Optometric Physician

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


Volume 20, Number 44

Monday, October 19, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: A Dose of Reality

######### Intraocular Pressure Reduction After Phacoemulsification
######### Prevalence of Vision Loss and Associations with Age-Related Eye Diseases Among Nursing Home Residents Ages ≥65 Years
  The Role of Estrogen in Primary Open-angle Glaucoma
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: A Dose of Reality

For those still waiting for the new normal, I think it’s going to be a very long wait. As much as I would like to greet a patient and see their face as I examine them, I don’t expect that to happen any time soon. Yes, I want to get on a plane and go somewhere, give a talk, chat with colleagues, have dinner and fly back in time for patients the next day. Sadly, I know that also isn’t happening any time soon.

As the reality has settled in, I have come to accept it and even appreciate some aspects. I enjoy spending time at home and with Shannon. I just wish there were more time and more things to do. For some reason I am busier than I was when I was busy before. Some regular readers are thinking I’ve finally gone mad. Stir crazy from being cooped up too long. Hypoxic from excessive mask wearing. Well to be frank, all of the above may be true, but it doesn’t change the facts. The facts are both stark and sobering.

A paper in the October Lancet Infectious Diseases reported the first confirmed case of COVID-19 reinfection in the US, in a 25-year-old Nevada man whose second infection was far more severe than his first. Despite billions of dollars invested in finding a COVID vaccine, it seems increasingly likely that the rapidly mutating virus is either too wily, or more likely too sophisticated, for a vaccine to be effective. Almost a year into it, modern medicine is still struggling to understand COVID. Remdesivir, a few months ago was believed to be a cure. Earlier today it was reported to be ineffective. A September report by the CDC not widely covered by the US media, found that 70% of 154 "case-patients" who tested positive for COVID-19, became infected despite following CDC guidelines including wearing a mask or facial coverings. Infection numbers are rising dramatically throughout most of the US, and much of Europe is starting to shut down again from a new wave of infection. What the virus lacks in pure lethality it more than makes up for in economic and political misery.

The truth is that once the virus escaped China nothing anyone would have done could have altered its long-term trajectory or global impact. Life as we know it has fundamentally changed and may never be the same again. We need to face that possibility. Don’t get me wrong. We will learn to live with COVID, and likely even develop an effective treatment for it, but that won’t be for a long time. For now, there are things that we can and must do. Next week I will share my thoughts on how optometry can survive, and perhaps even thrive, during the continued pandemic.


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.



Intraocular Pressure Reduction After Phacoemulsification

Phacoemulsification has been linked to lowered intraocular pressure (IOP) in patients with glaucoma, ocular hypertension, anatomic narrow angles and in glaucoma suspects ("glaucoma"), but the reported magnitude of change has varied. Patients with glaucoma who underwent phacoemulsification ("surgical") between June 2010 to May 2015 were matched one-to-one to patients who did not ("non-surgical") on age, gender, type of glaucoma, baseline IOP, and number and type of glaucoma medications. Electronic medical record information was used to compare the matched surgical and non-surgical groups. Main outcome measures were change in IOP, change in number of glaucoma medications and likelihood of a glaucoma procedure within 36 months after phacoemulsification. IOP measures were obtained from Goldmann applanation tonometry when available (45%), and otherwise from Icare, Tono-pen, noncontact tonometry and pneumotonometry.

Among 16,169 matched pairs, average IOP after the index date was lower in the surgical than non-surgical group throughout follow-up to 36 months. The difference was greatest during one to 18 months, during which IOP increased by 0.22 mmHg from 16.49 mmHg in the average non-surgical patient; and decreased by 0.99 mmHg from 16.50 mmHg in the average surgical patient (difference-in-difference, 1.21 with 95% CI, 1.12 to 1.30 mm Hg). The difference-in-difference was greatest for patients with ocular hypertension (2.00 mmHg) and for patients with preoperative IOP ≥20 (2.46 mmHg). A subgroup analysis with matched patients using only Goldmann applanation tonometry found similar results. By 30 to 36 months, 5% fewer surgical patients used an ophthalmic medication. In the surgical group, the odds of selective laser trabeculoplasty was reduced in patients with ocular hypertension or glaucoma suspect, while the odds of glaucoma surgery were elevated in surgical patients with primary open-angle glaucoma.

