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


Volume 18, Number 42

Monday, October 16, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: True Enlightenment
######### Correlation Between Presence of Primary Iris & Ciliary Body Cysts & IOP
######### Factors Effecting Ortho-K for Controlling Juvenile Myopia Progression
######### Patient Awareness of Cataract & Age-related Macular Degeneration
######### News & Notes

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Off the Cuff: True Enlightenment

Among the things most of us love about optometry is the opportunity for lifelong learning Personally, rarely a day goes by where I haven’t learned something new or figured something out. A passion for learning and, in turn, teaching drove what has been a decades-long career on the podium.

As both student and teacher, I never gave much thought to the learning process, at least until recently. Learning was all about absorbing information from others while carefully examining my own insights and analyzing my missteps. I naturally questioned everything I learned and shared only what I knew for certain.

My narrowing clinical focus has given rise to my questioning more and more of what I believe and, sometimes, what others teach. With some concepts, I find myself humbled by the elegance and complexity of what I now understand; while others leave me perplexed and questioning why some colleagues choose to overcomplicate what seems so simple to me.

Scientific evidence is the foundation of clinical practice; yet; oddly, the exact same evidence is often used to support completely contrary clinical perspectives. With similar signs and symptoms, the same “dry eye” is an aqueous deficiency disorder for some and secondary to meibomian gland dysfunction for others. The same glaucoma can be elevated intraocular pressure or decreased ocular perfusion, depending on your perspective.

One thing I know for certain is that when it comes to patient care a good clinician’s obligation is to question everything. Constantly questioning what you know is rarely easy or pleasant, but it is the only path to true enlightenment.

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.


Correlation Between Presence of Primary Iris & Ciliary Body Cysts & IOP
The objective of this study was to examine the correlation between the presence of primary iris-ciliary cysts and intraocular pressure. Sixty patients with near-sightedness undergoing routine examinations for laser vision correction in the researchers’ hospital in 2003 were enrolled. Patients with known high intraocular pressure and risk of glaucoma were excluded from the study. A total of 119 eyes were examined by the Ultrasound Biomicroscope (UBM), and presence of primary iris-ciliary cysts was confirmed. Intraocular pressure was measured by using non-contact tonometer for each eye in triplicate. Through Pentacam correction of intraocular pressure using the Ehlers formula, the influence of the thickness of central cornea on intraocular pressure was excluded.

Among all participants, 62 eyes (52.1%) had high myopia, 57 eyes (47.9%) had low and moderate myopia, 27 eyes (22.7%) had single cyst, 20 eyes (16.8%) had multiple cysts, and 72 eyes (60.5%) were free from cysts. Moreover, the intraocular pressure was found within the normal range in 72 eyes (60.5%) and was abnormally high in 47 eyes (39.5%).

The results showed that the presence of primary iris-ciliary cysts and the intraocular pressure were positively correlated. Researchers wrote that these findings might prove useful for prediction and screening of high intraocular pressure.

SOURCE: Xue KC, Hu DD, Zhao L, et al. Correlation between presence of primary iris- and cilliary body cysts and intraocular pressure. Eur Rev Med Pharmacol Sci. 2017;21(18):3985-9.


Factors Effecting Ortho-K for Controlling Juvenile Myopia Progression

Investigators aimed to identify factors influencing the therapeutic outcome of orthokeratology on controlling juvenile myopia progression and the risk factors for complications. Myopic patients (n=724) in Shenzhen Second Hospital from January 2011 to January 2016 who were fitted with orthokeratology lenses and followed-up for six to 65 months were reviewed retrospectively. Univariate and multivariate logistic regression analyses were used to screen for the factors that can improve treatment outcome and prevent the development of complications.

Patients in whom the orthokeratology treatment was effective displayed a shorter myopia time, smaller diopter and corneal curvature, larger corneal endothelium density, high proportion of overnight wear and longer wearing times compared with patients whose treatments were ineffective. Additionally, wearing Ortho-k for six or 12 months yielded improved corrective effects and achieved higher comfort levels. Logistic regression analyses showed that myopia time, diopter, corneal curvature e value, corneal endothelium density, time with Ortho-k and corrective effect after wearing Ortho-k for six or 12 months were all independent factors influencing the treatment effects. Results showed corneal curvature, anterior chamber depth and central corneal thickness were independent risk factors.

