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


Volume 17, Number 40

Monday, October 2, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: The Important Things
######### The Impact of Scleral Contact Lens Vault on Visual Acuity and Comfort
######### Assessment of Eye Drop Instillation Technique in Glaucoma Patients
######### Glaucoma, Depression and Quality of Life: Comorbidities and Assessments, and Multidisciplinary Plan Treatment
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: The Important Things

This was not a particularly good week for optometry. I had planned on sharing some of these pressing issues, but decided against it. I realized I had other things I wanted to say. I decided to write about some of the truly important things—the bonds of friendship, pride in others and how important we can be in other people’s lives.

Earlier this week I spoke at Bausch + Lomb’s B+Lieve event in Philadelphia. I’ve had the honor of speaking at several of these events this year, sharing the podium with Drs. George Grobe of Valeant Pharmaceuticals R&D and Dan Hook of B+L R&D, where I talked about innovation and the clinical significance of their breakthrough work in lens and materials design.

One treat for me at these events is that I always connect with friends from around the country. Such was the case in Philly, but two things made this last B+Lieve event of the year truly special. First, my best friend from optometry school, Harold Schiff, was there. Incredibly, we didn’t skip a beat. After all of these years, we were still as strongly connected as we were when we rode the F train together into school each morning. We shared stories about our families and talked about old times. It was great!

If that were not enough, one of our favorite professors from SUNY’s early years, George Obssuth, was also there. I wrote about George a few years back after reconnecting with him at a CE event in Aspen. He saw the piece only after a patient, who had found the editorial online, tracked me down and asked me to help find George. She wanted to thank him for changing her life when she was a child. She did.

So there we were, George nearly 80 and sharp as ever, and Harold and I beside him. George shared how proud he was of us, but he actually didn’t have to utter a word. Seeing him visibly swell with pride was gratifying beyond words. In turn, I got to share how important he was to me and how he remains a role model to this day.

My long flight home had me thinking of how lucky I am to have had such amazing mentors and lasting friendships. Sometimes we all need to be reminded of what truly is important. The news can wait for next week.

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.


The Impact of Scleral Contact Lens Vault on Visual Acuity and Comfort
This study assessed how varying degrees of corneal clearance of scleral contact lenses (ScCL) impact visual acuity (VA) and comfort in patients with corneal ectasia. Three ScCL were fitted to 20 subjects with previous diagnosis of either keratoconus (n=18) or pellucid marginal degeneration (n=2). Fitting of ScCL was based on corneal sagittal height (CSH) measured with Visante OCT at a 15-mm chord on the horizontal meridian. To select the ScCL from the diagnostic lens set, values of 325μm, 375μm and 425μm were randomly added in sequence to CSH. Subjects wore ScCL for one hour. Central corneal clearance (CCC) and topographic corneal clearance (TCC) along the vertical meridian were assessed using an ultralong optical coherence tomographer. High-contrast VA (HCVA) and low-contrast VA (LCVA) were measured using a logarithm of the minimum angle of resolution VA chart, and comfort ratings were obtained with a standard comfort scale (zero to 100).

Mean CSH in the horizontal meridian was 3.78mm ± 0.53mm (range: 3.33 to 4.17) at a 15-mm chord. Mean CCC was 190μm ± 100μm (TCC: 160μm ± 94μm at +3mm; and 180μm ± 94μm at -3mm), 360μm ± 120μm (TCC: 260μm ± 100μm at +3mm; and 330μm ± 110μm at -3mm), and 450μm ± 170μm (TCC: 320μm ± 120μm at +3mm; and 400μm ±120μm at -3mm) for each lens. The mean HCVA for lenses one, two and three were 0.05 ± 0.12, 0.07 ± 0.11 and 0.11 ± 0.08 respectively, which were significantly different. Tukey post hoc analysis showed that this difference was only significant between lenses one and three. Similar findings were found for LCVA. Comfort ratings for lenses one, two and three were 74.9 ± 9.2, 79.7 ± 11.6 and 78.6 ± 10.8, respectively.

