Optometric Physician



Vol. 23, #39  •   Monday, October 10, 2022


Off the Cuff: Some Missing Details

First of all, the tributes and outpouring of love and support from the optometric community have been incredibly comforting. The stories people have shared about interactions they had with Arthur both in-person and via email conversations have made me laugh and cry at the same time. I could not possibly thank you all enough. Many of you requested more detail about what happened, especially since my last update was so positive. So here goes…

Arthur had surgery August 17, and 20 pounds of tissue including the kidney, the 15cm tumor, his gallbladder, 23 lymph nodes, a liver biopsy and some umbilical connective tissue were removed. Pathology reported renal cell carcinoma papillary type 2 with every piece of tissue sent to the lab having cancer in it. Many complications later, he was discharged to an in-patient physical therapy rehab. The morning he died I was on the phone with him all morning while I got ready to go to work and took the dogs to daycare. He said he was feeling great and was optimistic about physical therapy that day since he was already feeling stronger. We were making plans for what to do next after he came home. I got off the phone to see my first patient. Before I even finished, I got a call from the physical therapy rehab saying they were doing CPR, and he was unresponsive. I thought they called the wrong room's emergency contact. It wasn’t possible. I was just on the phone with him. I dropped everything and when I got there, they were still doing CPR. They never got him back.

Before the surgery, he said to me that he couldn’t believe he was going to die slowly with cancer because the men in his family always died quickly. His father had died suddenly with a heart attack bringing groceries into his house. His brother had died suddenly from a brain aneurysm. Oddly, it seems fitting that he followed in their footsteps and didn’t linger for months or years as the oncologist had predicted. So, as shocking and unexpected his passing was, it was exactly how he wanted it.

I am planning a Celebration of Life in November here in Arizona. Here is the link for RSVPs and the live stream. It is open to everyone who wants to participate.



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.




Determining the Best Management Strategy for Preventing Short-Term Effects of Digital Display Use on Dry Eyes

The ocular surface, tear film, and visual fatigue of 47 healthy individuals were assessed before and after reading on a laptop computer for 20 minutes under five different experimental conditions: control, instillation of artificial tears, taking a brief break, using a blue light screen filter, and blink control to assess and compare the effectiveness of four main management strategies for preventing short-term effects of digital display use on dry eye signs and symptoms. Measurements included the Ocular Surface Disease Index (OSDI) Questionnaire, 5-item Dry Eye Questionnaire (DEQ-5), tear meniscus height (TMH), noninvasive keratograph break-up time (NIKBUT), bulbar conjunctival redness, and pupil size.

Worse results were obtained after the control and blue light filter conditions in all variables (p≤0.037). A higher post-task DEQ-5 score (p=0.013) and TMH (p<0.0005) were obtained when taking a brief break compared with pretask, although the increase in symptoms was significantly smaller than that observed in the non-management control condition (p≤0.036). Similarly, a smaller increase in OSDI and DEQ-5 was obtained with the use of artificial tears and blink control in comparison with the control condition (p≤0.008), whereas a greater increase in DEQ-5 and decrease in NIKBUT was obtained for the blue light filter condition in comparison with the instillation of artificial tears (p=0.017) or blink control (p=0.008), respectively. Finally, a significantly lower post-task pupil size was obtained for all the conditions (p≤0.027).

The instillation of artificial tears and blink control were the best management strategies for preventing short-term effects of digital display use on dry eyes. Conversely, using a blue light filter did not offer any benefits.

SOURCE: Talens-Estarelles C, García-Marqués JV, Cerviño A, et al. Determining the best management strategy for preventing short-term effects of digital display use on dry eyes. Eye Contact Lens. 2022; Oct 1;48(10):416-23.





Association Between Systemic Omega-3 Polyunsaturated Fatty Acid Levels, and Corneal Nerve Structure and Function

Omega-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anti-inflammatory and neuroprotective properties. This study sought to determine the relationship between corneal parameters and systemic omega-3 fatty acid levels. Forty-seven participants with no/mild peripheral neuropathy (26 with diabetes and 21 without) underwent comprehensive ocular surface and systemic PUFA assessments. Corneal anatomical parameters were assessed using in vivo confocal microscopy. Corneal sensitivity was measured using non-contact esthesiometry. Relationships between systemic PUFA levels and corneal parameters were evaluated with multiple linear regression, adjusted for age, sex, neuropathy symptom score, and presence of diabetes and dry eye disease. The relationship between corneal nerve fiber length (CNFL) and corneal sensitivity threshold was evaluated.

