjects earlier this year with its lead product candidate, AVX-012. The active ingredient in AVX-012 is a selective agonist of the TRPM8 ion channel, a cold sensor and osmolarity sensor that regulates ocular surface wetness and blink rate. By stimulating these processes in a physiological manner, TRPM8 agonists have the potential to restore tear film stability and reduce discomfort in patients with dry eye. Positive results from the Phase IIa study support the therapeutic potential of AVX-012 to treat signs and symptoms of dry eye, and Aerie is planning to initiate a larger Phase IIb study in late 2020. 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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