Optometric Physician

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


Volume 20, Number 47

Monday, November 9, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: Will Presbyopia Save Optometry?

######### Proinflammatory and Angiogenesis-related Cytokines in Vitreous Samples of Highly Myopic Patients
######### Is the Axial Length a Risk Factor for Post-LASIK Myopic Regression?
  Anti-retinal Autoantibodies in Myopic Macular Degeneration: a Pilot Study
######### News & Notes

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Off the Cuff: Will Presbyopia Save Optometry?

Long ago, before any of us were born, optometry took root in the back of jewelry stores in the big cities of the East and in wagons that went from town to town in the old West. While ametropia certainly existed and was likely treated by our more intrepid predecessors, the vast majority of eyeglass fitting was to correct for presbyopia. In that sense, presbyopia gave optometry its start, and today, presbyopia may help our profession survive to see the next century.

Most of you likely know that a number of drugs are currently being developed to treat presbyopia. Several have already shown pretty impressive results. While I think it’s natural for some of us to initially view this with a tinge of panic, I can assure you that all isn’t lost. Rather than seeing this as yet another thing to interfere with patient care and compete with our practices, we should view these developments as a means to help fill our offices with new patients that we would not have otherwise seen. These advancements will also reinforce our profession’s importance as the primary provider of eyecare, both refractive and medical.

Consider the impact of a drug that effectively pushes back presbyopia a decade or two for contact lens wearers. How many contact lens patients are lost each year to presbyopia despite major advances in multifocal lenses? With a presbyopia drop, a successful spherical or toric lens patient will be able to wear a lens they are already happy with for an additional decade or more. The power of sustained near vision will be multiplied by developments in contact lens materials science yielding improved comfort and wearing time. Better yet, all of these patients will have to return to refill their presbyopia prescriptions.

A presbyopia drug will also serve as another gateway to medical eyecare for colleagues who are having difficulty bridging that gap. While friends who once supported us increasingly compete with us, presbyopia drugs may be the disruptive technology that finally turns the tables in favor of the independent provider. All we need to do is embrace the opportunity and see it clearly as it comes closer into focus.


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.



Proinflammatory and Angiogenesis-related Cytokines in Vitreous Samples of Highly Myopic Patients

To determine the concentrations of vitreous proinflammatory cytokines and angiogenesis-related growth cytokines in highly myopic (HM) patients and controls, vitreous humor (VH) was obtained from patients during vitrectomy for rhegmatogenous retinal detachment (RRD), myopic retinoschisis (MRS), idiopathic epiretinal membrane (ERM) or macular hole (MH). High myopia was defined as an axial length (AL) of ≥26 mm and a spherical equivalent refractive error more negative than -6D. A multiplex fluorescent-bead-based immunoassay was employed to measure the levels of 29 designated cytokines. The results were compared across groups.

Seventy-eight VH samples were collected from 78 patients (36 HM vs. 42 controls). Vascular endothelial growth factor (VEGF) was significantly higher in the VH samples from HM patients than in those from the controls. Five inflammation-related factors, interferon γ (IFN-γ), interleukin 6 (IL6), IFN-γ-induced protein 10 (IP-10), eotaxin, and macrophage inflammatory protein 1α (MIP-1α), were significantly higher in the HM group than in the control group. The vitreous concentrations of well-known angiogenic growth factors monocyte chemoattractant protein 1 (MCP1) and IL5 were significantly elevated in the VH samples from HM patients.

Researchers wrote that proinflammatory cytokines and angiogenic growth factors were elevated in the VH of HM patients, suggesting that an elevated inflammatory status and higher levels of angiogenic factors were present in eyes with HM.

SOURCE: Wei Q, Zhuang X, Fan J, et al. Proinflammatory and angiogenesis-related cytokines in vitreous samples of highly myopic patients. Cytokine. 2020; Oct 28. [Epub ahead of print].


Is the Axial Length a Risk Factor for Post-LASIK Myopic Regression?

The clinical records of patients who experienced LASIK to correct myopia from January 2016 to January 2018 were analyzed to assess the relationship between the axial length and post-LASIK regression in myopic patients. This was a retrospective case series study conducted at a private eye centre, Ismailia, Egypt. The patients were operated on, examined and followed up one year by one surgeon (AAG).