The median Omega-3 Index, a measure of erythrocyte EPA and DHA, was 5.21% (interquartile range: 4.44 to 5.94%) in the study population. Mean (±SD) CNFL was 13.53±3.37 mm/mm2. Multiple linear regression showed that Omega-3 Index (β=0.33; p=0.02), age (β=-0.46; p=0.001) and diabetes (β=-0.30; p=0.03) were independently associated with CNFL (R2=0.39, p=0.002). In a separate model, DHA (β=0.32; p=0.027) and age (β=-0.41; p=0.003) were associated with CNFL (R2=0.37, p=0.003). Neither systemic EPA nor omega-6 fatty acid levels correlated with CNFL. There was no association between PUFA levels and corneal sensitivity or corneal immune cell density. A negative correlation was found between CNFL and corneal sensation thresholds to a cooled stimulus in diabetes participants, in the central (ρ=-0.50; p=0.009) and peripheral (ρ=-0.50; p=0.01) cornea.

Researchers wrote that a positive relationship between the systemic Omega-3 Index and corneal nerve parameters suggests omega-3 PUFA intake may influence corneal nerve architecture.

SOURCE: Britten-Jones AC, Craig JP, Anderson AJ, et al. Association between systemic omega-3 polyunsaturated fatty acid levels, and corneal nerve structure and function. Eye (Lond). 2022; Sep 26. [Epub ahead of print].




Reduction of Disinfection Efficacy of Contact Lens Care Products on the Global Market in the Presence of Contact Lenses and Cases

Sight-threatening infections can be caused by pathogenic microorganisms colonizing the cornea, leading to microbial keratitis (MK). These microorganisms can be introduced to the eye via improper contact lens use and care. MK can also result from ineffective contact lens care solutions (CLCs), even if the patient is following best practice guidelines. Therefore, it is critical to understand the differences between the effectiveness of popular CLCs on the global market. Following the International Standards Organization standards 14,729 and 18,259, bacteria (Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus), fungi (Candida albicans, Fusarium strains) and Acanthamoeba strains were inoculated into each CLC with and without contact lenses, and held for the manufacturer's stated disinfection time. Plate counts were conducted to determine the number of surviving microorganisms.

All CLCs examined met the primary log reduction criteria during stand-alone testing for Pseudomonas, Staphylococcus, Candida and Fusarium. renu Multiplus, All Clean Soft, and Kombilösung Super did not meet the primary criteria when challenged with Serratia. Only OPTI-FREE Express exceeded four log reduction for both strains of Acanthamoeba tested. Investigators noted a substantial reduction in disinfection efficacy when CLCs were challenged with Fusarium in the presence of lenses and cases versus stand-alone testing. OPTI-FREE Express demonstrated significantly less net log reduction loss than the other four CLCs tested.

Investigators reported, of the popular CLCs on the global market, the product that relies on dual biocides polyquaternium-1 and myristamidopropyl dimethylamine demonstrated the highest disinfection efficacy in microbial disinfection challenges in the absence and presence of contact lenses.

SOURCE: Walters R, Campolo A, Miller E, et al. Reduction of disinfection efficacy of contact lens care products on the global market in the presence of contact lenses and cases. BMJ Open Ophthalmol. 2022 Jun;7(1):e000955.







Industry News

J&J Vision Expands Access to Myopia Management for More Patients with Abiliti Overnight Lenses

Johnson & Johnson Vision announced FDA approval of an expanded range of Acuvue Abiliti Overnight Therapeutic Lenses for Myopia Management, now up to 6.00 diopters (previously 4.00 diopters). The company also announced greater availability of the lenses nationwide at Vision By Design 2022, an annual myopia control and management meeting that took place September 28 and October 2 in Bellevue, Wash. Read more.

NovaSight Announces FDA Nod for CureSight Digital Amblyopia Therapy

NovaSight announced the FDA cleared CureSight, a digital therapy device for amblyopia. CureSight is an eye-tracking-based system aimed at improving visual acuity and stereo acuity by training the visual system to use both eyes simultaneously. FDA clearance was based on visual outcomes data from a multicenter, randomized, controlled trial in which 103 participants ages 4 to <9 were randomized to CureSight or eye patching. The digital device was shown to be non-inferior to patching for amblyopia treatment in children. Learn more.

Santen & UBE Get FDA Nod for Omlonti 0.002%

Santen announced FDA approval of Omlonti (omidenepag isopropyl ophthalmic solution) 0.002% eye drops for the reduction of elevated intraocular pressure in patients with primary open-angle glaucoma or ocular hypertension. Omlonti 0.002%, is a “relatively selective” prostaglandin E2 receptor agonist that increases aqueous humor drainage through the conventional (or trabecular) and uveoscleral outflow pathways. Learn more.