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


Volume 18, Number 37

Monday, September 11, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: Why Are Dry Eye Patients Always So Unhappy?
######### Kawasaki Disease Increases the Incidence of Myopia
######### Multifocal Intraocular Lens Implantation After Previous Corneal Refractive Laser Surgery for Myopia
######### Relationship Between Higher-order Wavefront Aberrations and Natural Progression of Myopia in Schoolchildren
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Why Are Dry Eye Patients Always So Unhappy?

The other day I stood in front of a packed room in Orange County sharing how “dry eye” management remains one of the greatest opportunities in optometry today. I typically have at least two tracks running in my head at any given time, and as I was speaking, I was also thinking about the typical dry eye patient.

So many people remain miserable despite treatment, and many doctors burn out after not achieving meaningful improvement. As a result, dry eye has earned a reputation of being a thankless subspecialty with limited success and an overabundance of frustration for both clinician and patient.

I see this every day. Regardless of whether the patient was referred to us or found the practice on their own, virtually all share the same story: a grab bag of artificial tears that marginally helped, one or two medications that haven’t, and a sense of helplessness and despair that can fill an exam room.

I’ve known this enemy for quite a while. After relocating to Arizona and focusing primarily on dry eye and ocular surface disease, I braced myself for the misery I knew was sure to come. I had seen plenty of it managing dry eye patients in New York. However, a near singular focus on the ocular surface, a natural aversion to failure and no one to send my failures to, quickly forced an epiphany. Many dry eye patients remain miserable because much of what we use to treat them just doesn’t work. Failure can be that simple, and, oddly, understanding and success even simpler.

For those attending Vision Expo next week who want to learn more about how I approach these patients, a list of courses is below. I’ll also be on the exhibit floor and look forward to seeing you there.

Friday Sept. 15: 11:30am-12:30pm: A Contemporary Approach to Dry Eye Management: Secrets of Practice Success, sponsored by PRN (Medical and Scientific Theater)

Thursday Sept. 14: 5pm-6pm The Zen of Dry Eye Mastery: A Simple
System for Clinical and Practice Success

Friday Sept. 15: 2:45pm-4:45pm The Shifting Sands of Dry Eye and MGD - Expert Perspective, with Dave Kading (33C4)

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.


Kawasaki Disease Increases the Incidence of Myopia
The prevalence of myopia has rapidly increased in recent decades and has led to a considerable global public health concern. In this study, researchers elucidated the relationship between Kawasaki disease (KD) and the incidence of myopia. They used Taiwan's National Health Insurance Research Database to conduct a population-based cohort study. Researchers identified patients diagnosed with KD and individuals without KD who were selected by frequency matched based on sex, age and the index year. The Cox proportional hazards regression model was used to estimate the hazard ratio and 95% confidence intervals for the comparison of the two cohorts. The log-rank test was used to test the incidence of myopia in the two cohorts.

A total of 532 patients were included in the KD cohort and 2,128 in the non-KD cohort. The risk of myopia (hazard ratio, 1.31; 95% CI, 1.08 to 1.58) was higher among patients with KD than among those in the non-KD cohort. The Cox proportional hazards regression model showed that irrespective of age, gender and urbanization, Kawasaki disease was an independent risk factor for myopia.

Researchers concluded that patients with Kawasaki disease exhibited a substantially higher risk for developing myopia.

SOURCE: Kung YJ, Wei CC, Chen LA, et al. Kawasaki disease increases the incidence of myopia. Biomed Res Int. 2017;2017:2657913. 2017; Jul 30. [Epub ahead of print].

Multifocal Intraocular Lens Implantation After Previous Corneal Refractive Laser Surgery for Myopia
This study described the refraction and visual acuity outcomes of multifocal intraocular lens (IOL) implantation in patients with previous corneal refractive laser surgery for myopia at the Academic Medical Center, University of Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. The three-month results after implantation of a multifocal IOL (Acrysof Restor) in patients who had corneal refractive laser surgery for myopia were analyzed. The primary outcome measures were corrected distance visual acuity, uncorrected distance visual acuity (UDVA) and refraction. The secondary outcome measures were number of laser enhancements, corneal irregularity, pre-laser magnitude of myopia and posterior capsule opacification (PCO) rate.

Seventy-seven eyes of 43 patients were included. Twenty-nine eyes had lens extraction because of cataract, and 48 eyes had a refractive lens exchange. The mean postoperative UDVA was 0.14 logarithm of minimum angle of resolution ± 0.22 (SD). The mean postoperative spherical equivalent was -0.38D ± 0.78D. Fifty-seven percent of eyes were within ±0.50D of emmetropia, and 86% were within ±1D. Sixteen eyes (20.8%) had laser enhancement because of residual refraction. Fourteen eyes (18.2%) had a neodymium:YAG laser capsulotomy because of PCO. Eyes with pre-laser myopia greater than 6D had a less predictable outcome than eyes with pre-laser myopia less than 6D.

The center-distance lens exhibited a relative peripheral myopic shift in M2/4 and J0, positive on-axis C[4, 0] and negative on-axis C[3, 1]; and on-axis M4 was less negative for accommodative demands -3.00D. Inversely, the center-near lenses showed a relative peripheral hyperopic shift in M2/4 and J0, negative on-axis C[4, 0] and positive on-axis C[3, 1]; and on-axis M4 was more negative for demands of -2.00D and -3.00D. Independent of lens type, relative peripheral M4 significantly decreased during accommodation. Accounting for C[4, 0], a greater change in relative M profiles and accommodative responses was found for multifocal lenses.