This study included 1,219 patients (2,316 eyes) with myopia. Mean ± SD of preoperative spherical equivalent (SE) was - 4.3 ± 2.1D, range (- 0.50 to - 10D). Mean ± SD age of the patients was 26.4 ± 6.8 years, range (21 to 50 years). Male to female ratio was 30.5 to 69.5%. The cumulative incidence rate of myopic regression according to the medical records of the patients was 25.12% (582 eyes out of total 2,316 eyes) along the two years of this study (12.6% per year). Of the total patients, 14.94% had preoperative high myopia, 35.84% had preoperative moderate myopia, and 49.2% had preoperative low myopia. Of the patients with myopic regression, 52.6% had pre-operative high myopia, 34% had pre-operative moderate myopia and 13.4% had pre-operative low myopia. The mean ± SD of the axial length of the patients with myopic regression was 26.6 ± 0.44 mm, range (26.0 to 27.86 mm), while the mean ± SD of the axial length of other patients with stable refraction was 24.38 ± 0.73 mm, range (22.9 to 25.9 mm).

Investigators reported that preoperative high axial length increased the risk of myopic regression after LASIK.

SOURCE: Gab-Alla AA. Is the axial length a risk factor for post-LASIK myopic regression? Graefes Arch Clin Exp Ophthalmol. 2020; Oct 31. [Epub ahead of print].




Anti-retinal Autoantibodies in Myopic Macular Degeneration: a Pilot Study

The aim of this study was to evaluate the frequency and types of anti-retinal autoantibodies (ARAs) in highly myopic patients and to explore any association between ARAs and the severity of myopic macular degeneration (MMD). This was a clinic-based study of 16 patients with high myopia (spherical equivalent worse than -6 dioptres or axial length (AL) ≥ 26.5 mm) recruited from the High Myopia clinic of the Singapore National Eye Centre. MMD was graded from fundus photographs according to the Meta-analysis for Pathologic Myopia (META-PM) classification. Severe MMD was defined as META-PM category 3 or 4. AL and logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) were measured. Sera were obtained from subjects and analyzed for the presence of ARAs with the western blot technique.

The mean AL was significantly longer in patients with severe MMD (n=8) than those without severe MMD (n=8) (31.50 vs. 28.51). There was at least one ARA identified in all patients. The most common ARA was anti-carbonic anhydrase II (anti-CAII), present in nine patients (56.3%). Anti-CAII was detected in more patients with severe MMD than those without (75 vs. 37.5%). logMar BCVA was also worse in subjects with anti-CAII (0.5 ± 0.38 vs. 0.22 ± 0.08). The number of ARAs significantly correlated with increasing AL.

Researchers wrote that ARAs were prevalent in patients with high myopia, and this increased with increasing AL. In particular, anti-CAII antibodies were highly prevalent in patients with severe MMD, suggesting that ARAs may be associated with MMD. Researchers added that further studies would be necessary to confirm these observations in larger cohorts.

SOURCE: Sim SS, Wong CW, Hoang QV, et al. Anti-retinal autoantibodies in myopic macular degeneration: a pilot study. Eye (Lond). 2020; Oct 28. [Epub ahead of print.]


News & Notes

SECO International Changes SECO 2021 Dates
SECO International announced that it changed the timing of SECO 2021. Originally scheduled for February 24 to 28, SECO 2021 will now take place April 28 to May 2 at the Georgia World Congress Center in Atlanta, and will be offered as an in-person event with options for virtual attendance. Max Raynor, OD, president of SECO International, issued the following statement:
“As we look toward 2021, our priority is to deliver a safe and successful meeting where we can come together to access emerging eyecare trends, explore the latest technologies, gain hands-on training, and forge new connections with the eyecare community. The decision to move the dates of our annual Congress from February to April was not taken lightly. Following discussion with the Board of Trustees, input from members, and feedback from our key partners, the final sentiment indicated a strong desire for a rescheduled in-person event later in the Spring. We are unified in our decision that adjusting the date will allow SECO and the industry to host a more successful meeting. SECO International will implement several infection control and prevention guidelines for SECO 2021 and will ensure our plans follow recommendations from public health experts and standards set by the federal, state, and local governments. We expect that safety guidelines and measures will continue to evolve and will communicate these details as they become available.”
In addition to SECO’s safety protocols, the Georgia World Congress Center has implemented a program of stringent processes for cleaning, disinfection and infectious disease prevention under its GBAC STAR™ facility accreditation. Registration for SECO 2021 will open in early December. Learn more.



IDOC Teams with CooperVision to Capture ECP Stories
IDOC has teamed with contact lens manufacturer CooperVision to create a campaign (Dream it. Do it. Share it.) to encourage eye health practitioners to tell what attracted them to their field and to tell their personal stories. The organizations sought out professionals who had uplifting stories to share about their lives and their work. A production team captured those stories and created a growing playlist of short stories. One of the first contributors to the campaign, Jennifer Stewart, OD, optometrist and partner at Norwalk Eye Care in Norwalk, Conn., described in her video how she found a way to combine her love of sports with her passion for her profession. Another early contributor, Andrew Neukirch, OD, optometrist and owner of Carillon Vision Care in Glenview, Ill., tells how optometry represented a new life direction for him. View the stories.









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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