Optometric Physician

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


Volume 20, Number 41

Monday, September 28, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: Of Hope and Hopelessness

######### Social Media Listening to Understand the Lived Experience of Presbyopia: Systematic Search and Content Analysis Study
######### Personal Hygiene Risk Factors for Contact Lens-related Microbial Keratitis
  Presumed Herpes Zoster Ophthalmicus Reactivation Following Recombinant Zoster Vaccination
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: Of Hope and Hopelessness

As most of you know, Shannon and I left Phoenix for Kearney, Nebraska late last week so she could be with her family and her mom, whose battle with cancer was rapidly coming to an end. Our deepest thanks to so many of you who took the time to send prayers and support. It was quite overwhelming.

I want to share some thoughts. I’ll caution that this is not about optometry, and it may not be comfortable for some. Still, I feel obliged to write it.

I imagine that many of you have had to deal with the passing of a loved one. It’s never easy and it's never the same. Over the years I’ve lost many friends. I’ve lost both of my parents and my brother. I’ve stared death in the eye, and I’ve seen its cruelty and its twists and turns. I’ve seen the moment life leaves a body, an image that can never be unseen. Death can be quick, over before the person even knows they’re gone. It can be gentle and slow enough to allow time for goodbyes and closure. Occasionally, death is painfully slow and agonizing for both loved and loved ones.

Cancer is cruel beyond description. It is relentless, miserable, and excruciating. Cancer often kills slowly and painfully. Watching a loved one die of cancer, especially after being worn down by its prolonged emotional rollercoaster of hope and hopelessness can be devastating.

Hospice is not what I thought it was. I’ve always believed hospice was an end-of-life resource that took over many of the most difficult and unpleasant parts of caring for the dying, allowing the patient some dignity and the family as much remaining quality time as possible. I am sure that for many hospice nurses what they do is a true calling of mercy and caring. Experiencing it this past week, hospice is also a business and a way of transferring responsibility for a patient’s last days to the unfortunate, overwhelmed and ill-prepared family of the dying. It is exactly what it shouldn’t be—a costly do-it-yourself kit for death. Covered by Medicare, the house was filled with walkers, wheelchairs, drugs and paraphernalia, well beyond what was needed or could possibly be used. Some of the advice the family received was helpful. Much of it illogical, contradictory or medically unsound.

I’ve never given much thought to euthanasia. I view all life as precious, and even having a sick pet put to sleep has been excruciatingly painful. As I sit here writing this, listening to the sounds of death rattling when all hope is gone and only pain and suffering remain, my perspective has changed. Death is inevitable, but sometimes it doesn’t come soon enough to be merciful. Seeing the magnitude of agony, I can’t imagine a just and caring God who would want needless suffering or a civilized society that would tolerate it. We should not worry more about the comfort of heinous death row inmates than we do our loved cancer patients. After one of the most difficult weeks of our lives, Kathy Steinhauser passed away early Thursday morning with Shannon and her dad by her side.

Personal note: Our profession has lost two giants over the past month. Irving Bennett was among the first to understand not only the value of optometry, but that optometry should be valued. The founder of Optometric Management, I had the honor of following him as chief optometric editor years later. Irv was a prolific author, educator and speaker, and helped shape the profession as it exists today. I relished his occasional emails about Off the Cuff topics. He will be missed.

James Boucher also left us this month. An always-friendly face and a friend, Jim was a transformative force in the profession. Chair of the AOA CLCS (then the CLS), I followed in his footsteps as chair years later. A diplomate in the Cornea and Contact Lens Section of the AAO. He also served on the AOA Board of Trustees and chaired the Accreditation Council on Optometric Education. Serving on the FDA Ophthalmic Devices panel for 18 years, Jim helped elevate the profession’s stature within the medical community, and was an amazingly kind and gentle soul. I am only scratching the surface of his incredible career and accomplishments.

Finally, on a bright note, as you have probably heard, the despicably anti-optometry referendum initiative seeking to overturn recent scope expansion legislation was thrown off the ballot in Arkansas. Kudos to the Arkansas Optometric Association and the AOA for their steadfast resolve in making sure that this attempt by another profession to control our profession was neutralized. I will have more to say about this in a future editorial. Enough is enough.


