Optometric Physician


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

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Volume 19, Number 42

Monday, October 21, 2019

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Inside this issue: (click heading to view article)
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######### Off the Cuff: The Law of Unintended Consequences Again Proves Optometry is its Own Worst Enemy
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######### Measurement of Quality of Life in Keratoconus
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######### Influence of Epiretinal Membranes on the Retinal Nerve Fiber Layer Thickness Measured by Spectral-domain Optical Coherence Tomography in Glaucoma
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######### Analysis of Neuroretinal Rim by Age, Race and Gender Using High-Density Three-Dimensional Spectral-domain Optical Coherence Tomography
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######### News & Notes
 

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Off the Cuff: The Law of Unintended Consequences Again Proves Optometry is its Own Worst Enemy

Over the years I’ve witnessed some pretty inexplicable things that ODs have done, sometimes to patients, but all too frequently to each other. I have also become a student of unintended consequences with particular focus on avoiding them. Consequences are by nature often bitter, but the unintended ones are usually the worst.

What I am about to share may well be the most bizarre example of the convergence of optometry’s self-injurious nature and unintended consequences that should have been 20/15 clear, especially to optometrists. Keep in mind that much of what I am reporting comes from colleagues in Tennessee, except for the actual complaint, which was filed in the US District Court for the Middle District of Tennessee in April 2017, and only recently unsealed and made public.

According to the complaint, the action by the US and Tennessee Attorneys General was instigated by current TAOP Executive Director Gary Odom and Past President Ross Lumpkin. It charges Southeast Eye Specialists, a large Tennessee ophthalmic surgery group practice, with illegally inducing referrals from local ODs and using comanagement to routinely fee split with referrers, among other things. While the complaint speaks for itself in great detail, its motivation is far less clear, at least to me.

It is important to note that in the complaint, the Academy of Ophthalmology’s extremely restrictive and more-than-a-little-anti-optometry guidelines for MD-OD post-surgical comanagement are extensively referenced. While the action is apparently not moving forward unless the two initiators continue it in civil court, it’s consequences could be far reaching, not just for the individuals and practices involved, but for comanagement in Tennessee and perhaps throughout the US.

A discussion of comanagement is well beyond the scope and space that I have here, but increasing clinical coordination between surgeon and referring OD has grown dramatically for a variety of legitimate patient beneficial reasons. Regardless of whatever Odom and Lumpkin where thinking or hoped to gain, they have inadvertently given optometry’s enemies a potent weapon that misrepresents the overwhelming majority of legitimate comanagement relationships that improve patient care and make both surgeon and comanaging OD more effective and cost-efficient.

While I have little doubt that this story will continue to develop, what I fear most are the unintended consequences that will likely ensue. I will remind our colleagues in Tennessee who I know are extremely upset at what can only be viewed as a setback for the profession, to avoid actions that will have their own unintended consequences and prove, yet again, that we are our own worst enemies.

Arthur B. Epstein, OD, FAAO
Chief Medical Editor
artepstein@optometricphysician.com

 

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.

 








Measurement of Quality of Life in Keratoconus
 
 
A literature search was carried out in Scopus, Web of Science, PubMed, MEDLINE, Cochrane and PsycINFO databases to identify and assess the quality of questionnaires used to measure quality of life in keratoconus and guide selection of the most appropriate questionnaire for evaluating the impact of keratoconus. Articles that described a questionnaire to measure quality of life in keratoconus were included. Information on psychometric properties and validity was extracted and analyzed based on a set of quality criteria. Finally, the impact of keratoconus and its management methods on quality of life was reviewed.