In this community-based study, the association of phacoemulsification for cataract with IOP reduction was lower than in past referral-based studies. Researchers wrote that surgeons should expect to reduce intraocular pressure approximately 1 to 2 mmHg with phacoemulsification in patients with preoperative IOP less than 20 mmHg.

SOURCE: Carolan JA, Liu L, Alexeeff SE, et al. Intraocular pressure reduction after phacoemulsification: a matched cohort study. Ophthalmol Glaucoma. 2020; Oct 9:S2589-4196(20)30265-9. [Epub ahead of print.]


Prevalence of Vision Loss and Associations with Age-Related Eye Diseases Among Nursing Home Residents Ages ≥65 Years

A cross-sectional, retrospective study of nursing home patients examineed data from Delaware nursing homes to determine prevalence of age-related eye diseases (AREDs), vision impairment and blindness, and to compare the findings with the results of 11 US investigations of vision and eye health in nursing homes. Twenty nursing homes in Delaware participated in the study, yielding comprehensive eye examination records for 2019 study participants.

The overall prevalence of vision impairment or blindness was 63.8% and was greater than 60% for each age, sex and race category. Prevalence of vision impairment or blindness was 68.4% among patients with cataracts, 69.4% among patients with macular degeneration, 70.5% among patients with glaucoma and 68.4% among patients with diabetic retinopathy. Prevalence of blindness was 14.1%. Among patients with AREDs, prevalence of blindness ranged from 15% for patients with cataracts to 22.6% for patients with diabetic retinopathy. When compared with other investigations, investigators found wide variation in vision and eye factors reported, and wide variation in the prevalence of those factors. Only four studies diagnosed both AREDs and visual function. Seven studies reported AREDs, and seven reported vision impairment and/or blindness. Vision impairment or blindness ranged from 29% to 67%; cataract ranged from 32% to 83%; macular degeneration ranged from 4.6% to 70.7%. Glaucoma ranged from 5.3% to 41.4%; diabetic retinopathy ranged from 1.7% to 3.1%.

Comprehensive eye examinations showed that vision impairment and blindness affected 63.8% of nursing home residents. Compared with other studies, there was a wide range of vision factors reported, and wide variation in the prevalence of vision impairment or blindness, and AREDs. This investigation suggested the importance of eye care in nursing homes and the importance of reporting standard vision and eye health factors to inform policy and practice.


SOURCE: Monaco WA, Crews JE, Nguyen ATH, et al. Prevalence of vision loss and associations with age-related eye diseases among nursing home residents aged ≥65 years. J Am Med Dir Assoc. 2020; Oct 8:S1525-8610(20)30742-8. [Epub ahead of print.]




The Role of Estrogen in Primary Open-angle Glaucoma

Estrogen is essential in maintaining various physiological features in women, and a decline in estrogen levels is known to give rise to numerous unfortunate symptoms associated with menopause. To alleviate these symptoms, hormone replacement therapy with estrogen is often used and has been shown to be fruitful in improving quality of life in women suffering from postmenopausal discomforts. An often-forgotten condition associated with menopause is the optic nerve disorder, glaucoma. As such, estrogen may also have an impact in maintaining the retinal ganglion cells (RGCs), which make up the optic nerve, thereby preventing glaucomatous neurodegeneration. This review aimed to provide an overview of possible associations of estrogen and the glaucoma subtype primary open-angle glaucoma (POAG) by evaluating the current literature through a PubMed-based literature search. Multiple in vitro and in vivo studies of RGC protection, as well as clinical and epidemiological data concerning the well-defined retinal neurodegenerative disorder POAG were reviewed.