Researchers concluded that using CSH measurements was an effective method for determining the appropriate lens/cornea relationship. Lens two (+375μm) gave the best combination of acuity and comfort ratings. Researchers added that evaluation of the fluorescein pattern must be balanced with VA and comfort ratings for successful fitting in a clinical setting.

SOURCE: Otchere H, Jones L, Sorbara L. The impact of scleral contact lens vault on visual acuity and comfort. eye contact lens. 2017; Sep 26. [Epub ahead of print].

Assessment of Eye Drop Instillation Technique in Glaucoma Patients
In this cross-sectional study, 71 consecutive patients with glaucoma or ocular hypertension, self-administering topical anti-glaucoma medications for ≥6 months were evaluated to study the technique of eye drop instillation in glaucoma patients and identify independent factors that may influence performance. All patients instilled a tear substitute into the eye with the worst eyesight using the technique normally used at home. The following parameters were evaluated: age, number of years receiving treatment with ocular hypotensive eye drops, time spent to instill the first drop, number of drops instilled, correct location of the eye drops, contact of the bottle with the eye, closing of the eyelids or occlusion of the tear punctum, and asepsis of the hands.

The mean age of the patients was 66 ± 10.8 years, and patients were on ocular hypotensive drugs for 11.3 ± 7.3 (range, 2 to 35) years. Only 28% of patients were able to correctly instill the eye drops (squeeze out one drop and instill it into the conjunctival sac without bottle tip contact). Touching the tip of the bottle to the globe or periocular tissue occurred in 62% of patients. In 49% of patients, the eye drops fell onto the eyelids or cheek. Two or more drops were squeezed by 27% of patients.

The majority of glaucoma patients were unable to correctly instill eye drops. Age was an independent factor associated with eye drop instillation performance.

SOURCE: Gomes BF, Paredes AF, Madeira N, et al. Assessment of eye drop instillation technique in glaucoma patients. Arq Bras Oftalmol. 2017;80(4):238-41.




Glaucoma, Depression and Quality of Life: Comorbidities and Assessments, and Multidisciplinary Plan Treatment
This review evaluated the assessment and comorbidity of glaucoma and depression with the possibility of treatment options. The web of science was searched for relevant articles using the search terms: "glaucoma," "depression," "glaucoma and depression" and "quality of life and glaucoma." Additional relevant papers were added from the bibliography of selected papers. All types of articles were included, and no time period was defined.

Authors reviewed 11 studies regarding the comorbidities of glaucoma and depression. The number of participants in all studies ranged from 86 to 6,760. The scale formats were self-reported in all but one study, which was clinician-rated. Two studies explored types of glaucoma. Three out of 11 revealed no significant evidence of elevated depressive symptoms associated with glaucoma. In six studies, the prevalence of depression was significant among glaucoma patients. One study provided suboptimal assessments of depression in glaucoma patients. Another showed the presence of glaucoma significantly associated with depression after adjustment for demographic factors. Most of the studies used one scale, while two used two scales. The reviewed studies did not analyze the therapy options of included patients.

The results indicated that glaucoma was accompanied by depression in the majority of analyzed studies. Authors wrote that the comorbidity of glaucoma and depression should be the subject of further research involving self-reflecting and clinician-rated scales, taking into account the subjective experience of patients and physicians. They added that therapy options should be assessed in future research, including novel possibilities for treating both conditions respectively.

SOURCE: Pelčić G, Ljubičić R, Barać J, et al. Glaucoma, depression and quality of life: multiple comorbidities, multiple assessments and multidisciplinary plan treatment. Psychiatr Danub. 2017;29(3):351-9.

News & Notes
NaturalVue Multifocal Lens Research: Myopia Reversal in Animal Model
The NaturalVue Multifocal 1 Day Contact Lens design was recently shown to fully reverse previously induced myopia in an animal model (chickens), according to research published in the September edition of Ophthalmic and Physiological Optics. The study, supported in part by a grant from Visioneering Technologies, was a follow-up to milestone research published by lead author Elizabeth L. Irving, OD, PhD, professor, University Research Chair, University of Waterloo, that showed that the lens design was able to fully stop the development of up to 10D of myopia in the same animal model. Read more.


