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


Volume 18, Number 38

Monday, September 18, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: Expo West Wow!
######### Etiology of Acquired Blepharoptosis in Young Adults
######### Feline-transmitted Staphylococcal Hyicus Endophthalmitis After Clear Lens Extraction
######### Effects of Intravitreal Anti-vascular Endothelial Growth Factor Injections on IOP
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Expo West…Wow!

I have attended just about every national optometry meeting for decades. Expo West usually stands as my favorite meeting of the year, but Expo West 2017 definitely stood out. There seemed to be more attendees and more positive buzz than any meeting since 9/11. And although I may be a bit biased, dry eye seemed to be the hottest topic at the meeting.

This year’s CE was over the top. Every room I saw was jam-packed—even my Thursday late-shift, 5-to-6pm Zen of Dry Eye. The Expos have always had innovative and fun educational programs going back to CE Chairs Wayne Wood and Kirk Smick. But Ben Gaddie and Mark Dunbar and Expo’s broadly focused CE committee has taken continuing education to an entirely new level. I’ve known both Ben and Mark for many years. Accomplished educators and leaders in their own right, they deserve a lot of credit for what they’ve accomplished.

The exhibit hall was busy. I didn’t get a chance to see as much as I wanted to, but I’ll share several highlights and new product intros. TearScience, recently acquired by Johnson & Johnson Vision, was one of the busiest booths of the meeting. With lower pricing on LipiFlow systems, the flow seemed non-stop. The Optovue booth was also hopping. Recent FDA approval of epithelial thickness mapping, which has important implications for dry eye diagnosis, along with the introduction of the AngioVue Essential OCTA drew a lot of interest from the crowds. Once you see OCT angiography, you’ll understand why.

Icare-USA was busy with their newly launched Icare Home . Their ic100 rebound tonometer is in regular use in our practice and we’ve also been testing the new Icare home for a while. I believe this easy-to-use implementation of rebound tonometry may well change the way we manage many of our glaucoma patients. Finally, although I only got a quick peek, the new Zeiss Clarus 500 next-generation fundus imaging system looks to be truly game-changing.

All in all, Expo West was a great meeting. After a pretty disappointing Apple iPhone 8 and X launch, for the first time in memory, innovation in eye care seems to be outpacing developments in consumer electronics. These are, indeed, interesting times.

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.


Etiology of Acquired Blepharoptosis in Young Adults
This study identified the causes of blepharoptosis in young adults, and explored cases that did not fit into current diagnostic categories. The retrospective cohort study included all patients ages 18 to 40 years old (“young adults”) with acquired blepharoptosis that presented to two specialist ocular plastics practices and a pediatric ophthalmologist over a period of up to 25 years. Each patient was classified according to diagnosis. Where the diagnosis was uncertain, the files were examined in detail to try to establish a cause.

A total of 266 young adult patients were included. The most common causes of acquired blepharoptosis were trauma-related (28.2%) and anophthalmic blepharoptosis (19.9%). In 12.4% of the cases, a definite diagnosis could not be made. Of these, one-third had a history of soft contact lens use, a possible etiologic factor.

The cause of acquired blepharoptosis could usually be established by an appropriate history and examination, with additional diagnostic tests sometimes required. Nearly half of all young adult ptosis was related to trauma or acquired anophthalmos. Around one in eight young adults had blepharoptosis of unknown cause, a group warranting further study, researchers wrote

SOURCE: Rasiah S, Hardy TG, Elder JE, et al. Aetiology of acquired blepharoptosis in young adults. Orbit. 2017; Sep 6:1-6. [Epub ahead of print].


Feline-transmitted Staphylococcal Hyicus Endophthalmitis After Clear Lens Extraction
Postoperative endophthalmitis is a dreaded post-surgery complication that can lead to legal blindness, investigators wrote. In addition to typical risk factors, some minor episodes may also lead to the occurrence of endophthalmitis. The purpose of this study was to report a case of acute postoperative endophthalmitis caused by Staphylococcus hyicus in a patient with a contact history of felines.

A 58-year-old Taiwanese female who had a history of contact with felines due to her occupation had received clear lens extraction surgery of the left eye on July 10, 2015. One day after the surgery, the best-corrected visual acuity (BCVA) of the left eye was 20/40, which rapidly deteriorated to light perception with hypopyon formation. She was admitted for acute postoperative endophthalmitis and received antibiotic therapy with topical levofloxacin instillation and intravitreal vancomycin plus amikacin injection. Trans pars plana vitrectomy (TPPV) was then performed one day after admission. The specimen obtained from the vitreous and anterior chambers yielded the growth of S. hyicus. The patient was discharged with BCVA measured by counting fingers. Another TPPV was arranged for the persistent vitreous opacity on October 20, 2015, and the BCVA recovered to 20/32 at the last visit.

Investigators wrote that, to their knowledge, this was the first case of acute postoperative endophthalmitis caused by S. hyicus due to feline contact. They suggested that unusual pathogens in the environment and personal hygiene status should be validated preoperatively to prevent the development of postoperative endophthalmitis.