This study systematically identified the factors leading to effective treatments as well as those carrying a risk for complications, to provide guidance for the prescription and follow-up of orthokeratology in the treatment of juvenile myopia.

SOURCE: Kong Q, Guo J, Zhou J, et al. Factors determining effective orthokeratology treatment for controlling juvenile myopia progression. Iran J Public Health. 2017;46(9):1217-22.


Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia


Patient Awareness of Cataract & Age-related Macular Degeneration
Age-related eye disease is often considered part of the natural aging process. Lack of awareness of eye conditions can result in missed treatment. Researchers investigated the rates of awareness of cataract and age-related macular degeneration—the most common age-related eye-diseases—and the associated factors among elderly Koreans. They identified 7,403 study subjects (≥40 years old) with cataract or age-related macular degeneration based on ophthalmic examination results during the fifth Korean National Health and Nutrition Examination Survey conducted between 2010 and 2012. They assessed whether patients were aware of their eye condition based on a previous diagnosis by a physician.

The average awareness rate over the three-year study period was 23.69% in subjects with cataracts and 1.45% in subjects with age-related macular degeneration. Logistic regression analyses showed that patients with cataracts were more likely to recognize their condition if they had myopia (odds ratio, 2.08), hyperopia (odds ratio, 1.33), family history of eye disease (odds ratio, 1.44) or a past eye examination (odds ratio, 4.07-29.10). The presence of diabetes mellitus was also a significant predictor of patient awareness of cataract (odds ratio, 1.88).

Poor patient recognition of eye disease among the Korean elderly highlighted the seriousness of this potential public health problem in an aging society. Pre-existing eye-related conditions and diabetes were significant predictors of awareness. As such, researchers determined that patients in frequent contact with their doctors had a greater chance of detecting eye disease.

SOURCE: Lee H, Jang YJ, Lee HK, et al. Patient awareness of cataract and age-related macular degeneration among the Korean elderly: A population-based study. Korean J Ophthalmol. 2017; Aug 26. [Epub ahead of print].

News & Notes
Bio-Tissue Releases Prokera Medical Coding & Compliance Guide
Bio-Tissue announced a new Prokera Medical Coding and Compliance Guide—introduced at the American Academy of Optometry’s annual meeting in Chicago—is available for practitioners. John Rumpakis, OD, MBA, an expert in medical coding and compliance issues in eye care, developed the guide, which provides practitioners with information needed for the medical coding and billing of Prokera, including: medical necessity and importance, ocular use and approval, MIPS and health economics, considerations for insurance companies, and Medicare modifiers and more. Read more.

Johnson & Johnson Vision Showcases Innovation at AAO
Johnson & Johnson Vision showcased the newest additions to its eye health portfolio, including Acuvue Brand Contact Lenses, the Blink Family of Products, cataract surgical technologies and medical devices from TearScience at American Academy of Optometry annual meeting. The company also supported the presentation of papers and posters highlighting new clinical and market research in eye health. Read more.


Alcon Celebrates World Sight Day
Alcon celebrated World Sight Day on Oct. 12 with activities planned around the world, including the Cycle for Sight 20/20 Challenge taking place at the American Academy of Optometry annual meeting in Chicago and at Alcon facilities in several countries. One arm of this year’s Cycle for Sight 20/20 Challenge took center stage at the AAO annual meeting where Academy members and Alcon leaders went head-to-head on stationary bikes for 2,020 minutes to trigger a $25,000 donation from the Alcon Foundation to the AAO Foundation to fund optometric education and research. Read more.

PanOptica Secures $11 Million to Advance PAN-90806
PanOptica secured $11 million in a Series B financing to enable clinical advancement of PAN-90806, a small-molecule, anti-vascular endothelial growth factor eye drop for the treatment of neovascular eye diseases. The additional financing, provided by Third Rock Ventures and SV Health Investors, will enable a Phase I/II study of a next-generation formulation of PAN-90806 as monotherapy for up to three months of treatment in patients with neovascular age-related macular degeneration. Read more.

CCLR Renamed Centre for Ocular Research & Education
For nearly three decades, optometry and ophthalmology communities have partnered with the Centre for Contact Lens Research at the University of Waterloo’s School of Optometry & Vision Science on pioneering studies. Beginning in January 2018, the organization will adopt a new name: the Centre for Ocular Research & Education. A new logo echoes CORE’s primary focus on the eye. The center was established in 1988. Read more.




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Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia




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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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