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


Volume 18, Number 38

Monday, September 17, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: Who the Hell is Dr. Craig Weiss, OD?
######### Macular Edema After Cataract Surgery in Eyes With and Without Pseudoexfoliation Syndrome
######### Is the Use of Refrigerated Fixed Combination of Dorzolamide 2%-Timolol 0.5% (COSOPT) Associated With Less Ocular Discomfort? A Pilot Study
######### Structure vs. Function in High Myopia Using Optical Coherence Tomography and Automated Perimetry
######### News & Notes

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Off the Cuff: Who the Hell is Dr. Craig Weiss, OD?

I think it’s time to declare scam awareness month for optometry. Like many of you, Shannon and I both received unapplied-for Amazon credit cards last year. Her one, me two. I am a naturally suspicious, cynical native NYer, so stuff like this doesn’t phase me. All three breaches were caught and accounts cancelled immediately, with appropriate steps taken to lock down our credit. I still have no idea why anyone would have gone to the trouble of applying for Amazon credit cards for ODs across the country.

A few weeks ago, Shannon got a call at the office in the middle of seeing patients from the Maricopa County Sheriff's Office. It seems that there was an arrest warrant out for her, for missing jury duty. Only she never received a jury duty summons. When she explained that it must be a mistake, the deputy demanded her cell phone number. This sounded suspicious and prompted a refusal from my sensible other half. When she told the “deputy” that she would have to call him back to verify the authenticity of the call, he got really annoyed and could be heard loudly telling someone in the background that she was being noncooperative. Realizing that patients were starting to back up, Shannon hung up, but before she could even get up from the chair, the phone rang with a caller ID of Maricopa Country Sherriff’s Office.

I have to admit that I probably would have been confused by the caller ID, but fearless Shannon answered, listened for a few seconds and decided that, despite the caller ID, it was a scam and told the deputy so. Really annoyed now, he loudly asserted that this was no scam and, apparently totally flustered by Shannon’s lack of apparent concern, he then threatened that he was going to send out Deputy Dawg to arrest her. Yes, I said Deputy Dawg. Shannon shot back, “Deputy Dawg? You’re going to send Deputy Dawg?” He said, “I didn’t say Deputy Dawg,” to which my intelligent wife laughed out loud, slammed the phone down and got back to seeing patients. I visit her every Sunday.

Just kidding, it was a scam, which the real Sherriff’s office later confirmed.

This past week, like many of you, we received a fax from Dr. Craig Weiss, OD, seeking employment. Other than misusing OD and title, Craig’s CV was quite impressive, except for one thing. Apparently, Craig doesn’t really exist. His name doesn’t appear as licensed in any state, he didn’t graduate from SCO or Gonzaga University, and apparently isn’t moving to a location near you any time soon, which is unfortunate because we would have hired him in a heartbeat.

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.


Macular Edema After Cataract Surgery in Eyes With and Without Pseudoexfoliation Syndrome
The purpose of the study was to identify macular edema after cataract surgery in eyes with and without pseudoexfoliation syndrome. The study was a post-hoc analysis of a randomized, double-blind, prospective single-center study. Patients were enrolled between January 2016 and October 2016 as per the national guidelines for the management of cataract in the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. A total of 156 eyes of 149 patients undergoing routine cataract surgery were included. Postoperatively anti-inflammatory medication was either dexamethasone (n=78) or diclofenac (n=78). Spectral-domain optical coherence tomography imaging and laser flare meter measurement of the anterior chamber were conducted before surgery and at the control visit 28 days postoperatively.

Baseline variables were comparable between eyes with pseudoexfoliation syndrome (n=32) and those without (n=124), except for intraocular pressure and glaucoma medication. In patients having pseudoexfoliation syndrome, central retinal thickness increase (mean ± standard error of the mean) was 63.3μm  ± 35.5μm for dexamethasone and 17.6μm  ± 5.8μm for diclofenac, compared with 28.9μm  ± 8μm and 6.9μm  ± 1.3μm in eyes without pseudoexfoliation syndrome, respectively. Aqueous flare at 28 days was 25.8 ± 5.4 pu/ms for patients with pseudoexfoliation syndrome and 18.3 ± 1.8 pu/ms for those without. Best-corrected visual acuity gain and best corrected visual acuity at 28 days were less in patients having pseudoexfoliation syndrome compared to those without (0.39 ± 0.07 vs. 0.59 ± 0.03 decimals; and 0.77 ± 0.06 vs. 0.92 ± 0.03 decimals, respectively).

Researchers concluded that eyes with pseudoexfoliation syndrome might be predisposed to an increased aqueous flare and macular edema after cataract surgery. Their findings outlined the need to determine the optimal anti-inflammatory medication after cataract surgery in patients with pseudoexfoliation syndrome.

SOURCE: Ilveskoski L, Taipale C, Holmström EJ, et al. Macular edema after cataract surgery in eyes with and without pseudoexfoliation syndrome. Eur J Ophthalmol. 2018; Sep 12. [Epub ahead of print].


Is the Use of Refrigerated Fixed Combination of Dorzolamide 2%-Timolol 0.5% (COSOPT) Associated With Less Ocular Discomfort? A Pilot Study
In this prospective comparative study, 30 primary open-angle patients and 30 healthy subjects filled in the questionnaire on symptoms (Ocular Surface Disease Index) and subjective stinging feeling scale (one to 10), at the start of study, and 30 days after continuous use of refrigerated fixed combination or placebo eye drops to test the hypothesis that the use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% solution (Cosopt) was associated with less ocular discomfort compared with the use of the solution kept at room temperature. Results were processed by applying the methods of descriptive (arithmetical mean, standard deviation) and analytical statistics for evaluation of significance of the difference (Student's t-test).

