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


Volume 18, Number 41

Monday, October 8, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: A Time of Great Sorrow – The Passing of Uncle Frank Fontana
######### Relevance of Swept-Source Anterior Segment Optical Coherence Tomography for Corneal Imaging in Patients With Flap-Related Complications After LASIK
######### Analysis of Corneal Higher Order Aberrations in Cataract Patients With High Myopia
######### Prevalence of Keratoconus in a Refractive Surgery Population
######### News & Notes

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Off the Cuff: A Time of Great Sorrow – The Passing of Uncle Frank Fontana

It is with deep sadness that I note the passing of my dear friend, mentor and role model Uncle Frank Fontana. A St. Louis-based, internationally recognized optometric icon, Frank was an unstoppable force of nature who helped shape the profession, but will be best remembered by his many friends for his incredible humanity. Frank had many “nieces” and “nephews,” and I was proud to be among them. He was the only person I’ve ever met who carried photos of his friends’ kids in his wallet. The title “Uncle” wasn’t honorary. Frank earned it.

Optometry was Frank’s life, and his love for the profession was infectious. He graduated from ICO in 1949 after serving in the US Army during WWII. Many of us were lucky enough to hear Frank’s stories from the war, which he would happily share, usually over dinner. Frank opened his practice in 1950 and never stopped doing what he loved. He was a true contact lens pioneer, helping to popularize contact lenses by teaching colleagues across the country about the advancing technology. He was also among the very first key opinion leaders and industry consultants in optometry, and his hard work and dedication paved a path of respect for those of us who followed.

Uncle Frank was a prolific and sought-after lecturer and author. One of my great memories was sharing the podium with him at the old Vision Expo Midwest some years ago during what I suspect was his last lecture. Always involved in the profession, Frank was a founding member and second chair of the AOA Contact Lens Section and a tireless AOA volunteer. I had the honor of being sworn in by Frank when I became chair of the CLCS in 2005. Review of Optometry was another passion we shared. Frank served as an editor since 1999 and was an important part of the Review family. He received the first Review of Optometry Life Achievement award. I’ve also written pieces about Frank in Optometric Physician more than I’ve written about anyone else.

As life ran its unpredictable course, Frank and I became increasingly intertwined. I got to share many incredible moments and memories with him, his beloved wife Doris and my buddy Frankie Jr., who was always at his dad’s side. While Shannon and I are devastated by his loss, there is some solace in knowing that Uncle Frank left us doing what he loved most. He was in Las Vegas, attending Vision Expo West, holding court, surrounded by people who loved him.

Arrangements for a memorial service and a celebration of his life will be announced.


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.


Relevance of Swept-Source Anterior Segment Optical Coherence Tomography for Corneal Imaging in Patients With Flap-Related Complications After LASIK
These researchers evaluated the role of swept-source anterior segment optical coherence tomography (AS-OCT) in the diagnosis and management of laser in situ keratomileusis (LASIK) flap-related complications. This prospective study included 25 eyes with LASIK flap-related complications imaged using swept-source AS-OCT between February and August 2016, at Alforsan Eye Centre, Assiut, Egypt. The images were acquired using a 6-mm line scan.

Imaging of flap-related LASIK complications using AS-OCT revealed specific and nonspecific findings. Of note, epithelial ingrowth appeared as highly reflective lesions below the LASIK flap in the form of islands, nests, or a continuous sheet with or without changes in the overlying flap. Macrostriae manifested as dome-shaped irregularities on the stromal surface with regular overlying epithelium, whereas microstriae appeared as corrugations on the stromal surface with regular overlying epithelium. Less common complications included multiple flap macrostriae accompanied by a traumatic folded flap with a flap edge at the interface. Interface debris appeared as a highly reflective interface lesion with or without a surrounding reaction. One eye with a flap that was torn and lost intraoperatively showed epithelialization over a thin residual stroma underlying a contact lens with no stromal infiltration on the second postoperative day. AS-OCT was useful for the assessment of flap thickness and planning of the new flap thickness in the event of an incomplete cut.

Researchers wrote that swept-source AS-OCT was useful not only for diagnosis, but also for management of eyes with LASIK flap-related complications, by enabling noninvasive, noncontact, real-time acquisition of cross-sectional AS images.

SOURCE: Abdelazeem K, Sharaf M, Saleh MGA, et al. Relevance of swept-source anterior segment optical coherence tomography for corneal imaging in patients with flap-related complications after LASIK. Cornea. 2018; Sep 27. [Epub ahead of print].