The search yielded 331 publications, of which 45 articles describing 18 (12 ophthalmic including two keratoconus-specific and six generic) questionnaires were reviewed. Most of the articles (40, 88.9%) described ophthalmic questionnaires not specific to keratoconus. The National Eye Institute Visual Function Questionnaire was the most frequently used questionnaire (n=26). Only four articles provided information on psychometric properties. The Keratoconus Outcomes Research Questionnaire, the only validated keratoconus-specific questionnaire, had the most superior psychometric properties. However, it consisted of items on only two domains of quality of life (activity limitation and symptoms). Overall, keratoconus management methods (spectacles, contact lenses and cross-linking in early stages, corneal transplantation in late stages) improved quality of life. The quality of life scores were associated with clinical measures including visual acuity, corneal topography, pachymetry and keratoconus severity.

The authors wrote that there was a need for a comprehensive and high-quality patient-reported outcome measure in keratoconus. They added that a questionnaire should be chosen based on the purpose and the quality of the questionnaire. This review guideed selection of an appropriate questionnaire.


SOURCE: Kandel H, Pesudovs K, L Watson S. Measurement of quality of life in keratoconus. Cornea. 2019; Oct 9. [Epub ahead of print].




Influence of Epiretinal Membranes on the Retinal Nerve Fiber Layer Thickness Measured by Spectral-domain Optical Coherence Tomography in Glaucoma
 
 
The authors investigated changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL) following the onset of epiretinal membrane (ERM) in glaucoma patients. Among regularly monitored glaucoma patients, patients with a newly diagnosed ERM were consecutively enrolled. Before and after the onset of ERM, the RNFL thickness was measured using spectral-domain optical coherence tomography, and a visual field examination was performed using a Humphrey field analyzer. Changes in RNFL thickness parameters and global indices of the visual field analyzer were assessed.

In a total of 28 eyes from 28 patients, the average RNFL thickness increased by a mean of 4 ± 7.4 μm after ERM onset. There was an increase in the superior, nasal and temporal quadrant RNFL thicknesses, and the change in the temporal RNFL thickness was significant (14.4 ± 21.2 μm). However, the inferior RNFL thickness decreased by -0.6 ± 7.5 μm. In the visual field examination, the mean deviation decreased significantly by -0.8 ± 1.7 dB, from -14.6 to -15.4 dB.

A significant increase in average RNFL thickness was detected following ERM onset in glaucoma patients, although there was deterioration of the mean deviation in the visual field. Researchers wrote that when ERM occurs in glaucoma patients, clinicians should be aware that RNFL thickness measurements obtained with a spectral-domain OCT may underestimate the status of glaucomatous optic neuropathy.


SOURCE: Kim JM, Kim KN, Kim WJ, et al. Influence of epiretinal membranes on the retinal nerve fiber layer thickness measured by spectral domain optical coherence tomography in glaucoma. Korean J Ophthalmol. 2019;33(5):422-9.

 

 

Analysis of Neuroretinal Rim by Age, Race and Gender Using High-Density Three-Dimensional Spectral-domain Optical Coherence Tomography
 
 
Neuroretinal rim minimum distance band thickness is significantly lower in older subjects and African Americans compared to Caucasians. It is similar in both genders. To evaluate the relationship between age, race and gender with the neuroretinal rim using high-density spectral- domain optical coherence tomography (SD-OCT) optic nerve volume scans of normal eyes, 256 normal subjects underwent Spectralis (Heidelberg Engineering) SD-OCT optic nerve head volume scans. One eye was randomly selected and analyzed for each subject. Using custom-designed software, the neuroretinal rim minimum distance band (MDB) thickness was calculated from volume scans, and global and quadrant neuroretinal rim thickness values were determined. The MDB is a three-dimensional neuroretinal rim band comprised of the shortest distance between the internal limiting membrane (ILM) and the termination of the retinal pigment epithelium/Bruch's membrane (RPE/BM) complex. Multiple linear regression analysis was performed to determine the associations of age, race and gender with neuroretinal rim MDB measurements.

The population was 57% female and 69% Caucasian with a mean age of 58.4 ± 15.3 years. Mean MDB thickness in the normal population was 278.4 ± 47.5µm. For this normal population, MDB thickness decreased by 0.84µm annually. African Americans had thinner MDBs compared with Caucasians. Males and females had similar MDB thickness values.

