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


Volume 18, Number 39

Monday, September 25, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: Biting the Hands That Feed Them
######### Effect of Contact Lens Surface Properties on Comfort, Tear Stability and Ocular Physiology
######### Refractive and Ocular Biometric Profile of Children with a History of Laser Treatment for Retinopathy of Prematurity
######### Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia
######### News & Notes

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Off the Cuff: Biting the Hands That Feed Them

In a country that leads the world in so many ways, too many people, including those in the middle class, lack adequate healthcare. Healthcare in the United States is sick, and it increasingly seems that a reasonable or intelligent cure is unlikely anytime soon. What does it say about Congress that late night talk show host Jimmy Kimmel has become one of the most rational voices in a sea of disingenuous legislative babble and doubletalk?

Some years back, I received an email from Brien Holden who shared that Australia had it figured out and suggested that it would be a good model for the United States. Australia provides basic healthcare for all with additional coverage available for those whose situation allows. Virtually every other advanced nation insures basic healthcare for its citizens. Why can’t we?

There are two primary reasons: The first is the health insurance lobby, and the second, spineless politicians who are more interested in special interest dollars than the interests of those they represent. As flawed as Obamacare is, replacing it with something even more dysfunctional will only do more harm to an already devastated system.

The problem—though no one in Washington D.C. is willing to standup and actually say it—is the healthcare insurance industry. I’ve thought long and hard about a single-payer system, e.g., Medicare for everyone, but I shudder at the thought of a government-run bureaucracy. The only other alternative would be to regulate insurers like utilities were once regulated for the public good. Ultimately, it will come down to our legislators’ integrity and willingness to do the right thing for their constituents, and whether they can find the courage to bite the hands that feed them.

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.


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

Effect of Contact Lens Surface Properties on Comfort, Tear Stability and Ocular Physiology
Retrospective analysis of different contact lens wearing groups suggests lens surface lubricity is the main factor influencing contact lens comfort. However, in this study, the examined commercially available contact lenses differed in material and design as well as surface properties. Researchers isolated the contribution of lens surface properties using an ultra-thin coating technology. Nineteen habitual contact lens wearers (21.6 ± 1.7 years) wore formofilcon B soft monthly disposable contact lenses with and without coating technology modified surface properties for a month each in a randomized double-masked cross-over study. Breakup time (NIKBUT), NIKBUT average and ocular redness (Jenvis grading scale) were evaluated (Keratograph 5M) after one week and one month of wear. Symptoms were assessed using the Contact Lens Dry Eye Questionnaire (CLDEQ-8); perceived vision quality and subjective lens comfort at insertion, mid-day and end of the day were rated with four Visual Analog Scales.

Perceived visual quality, contact lens dry eye symptoms and subjective lens comfort were better for coated compared with uncoated lenses. The surface coating postponed the lens de-wetting and increased the pre-lens tear film stability, but bulbar and limbal redness were similar for both contact lenses. No parameter changed significantly between a weeks' and months' wear. Lens surface wettability and ocular redness were not correlated to changes in symptoms.

Researchers wrote that, as previously hypothesized, enhancing the physical surface properties of a soft contact lens improved subjectively rated wearer comfort, which, in turn, was expected to result in reduced contact lens discontinuation.

SOURCE: Vidal-Rohr M, Wolffsohn JS, Davies LN, et al. Effect of contact lens surface properties on comfort, tear stability and ocular physiology. Cont Lens Anterior Eye. 2017; Sep 15. [Epub ahead of print].


Refractive and Ocular Biometric Profile of Children with a History of Laser Treatment for Retinopathy of Prematurity
Indian children belong to a diverse socioeconomic strata with retinopathy of prematurity (ROP) developing in mature, higher birth weight babies as well, investigators wrote. The purpose of this study was to analyze the long-term status of refractive errors and its relationship with ocular biometry in children with ROP who were laser treated at a tertiary center in North India. Participants included children (<16 years) enrolled from January 2014 to December 2014 with a history of laser treatment for ROP examined for refractive and biometric status.

Thirty-six children presenting at the mean age of 7.37 ± 3.07 years (6 to 15 years) were included. Mean spherical equivalent (SE) was -4.05D ± 5.10. Seventy-five percent were myopic, with high astigmatism in 31%. Higher lens thickness and higher SE at one year postnatal age were predictors of larger SE. A total of 79.4% achieved a favorable functional outcome (visual acuity ≥20/40), while 5.88% achieved unsatisfactory outcome (<20/200) despite having a favorable structural outcome.

Investigators wrote that a substantial number of children developed myopia and high astigmatism while undergoing laser treatment for ROP. They found myopia in their cohort to be lenticular with greater axial length contributing to the development of high myopia. Investigators concluded that an initial large refractive error predicted future development of myopia in these children. Nearly 6% of patients with good structural outcomes had unexplained subnormal vision, so investigators suggested that the clinical threshold for prescribing glasses in this category of children should be low.

SOURCE: Kaur S, Sukhija J, Katoch D, et al. Refractive and ocular biometric profile of children with a history of laser treatment for retinopathy of prematurity. Indian J Ophthalmol; 2017;65(9):835-40.




Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia
Among four- and five-year-old children, deficits in measures of attention, visual-motor integration (VMI) and visual perception (VP) were associated with moderate, uncorrected hyperopia (3D to 6D) accompanied by reduced near visual function (near visual acuity worse than 20/40 or stereoacuity worse than 240 seconds of arc). This study compared attention, visual motor and visual perceptual skills in uncorrected hyperopes and emmetropes attending preschool or kindergarten, and evaluated associations with visual function. Participants were four and five years of age with either hyperopia (≥3D to ≤6D; astigmatism ≤1.5D; anisometropia ≤1D) or emmetropia (hyperopia ≤1D; astigmatism, anisometropia and myopia each <1D) without amblyopia or strabismus. Examiners masked to refractive status administered tests of attention (sustained, receptive and expressive), VMI and VP. Binocular visual acuity, stereoacuity and accommodative accuracy were also assessed at near. Analyses were adjusted for age, sex, race/ethnicity and parent's/caregiver's education.

Two hundred forty-four hyperopes (mean, +3.8D ± [SD] 0.8D) and 248 emmetropes (+0.5D ± 0.5D) completed testing. Results included that: the mean sustained attention score was worse in hyperopes compared with emmetropes; the mean receptive attention score was worse in 4D to 6D hyperopes compared with emmetropes; hyperopes with reduced near visual acuity (20/40 or worse) had worse scores than emmetropes; and hyperopes with stereoacuity of 240 seconds of arc or worse scored significantly worse than emmetropes. Overall, hyperopes with better near visual function generally performed similarly to emmetropes.

Researchers found that moderately hyperopic children had deficits in measures of attention and that hyperopic children with reduced near visual function had lower scores on VMI and VP than emmetropic children.

SOURCE: Kulp MT, Ciner E, Maguire M, et al. Attention and visual motor integration in young children with uncorrected hyperopia. Optom Vis Sci. 2017; Sep 11. [Epub ahead of print].

News & Notes
Lacrivera Introduces Veraplug Flexfit Punctal Occluder
The new FlexFit Punctal Occluder by Lacrivera now offers the FlexFit nose technology for dry eye practices, which is designed to collapse when inserted. As such, the device allows for ease of sizing and insertion, as well as excellent retention and patient comfort. The VeraPlug FlexFit offers four sizes in sterile preloaded and non-sterile bulk packaging. Read more.

Johnson & Johnson Vision Acquires Sightbox, Expands Monthly Offering with Acuvue Vita Brand Contact Lenses for Astigmatism
Johnson & Johnson Vision acquired Sightbox, an online, membership-based subscription service for contact lens wearers in the United States. The service helps patients connect with eye care professionals and addresses a consumer trend of patients seeking more convenient access to eye health services and products. Services include scheduling a comprehensive annual eye exam and contact lens evaluation for members, as well as providing an annual supply of contact lenses. While Sightbox will become part of Johnson & Johnson Vision, it will operate as a separate business, leveraging its own business model. Read more. Johnson & Johnson Vision also announced the U.S. launch of Acuvue Vita Brand Contact Lenses for Astigmatism, a daily-wear, monthly-replacement contact lens with blink-stabilized design keep the lens in the correct position and HydraMax technology to help maximize and maintain hydration throughout the lens for consistent, clear, stable vision with exceptional comfort during the month.

First Phase III Study Evaluating Spectri Fails to Meet Primary Endpoint
Roche announced that 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 with the sham treatment at one year (48 weeks). Given the lack of efficacy, further dosing in individuals will be interrupted until the results from the second Phase III study are evaluated, according to the company. Read more.

AAOF Selects Douglas W. Hopkins Primary Care Residency Award Recipient
Ashley Rose Luke, OD, BS, primary care/ocular disease resident at the Zuni Comprehensive Community Health Center and graduate of Southern California College of Optometry at Marshall B. Ketchum University was chosen by a committee of members in the Comprehensive Eye Care Section of the American Academy of Optometry as this year’s recipient for the Douglas W. Hopkins Primary Care Residency Award. She will receive a $2,000 education award and a $750 travel fellowship to attend Academy 2017 (Oct. 11 to 14) in Chicago in October. Read more.

2017 East Coast Optometric Glaucoma Symposium - Click to Register

AAOF Names Bert C. And Lydia M. Corwin Contact Lens Residency Award Recipient
Jesus Gabriel Martinez, OD, cornea and contact lens fellow at the University of Houston, was chosen by a committee of members in the Cornea, Contact Lenses and Refractive Technologies Section of the American Academy of Optometry as this year’s recipient for the Bert C. & Lydia M. Corwin Residency Award. Dr. Martinez will receive a $2,000 education award and a $750 travel fellowship to attend Academy 2017. Read more.

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

AAOF Releases Student Giving Match Program Recipients
The American Academy of Optometry Foundation announced the recipients of the 2017 Student Giving Matching Gift Program. The program was created in 2014 to increase AAOF student participation, create a climate of giving and involvement in AAO student clubs, and encourage AAO membership and AAOF participation by offering a matching student travel grant program to attend Academy 2017. View the recipients.

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

AAO & AAOF Name Student Travel Fellowship & Resident Travel Fellowship Recipients
The American Academy of Optometry named the recipients of the 2017 Student Travel Fellowship Awards and Resident Travel Fellowship Awards. The fellowships will enable students and residents to attend Academy 2017. View the recipients.

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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