SOURCE: Chao SC, Lee CY, Nien CW, et al. Feline-transmitted Staphylococcal hyicus endophthalmitis after clear lens extraction: a case report. Int Med Case Rep J. 2017;10:279-83.



Effects of Intravitreal Anti-vascular Endothelial Growth Factor Injections on IOP
Authors wrote that the acute and chronic effects of repeated intravitreal anti-vascular endothelial growth factor (VEGF) injections on intraocular pressure (IOP) have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well-tolerated, they added. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive, authors wrote.

Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension following each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection and pre-existing glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss.

While definitive evidence of damage to the retinal nerve fiber layer is lacking, authors recommended that patients receiving repeated injections should be monitored for ocular hypertension, and those who subsequently develop sustained ocular hypertension should be periodically monitored for glaucomatous changes with an optic nerve optical coherence tomography (OCT) and static visual fields.

SOURCE: Bracha P, Moore NA, Ciulla TA, et al. The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A Review. Surv Ophthalmol. 2017; Sep 4. [Epub ahead of print].

News & Notes
SECO 2019 Conference Moves to New Orleans
SECO International announced that SECO will move the 2019 event to New Orleans, returning to Atlanta in 2020. This marks the first time SECO has held a meeting outside of Atlanta since 1957. SECO 2019 will take place February 20-24 at the New Orleans Ernest Morial Convention Center. As a result of the move, SECO is looking to recraft the show strategy to ensure that all aspects of the event are in line with best practices. Attendees will benefit from show enhancements, and competitive hotel selections and rates. SECO exhibitors will enjoy lower costs to exhibit.


Zeiss Unveils Ultra-wide Field Fundus Imaging Technology
Zeiss announced the U.S. launch of its next-generation, high-definition, ultra-wide field fundus imaging system, Clarus 500, at the International Vision Expo & Conference in Las Vegas. The Clarus 500 combines true color with high-resolution clarity down to seven microns in an ultra-wide field view from the macula to the far periphery, according to the company. Read more.

New Published Papers Demonstrate RightEye Reliability
RightEye announced the recent publication of three new research papers in the journals Vision Development and Rehabilitation and Translational Vision Science and Technology. The articles, co-authored by RightEye co-founder and chief science officer, Melissa Hunfalvay, PHd, provide normative data, reliability and validity of RightEye dynamic visual acuity and fine depth perception tests, and show the validity of inter-pupillary distance and pupil diameter measures using an infrared eye tracker and central point stimuli. Read more.

Douglas Benoit to Head Professional Affairs at Visioneering Technologies
Visioneering Technologies named Douglas P. Benoit, OD, FAAO, to the newly created position of executive director, professional affairs. Dr. Benoit will be responsible for interfacing with eye care professionals to increase awareness and use of the NaturalVue 1 Day contact lens product line and its technology designs. Dr. Benoit previously served as chair on the executive committee for the American Academy of Optometry’s Section on Cornea, Contact Lenses, and Refractive Technologies. He is also a fellow in the National Academies of Practice-Optometry Section, and a diplomate of the American Board of Optometry. Read more.

2017 East Coast Optometric Glaucoma Symposium - Click to Register

Genentech: Primary Endpoint in Spectri Not Met
Genentech announced the primary endpoint was not met in Spectri, the first of two Phase III studies evaluating the safety and efficacy of lampalizumab, an investigational medicine for the treatment of geographic atrophy due to age-related macular degeneration. Lampalizumab didn’t reduce mean change in GA lesion area compared to sham treatment at one year (48 weeks). Given the lack of efficacy, further dosing will be interrupted until the results from the second Phase III study, Chroma, are evaluated, according to the company. The two Phase III trials are identically designed, double-masked, randomized, global studies evaluating the efficacy and safety of a 10 mg dose of lampalizumab administered every four or six weeks by intravitreal injection vs. sham injections in people with GA due to AMD. Read more.

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

Illuvien Available in Ireland for Chronic DME
Alimera Sciences announced that Iluvien, its sustained release intravitreal implant for the treatment of diabetic macular edema, was available in Ireland through VHI Healthcare Group. Iluvien (fluocinolone acetonide intravitreal implant) 0.19 mg is a sustained-release intravitreal implant indicated in the European Union to treat vision impairment associated with chronic DME considered insufficiently responsive to available therapies. Each implant has continuous microdosing and is designed to release submicrogram levels of fluocinolone acetonide, a corticosteroid, for 36 months. Read more.

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

Alcon Data: Patients Preferred Air Optix Plus HydraGlyde Contact Lenses
New survey data from Alcon reveals that nearly three out of four patients surveyed preferred Air Optix plus Hydraglyde contact lenses over their previous two-week or monthly replacement lenses. After using the lenses with Clear Care Plus or Opti-Free Puremoist for one month, patients reported that the lenses were more comfortable at the onset of wearing through the end of the day compared with their previous contact lenses.

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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