Pentacam AXL Integrates Barrett Formulas
The IOL Calculator of the Pentacam AXL now incorporates Barrett Universal II, Barrett Toric and Barrett True K formulas. A free software update with the formulas is available for all Pentacam AXL users. The Universal II and Toric formulas support IOL power calculations for virgin eyes, while the True K formula is beneficial for post-LASIK/PRK myopic and hyperopic eyes, and post-RK corneas. Spherical, aspheric, multifocal and toric IOLs are included in the IOL calculator database, and the implanted IOL data and post-op refraction can be stored with a few mouse clicks. The software includes IOL constant optimization capabilities. Read more.

Aerie Announces FDA Advisory Committee Meeting for Rhopressa
The U.S. Food and Drug Administration’s Dermatologic and Ophthalmic Drugs Advisory Committee was scheduled for Oct. 13, to review Aerie Pharmaceuticals’ New Drug Application for Rhopressa (netarsudil ophthalmic solution) 0.02% for the treatment of individuals with open-angle glaucoma or ocular hypertension. Aerie submitted the NDA in February 2017, after which the FDA set a Prescription Drug User Fee Act goal date of February 28, 2018, for completion of its NDA review. Read more.

Eyevance Enters into Licensing Agreement for Zerviate in the United States
Eyevance Pharmaceuticals entered into an exclusive licensing agreement with Nicox Ophthalmics in which Eyevance received commercialization rights to Zerviate (cetirizine ophthalmic solution) 0.24% in the United States. Zerviate is the first topical formulation of the antihistamine cetirizine approved for the treatment of ocular itching associated with allergic conjunctivitis. Cetirizine, the active ingredient in the systemic drug Zyrtec, is a second-generation antihistamine. Read more.

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

Alfred A. Rosenbloom, Jr., Low Vision Residency Award Recipient Chosen
Rachel Young, OD, a low vision, traumatic brain injury, and primary care resident at the VA Long Beach Medical Center, was chosen by a committee of members in the Low Vision Section of the American Academy of Optometry as this year’s recipient for the Alfred A. Rosenbloom, Jr., Low Vision Residency Award. Young will receive a $2,000 education award and a $750 travel fellowship to attend the Academy 2017 Chicago annual meeting in October. Read more.

Frontline Surface Care 2017 - Chicago, Illinois

AAOF Releases Johnson & Johnson Vision Residency Award Recipients
The American Academy of Optometry Foundation is proud to announce the recipients of the 2017 Johnson & Johnson Vision Residency Awards. View the recipients.

2017 OGS Meetings, Administered by Reviw of Optometry
SWOGS Registration WCOGS Registration

AAOF Selects Beta Sigma Kappa Research Fellowship Recipient
The AAOF, in collaboration with the Beta Sigma Kappa International Honor Society, selected Adam J. Peiffer, OD, as the 2017 recipient of the Beta Sigma Kappa (BSK) Research Fellowship. Dr. Peiffer is an advanced practice fellow and clinical instructor at The Ohio State University College of Optometry. The fellowship is designed to provide support for early career optometric and vision science faculty research. The award will fund Dr. Peiffer’s project titled “Collaborative Assessment of Neurocognition and Vision in Adolescents with Sports-related (CANVAS) Concussion Study.” Read more.

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


Fredric Rosemore Low Vision Grant Recipient Named
The American Academy of Optometry Foundation, in collaboration with the Fredric and Marion Rosemore Family Foundation, named Ava K. Bittner, OD, PhD, FAAO, associate professor at Nova Southeastern University College of Optometry, as the 2017 recipient of the Fredric Rosemore Low Vision Educational Grant. Dr. Bittner will receive a grant for her project titled “Tele-rehabilitation to provide expanded opportunities for low vision clinical training,” which is intended to increase interest and inspire excellence in the field of low vision. Read more.

2018 Winter Ophthalmic Conference



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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