Multifocal IOL implantation after corneal refractive laser surgery for myopia resulted in good visual acuity and refraction. Results were less predictable with myopia greater than 6D.

SOURCE: Vrijman V, van der Linden JW, van der Meulen IJE, et al. Multifocal intraocular lens implantation after previous corneal refractive laser surgery for myopia. J Cataract Refract Surg. 2017;43(7):909-14.



Relationship Between Higher-order Wavefront Aberrations and Natural Progression of Myopia in Schoolchildren
This study investigated the relationship between higher order aberrations (HOAs) and myopia progression as well as axial elongation in schoolchildren. Investigators examined cycloplegic refraction, axial length and wavefront aberrations prospectively in 71 myopic children. Changes in cycloplegic refraction and axial length during a two-year study period were assessed, and their correlations with HOA components were analyzed.

Sixty-four subjects ([mean ± SD] 9.2 ± 1.6 years) completed the two-year examinations. Cycloplegic refraction was significantly changed after two years, and the average change (myopia progression) was -1.60D ± 1.04D. Axial length also increased significantly, and the average increase (axial elongation) was 0.77mm  ± 0.40mm. Myopia progression and axial elongation showed significant correlations with many components of corneal HOA. Multivariate analysis showed that the total HOA of the cornea was the most relevant variable to myopia progression and axial elongation.

Eyes with larger amounts of corneal HOAs showed less myopia progression and smaller axial elongation, suggesting that corneal HOAs played a role in the refractive and ocular developments in children.

SOURCE: Hiraoka T, Kotsuka J, Kakita T, et al. Relationship between higher-order wavefront aberrations and natural progression of myopia in schoolchildren. Sci Rep. 2017;7(1):7876.


News & Notes
Coburn Introduces Huvitz Auto Refractor/Keratometer
Coburn Technologies’ new Huvitz- manufactured auto refractor/ keratometer, the HRK-1, comes to the market at an affordable price and designed for built-in data accuracy, especially in higher diopter and cylinder measurements. Dynamic optical technology measures the aberration of the eye, and the machine adapts the refraction method to a ring signal type as opposed to multifocal Wavefront technology. A rotating ring sensor gives the user an almost infinite number of measuring points, producing an optimal average of spherical, cylinder and axis values. The HRK-1 comes with a y-axis auto tracking function that automatically determines the height of the patient’s eyes, thus reducing the measurement time. Coburn will showcase the new HRK-1 at booth# LP6075 at this year’s Vision Expo West conference in Las Vegas. Read more.


Bausch + Lomb Offers Ocuvite Eye Vitamin Adult 50+ Formula Minigels
Bausch + Lomb launched Ocuvite Adult 50+ Formula Minigel daily eye vitamins designed to replenish vital nutrients that aging eyes can lose. The minigels replace the Ocuvite Adult 50+ soft gels, and include highly concentrated fish oil so they are 25 percent smaller and easier to swallow. The vitamins provide vital eye nutrients, including lutein, zeaxanthin and omega-3 fatty acids. Read more.

J&J Vision Completes TearScience Acquisition
Johnson & Johnson Vision completed its acquisition of TearScience. TearScience technologies enable physicians to evaluate meibomian gland health and treat MGD with a 12-minute in-office treatment. Johnson & Johnson Vision acquired TearScience through its surgical vision operating company, Abbott Medical Optics. Sales will be reported in the Medical Devices segment, under Vision Care. Financial terms of the transaction were not disclosed. Read more.

Oculus Incorporates Oculus Canada
Oculus incorporated Oculus Canada as its ninth international subsidiary. Oculus Canada will support new and existing customers throughout the region. In response to market dynamics, Oculus Germany decided to directly enter into the Canadian market. Read more.

2017 East Coast Optometric Glaucoma Symposium - Click to Register

Alcon Updates Packaging for Air Optix Monthly Contact Lenses
Alcon introduced a new packaging design for its Air Optix family of silicone hydrogel monthly replacement contact lenses. All packaging will feature the same contemporary blue on Air Optix plus HydraGlyde lens packaging, with secondary color variations to differentiate the contact lenses within the portfolio. Read more.

2017 West Coast Optometric Glaucoma Symposium - December 15-16, 2017 - Huntington Beach, California - Click to Register

MacuHealth & M&S Technologies Partner
M&S Technologies and MacuHealth entered into a cooperative marketing agreement to educate eye care professionals on the direct relationship between enriching macular pigment with nutritional supplements and optimizing visual performance. M&S developed a Letter Contrast Sensitivity Protocol using a single Sloan letter optotype at 20/100 at six cycles per degree, and offers peer-reviewed vision testing systems calibrated to ANSI and ISO specifications. Similarly, MacuHealth has a body of peer-reviewed evidence to support its safety and efficacy. Read more.

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

ReVision Optics Names Ophthalmic Experts as Medical Monitors
ReVision Optics announced that Bret Fisher, MD, and Sumit (Sam) Garg, MD, will serve as co-medical monitors to oversee the clinical performance of the company’s Raindrop Near Vision Inlay, an FDA-approved novel corneal inlay for the surgical correction of presbyopia. Dr. Fisher serves as medical director of the Eye Center of North Florida, specializing in refractive and cataract surgery. Dr. Garg is vice chair of clinical ophthalmology, medical director and associate professor in Cataract, Refractive, and External Disease and Corneal Surgery at the Gavin Herbert Eye Institute at the University of California, Irvine. 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



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