Neuroretinal rim MDB thickness measurements decreased significantly with age. African Americans had thinner MDB neuroretinal rims than Caucasians.


SOURCE: Antar H, Tsikata E, Ratanawongphaibul K, et al. Analysis of neuroretinal rim by age, race, and gender using high-density three-dimensional spectral domain optical coherence tomography. J Glaucoma. 2019; Oct 9. [Epub ahead of print].





News & Notes
 
B+L Expands Parameter Offering for Biotrue OneDay Daily Disposable CLs
Bausch + Lomb announced the US launch of expanded parameters for Biotrue OneDay daily disposable contact lenses. The expansion will add six new parameters (-9.50D, -10.00D, -10.50D, -11.00D, -11.50D and -12.00D), bringing the total offering to +6.00D to -12.00D. Biotrue OneDay lenses contain the same water content as the natural eye. The contact lenses provide all-day comfort, as well as UVA/UVB protection to help protect the eyes from sun damage. Learn more.



Sun Pharma Commercializes Cequa in U.S. for Treatment of DED
Sun Pharmaceutical Industries announced that one of its wholly owned subsidiaries has commercialized Cequa (cyclosporine ophthalmic solution) 0.09% in the United States, although the drug was approved by the FDA in August 2018. Cequa is indicated to increase tear production in patients with keratoconjunctivitis sicca, and is delivered with nanomicellar (NCELL) technology, which is designed to improve the bioavailability and physicochemical stability of cyclosporine for improved ocular tissue penetration. Read more.



WHO to Address First World Vision Report During the Academy Meeting
On the heels of the World Health Organization release of its first world report on vision identifying global “significant challenges” in vision health, the American Academy of Optometry announced a commitment to rise to those challenges. The first step will occur during the joint meeting of American Academy of Optometry and World Council of Optometry. The meeting will feature a plenary discussion on Oct. 23 at 10a.m. featuring leaders from WHO and AAO. The World report on vision says 2.2 billion people have some form of vision impairment, of whom 1 billion have an impairment that could have been prevented or is yet to be addressed. The report anticipates a growth in those numbers over the next few years and calls for stakeholders including eye care practitioners and policymakers to help shape a global agenda on vision to help stem the crisis.



J&J Vision Announces New Data, Products at AAO 2019
Johnson & Johnson Vision announced a series of breakthrough data, technology, and products at the upcoming American Academy of Ophthalmology Annual Meeting in San Francisco, including the FDA approval of the iDesign Refractive Studio Wavefront-guided PRK indication and the availability of Tecnis Simplicity Delivery System. Read more.



Moneyball Strategist Billy Beane to Address IDOC
IDOC announced that Billy Beane, executive VP of baseball operations for the Oakland A’s and the subject of Moneyball, will be the featured Keynote Speaker for the upcoming Connection 2020 conference, February 12-15, 2020 at Disney’s Coronado Springs Resort in Orlando, Fla. Beane implemented a statistical methodology that led the Oakland Athletics to six American League West Division Titles. That strategic methodology has come to be known as the “Moneyball” philosophy. Read more.



Eyevance Pharmaceuticals Acquires Tobradex ST and Natacyn
Eyevance Pharmaceuticals announced the acquisition of Tobradex ST (tobramycin/dexamethasone ophthalmic suspension) 0.3%/0.05% and Natacyn (natamycin ophthalmic suspension) 5% from Novartis. Hayfin Capital Management LLP provided debt financing and an equity investment to support the transaction. Tobradex ST (tobramycin/dexamethasone ophthalmic suspension) 0.3%/0.05%, FDA-approved in the United States, is a fixed-dose topical antibiotic and corticosteroid combination indicated for steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where superficial bacterial ocular infection or a risk of bacterial ocular infection exists. Natacyn (natamycin ophthalmic suspension) 5% is indicated for the treatment of fungal blepharitis, conjunctivitis and keratitis caused by susceptible organisms including Fusarium solani keratitis.



   
 
 


 


 






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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