Analysis of Corneal Higher Order Aberrations in Cataract Patients With High Myopia
Researchers evaluated the differences in corneal higher order aberrations (HOAs) between cataract patients with high axial myopia and normal cataract patients, and identified the associated factors. Corneal aberrations and axial lengths (ALs) were measured using a rotating Scheimpflug camera (Pentacam) and partial coherence interferometry (IOLMaster) in the high myopia group and the control group.

The study included 287 patients (520 eyes): 194 eyes in the high myopia group and 326 eyes in the control group. The five anterior corneal aberrations—vertical coma, vertical trefoil, horizontal coma, oblique trefoil and primary spherical aberration—in the high myopia group were 0.07μm ± 0.38 (SD), -0.11μm ± 0.23μm, 0.07μm ± 0.28μm, -0.02μm ± 0.18μm, and 0.39μm ± 0.19μm, respectively. No negative primary spherical aberrations of the total or anterior corneal surface were found in the high myopia group. Differences between the two groups were found in terms of central corneal thickness, astigmatism, primary spherical aberration, vertical coma and oblique trefoil; however, these differences were not consistent between different age subgroups. Higher order aberrations were correlated with age. Posterior corneal vertical coma was correlated with AL.

Negative primary spherical aberrations of the anterior or total corneal surface were not found in the high myopia group. Age showed a strong relationship with HOAs. Investigators wrote that, aspheric intraocular lens implantation is recommended for cataract patients with high myopia.

SOURCE: Zhang M, Jing Q, Chen J, Jiang Y. Analysis of corneal higher-order aberrations in cataract patients with high myopia. J Cataract Refract Surg. 2018; Sep 28. [Epub ahead of print].




Prevalence of Keratoconus in a Refractive Surgery Population
This study examined the prevalence of keratoconus among patients who were interested in undergoing refractive surgery. Corneal tomography measurements were used to help detect keratoconus. Adult subjects who presented to the private hospital Cataract and Refractive Surgery Unit (Abha, Saudi Arabia) for refractive surgery evaluation were considered for inclusion in this cross-sectional, retrospective study. All subjects were from the Aseer province, a southern, high-altitude region in Saudi Arabia, and presented between January and December 2017. The incidence of keratoconus and other refractive surgery contraindications were examined.

A total of 2,931 patients were considered for inclusion in analyses. Of these, 2,280 patients (77.8%) were not candidates for refractive surgery. These 2,280 patients had a mean age of 24.1 years ± 6.6 years and 1,231 patients (54.0%) were male. Of the subjects who did not undergo refractive surgery, 548 (24%) had keratoconus, 400 (17.5%) were keratoconus suspects, 344 (15.1%) had thin corneas, 321 (14.1%) had high myopia and 52 (2.3%) had a high astigmatism. An additional 479 subjects (21%) were candidates for refractive surgery, but chose not to undergo a procedure.

The incidence of keratoconus in Saudi Arabian refractive surgery prospects was 18.7%. Keratoconus was the most common reason for not performing refractive surgery and accounted for 24% of cases in which surgery was not performed.

SOURCE: Al-Amri AM. Prevalence of keratoconus in a refractive surgery population. J Ophthalmol. 2018;2018:5983530.


News & Notes

Essilor Launches Pro-E 700 Edging System
Essilor Instruments released the Pro-ETM 700 edging system. Designed for high-volume production and efficient processing of the most complex jobs, Pro-E 700 advanced features include engraving, half jacket wraps, Chemistrie clips, safety beveling, super chamfering and creative shapes. Read more.


NORA Names Members to Advisory Board
The Neuro-Optometric Rehabilitation Association, International announced the addition of six new members to its advisory board at the group’s 27th Annual Conference in St. Louis. Joining the advisory board are:
Tanya Polec, OD, FCOVD, neuro-optometric concussion specialist, VQ Learning Sports Rehab in North Central Tucson, Ariz.
Hannu Laukkanen, OD MEd FAAO FCOVD-A, professor emeritus of optometry, and graduate course instructor, Pacific University’s Vision Science
Jill Schultz, OD, FAAO, in practice, Bright Eyes Vision Clinic in Minnetonka and Otsego, Minn.
Shirley Ha, OD, FCOVD, graduate, University of Waterloo’s School of Optometry and Vision Science; board-certified fellow of the College of Optometrists in Vision Therapy
Patti Andrich, MA, OTR/L, COVT, CINPP, occupational therapist, Vision Development Team, Royalton, Ohio
Gina Kim, MOT, OTR/L, CBIS, lead therapist/occupational therapist, Centre for Neuro Skills, Encino, Calif. Read more.


2018 Ophthalmology Update

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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