Ocular discomfort parameters were significantly lower after the use of refrigerated fixed combinations of dorzolamide 2% plus timolol 0.5% solution (t-test, p<0.0001). Breakup time, Schirmer 1 test and intraocular pressure values did not differ.

The use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% (Cosopt) solution was associated with less ocular discomfort than the use of the same fixed combination at room temperature.

SOURCE: Bozic M, Stojkovic M, Knezevic M, et al. Is the use of refrigerated fixed combination of dorzolamide 2%-timolol 0.5% (Cosopt) associated with less ocular discomfort? a pilot study. J Ocul Pharmacol Ther. 2018; Sep 11. [Epub ahead of print].





Structure vs. Function in High Myopia Using Optical Coherence Tomography and Automated Perimetry
Fifty-eight highly myopic individuals with no posterior abnormalities (mean spherical equivalent refraction ≤ -6.00D and axial length ≥ 26mm) were examined to evaluate the structure-function relationship between retinal thickness using spectral-domain optical coherence tomography and standard automated perimetry in high myopia. All eyes underwent optical coherence tomography with the Spectralis spectral-domain optical coherence tomograph and visual field evaluation with the Humphrey Field Analyzer II-i. Average macular layer thicknesses in each quadrant were calculated in a 6mm × 6mm area centred on the fovea. The visual field was assessed from 17 central locations (10 degrees), approximately the equivalent of the area tested by optical coherence tomography in the macular scan. Linear correlations were made between different macular layer thicknesses and peripapillary retinal nerve layer thickness with their matched visual field sensitivities.

Participant ages were 28.2 years ± 6.4 years, mean spherical equivalent refractions were -8.20D ± 1.40D and axial lengths were 26.7mm ± 0.7mm. Investigators found significant positive correlations between layer thickness and corresponding visual field sensitivities as follows: ganglion cell layer in all quadrants, temporal quadrant of the nerve fiber layer with nasal quadrant of the visual field, inferior quadrant of the outer nuclear layer with superior visual field, and temporal-superior peripapillary nerve fiber layer with nasal-inferior visual field.

Investigators wrote that the correlation between retinal layer thicknesses and visual field sensitivity could be explained by myopia-related losses due to lateral retinal stretching, but that additional research would be needed to confirm the findings.

SOURCE: Moghadas Sharif N, Shoeibi N, Ehsaei A, et al. Structure versus function in high myopia using optical coherence tomography and automated perimetry. Clin Exp Optom. 2018; Sep 11. [Epub ahead of print].

News & Notes

Lumify Redness Reliever Eye Drops Honored
Bausch + Lomb announced that, as a result of votes from the nation’s largest retailers, Lumify brimonidine tartrate ophthalmic solution 0.025% redness reliever eye drops were named a Product Showcase winner in the healthcare and over-the-counter category at the National Association of Chain Drug Stores’ 2018 Total Store Expo. The NACDS Total Store Expo is the largest pharmacy industry trade show of the year in the United States. Lumify is the first and only over-the-counter eye drop developed with low-dose brimonidine tartrate 0.025% for the treatment of ocular redness. In clinical trials, Lumify demonstrated a strong safety and efficacy profile with low risk for rebound redness and 95% symptom improvement seen at one minute that lasts up to eight hours. Read more.

Alcon Introduces Air Optix Plus HydraGlyde Multifocal CLs, Adds Ultraviolet-absorbing-only IOL Options IOL Options,
Alcon expanded its multifocal portfolio with the launch of Air Optix plus HydraGlyde Multifocal contact lenses. As with Alcon’s other multifocal portfolio contact lens options—including Dailies Total1, Dailies Aquacomfort Plus and Air Optix Aqua—this latest innovation offers presbyopic patients a combination of technologies for seamless vision at all distances, plus enhanced moisture benefits, compared to Air Optix Aqua. The multifocal contact lenses incorporate Alcon’s Precision Profile design together with the HydraGlyde molecule to promote: clear, seamless vision at all distances; lasting lens surface moisture through the HydraGlyde Moisture Matrix; excellent deposit protection and consistent comfort via Alcon’s unique SmartShield Technology. Read more.
In addition, Alcon expanded its AcrySof intraocular lens portfolio with the introduction of multifocal and multifocal toric ultraviolet-absorbing IOLs, and the introduction of the AcrySof UV-absorbing monofocal IOL with the UltraSert Pre-loaded Delivery System. The new multifocal and multifocal toric options are the AcrySof ReSTOR +2.5 Multifocal UV-Absorbing IOL with Activefocus optical design and the AcrySof ReSTOR +2.5 Multifocal Toric UV-Absorbing IOL with Activefocus optical design. These UV-absorbing-only multifocal lenses are designed for individuals undergoing cataract surgery who choose to address their presbyopia or presbyopia with astigmatism at the same time. Read more.

Eyevance Acquires FreshKote Lubricant Eye Drop Family from Focus
Eyevance Pharmaceuticals announced the acquisition of FreshKote family of lubricant eye drops from Focus Laboratories. Under the terms of the agreement, Eyevance acquired FreshKote and all its formulations, including the preservative-free multi-dose bottle and single-unit vials to market and commercialize worldwide. New FreshKote PF is designed to support the integrity of all three layers of the eye’s tear film for relief from dry eye symptoms by combatting evaporation on the ocular surface with a patented polymer blend formulated to mimic the lipid layer of the tear film. Due to its non-irritating profile, FreshKote PF is safe for contact lens wearers and can be used on an as-needed basis. A non-prescription product, new FreshKote PF is available in 10mL multi-dose bottles or boxes of 30 single-unit vials. 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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