Investigators reported that, overall, deficiencies in retinal estrogen may potentially instigate RGC loss, visual disability and eventual blindness. They added that estrogen replacement therapy may therefore be a beneficial future treatment. However, they suggested that more studies are needed to confirm the relevance of estrogen in glaucoma prevention.

SOURCE: Fotesko K, Thomsen BSV, Kolko M, et al. Cell Mol Neurobiol. 2020; Oct 11. [Epub ahead of print].

News & Notes
Prevent Blindness Names Jobson’s Ferrara Person of Vision Award Recipient
Prevent Blindness has chosen Marc Ferrara, CEO of information services, Jobson Medical Information, as the recipient of the 2021 Prevent Blindness Person of Vision Award. The award will be presented on May 26, 2021, at the Prevent Blindness Person of Vision Dinner in New York City in conjunction with Vision Expo East. All proceeds will go to support the sight-saving programs from Prevent Blindness. The Prevent Blindness Person of Vision Award recognizes an individual or organization whose inspired outlook champions healthy vision and its importance for a healthy life. Ferrara has worked at Jobson Publishing for more than 30 years. In 1989, he was named editor-in-chief of 20/20 magazine and was later named publisher of the magazine. Later, he helped launch Sightstreet, one of the optical industry's initial ventures in web-related initiatives, and later managed VisionWeb, the industry's leading wholesale portal. Ferrara served as president of JHI's worldwide Optical Group since 2005, with wide-ranging responsibilities including 20/20, Frames Data, Vision Monday, Review of Optometry, Review of Ophthalmology, Jobson Research, Jobson Internet Solutions and Jobson's international business in Europe, Latin America and Asia. At Prevent Blindness, Ferrara has served on various committees including as chair of the 2017 Person of Vision Committee, honoring Marge Axelrad, senior vice president, editorial director at Vision Monday/Jobson Optical Group. He has also volunteered for numerous Prevent Blindness events, including the annual Swing Fore Sight golf outings. Read more.


Bausch Health Licenses Eyenovia's Investigational Treatment, Announces with Bausch + Lomb and BHVI Global Licensing Agreement for Myopia Control Contact Lens
Bausch Health Companies and Eyenovia announced that an affiliate of Bausch Health acquired an exclusive license in the US and Canada for the development and commercialization of an investigational microdose formulation of atropine ophthalmic solution, which is being investigated for the reduction of pediatric myopia progression in children ages 3 to 12. This investigational formulation of atropine is delivered with Eyenovia's proprietary Optejet dispenser technology. Read more.

In addition, Bausch Health Companies and Bausch + Lomb, along with BHVI, an Australian not-for-profit organization with an international focus on vision research, announced that an affiliate of Bausch Health acquired an exclusive license for a myopia control contact lens design developed by BHVI. Bausch + Lomb will pair BHVI's novel contact lens design with its advanced contact lens technologies to develop potential contact lens treatments designed to slow the progression of myopia in children. Read more. Read more.

  New World Medical Registers KDB Glide for Goniotomy
New World Medical announced FDA registration of the KDB Glide as a class 1 medical device, designed to give surgeons a refined, precise experience performing excisional goniotomy for treatment of glaucoma. The device improves on the successful Kahook Dual Blade technology by adding features such as a rounded heel, tapered sides and a smaller footplate in order to optimally interface with Schlemm’s canal for precise excision with the instrument's dual blades, even in variable anatomy. 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



Optometric Physician™ (OP) newsletter is owned and published by Dr. Arthur Epstein. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 19 Campus Boulevard, Newtown Square, PA 19073.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add Optometricphysician@jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Optometric Physician.

E-mail optometricphysician@jobson.com or FAX your news to: 610.492.1039.

For information on advertising in this e-mail newsletter or other creative advertising opportunities with Optometric Physician, please click here for advertising information.