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.



Social Media Listening to Understand the Lived Experience of Presbyopia: Systematic Search and Content Analysis Study

Presbyopia is defined as the age-related deterioration of near vision over time, which is experienced in more than 80% of people ages 40 years or older. Individuals with presbyopia have difficulty with tasks that rely on near vision. It is not currently possible to stop or reverse the aging process that causes presbyopia; generally, it is corrected with glasses, contact lenses, surgery or the use of a magnifying glass. This study aimed to explore how individuals used social media to describe their experience of presbyopia with regard to the symptoms experienced and the impacts of presbyopia on their quality of life. Social media sources including Twitter, forums, blogs, and news outlets were searched using a predefined search string relating to symptoms and impacts of presbyopia. The data that were downloaded, based on the keywords, underwent manual review to identify relevant data points. Relevant posts were further manually analyzed through a process of data tagging, categorization and clustering. Key themes relating to symptoms, impacts, treatment and lived experiences were identified.

A total of 4,456 social media posts related to presbyopia were identified between May 2017 and August 2017. Using a random sampling methodology, we selected 2,229 (50.0%) posts for manual review, with 1,470 (65.9%) of these 2,229 posts identified as relevant to the study objectives. Twitter was the most commonly used channel for discussions on presbyopia compared to forums and blogs. The majority of relevant posts originated in Spain (559/1,470, 38.0%) and the United States (426/1,470, 29.0%). Of the relevant posts, 270/1,470 (18.4%) were categorized as posts written by individuals who have presbyopia, of which 37 of the 270 posts (13.7%) discussed symptoms. On social media, individuals with presbyopia most frequently reported experiencing difficulty reading small print (24/37, 64.9%), difficulty focusing on near objects (15/37, 40.5%), eye strain (12/37, 32.4%), headaches (9/37, 24.3%) and blurred vision (8/37, 21.6%). A total of 81 of the 270 posts (30.0%) discussed impacts of presbyopia-emotional burden (57/81, 70.4%), functional or daily living impacts (46/81, 56.8%), such as difficulty reading (46/81, 56.8%) and using electronic devices (21/81, 25.9%), and impacts on work (3/81, 3.7%).

Findings from this social media listening study provided insight into how people with presbyopia discuss their condition online and highlight the impact of presbyopia on individuals' quality of life. Researchers noted that the social media listening methodology can be used to generate insights into the lived experience of a condition, but it is recommended that this research be combined with prospective qualitative research for added rigor and for confirmation of the relevance of the findings.

SOURCE: Wolffsohn JS, Leteneux-Pantais C, Chiva-Razavi S, et al. Social media listening to understand the lived experience of presbyopia: systematic search and content analysis study. J Med Internet Res. 2020; Sep 21;22(9):e18306.


Personal Hygiene Risk Factors for Contact Lens-related Microbial Keratitis

Microbial keratitis is a sight-threatening complication of contact lens wear, which affects thousands of patients and causes a significant burden on healthcare services. This study aimed to identify compliance with contact lens care recommendations and identify personal hygiene risk factors in patients who develop contact lens-related microbial keratitis. A case-control study was conducted at the University Hospital Southampton Eye Casualty from October to December 2015. Two participant groups were recruited: Cases were contact lens wearers presenting with microbial keratitis and controls were contact lens wearers without infection. Participants underwent face-to-face interviews to identify lens wear practices, including lens type, hours of wear, personal hygiene, and sleeping and showering in lenses. Univariate and multivariate regression models were used to compare groups.

A total of 37 cases and 41 controls were identified. Showering in contact lenses was identified as the greatest risk factor, with showering daily in lenses compared with never doing so, increasing the risk of microbial keratitis by more than seven times. Other risks included sleeping in lenses, and being ages 25-39 and 40-54.

The greatest personal hygiene risk factor for contact lens-related microbial keratitis was showering while wearing lenses, with an OR of 3.1, which increased to 7.1 if patients showered daily in lenses. The OR for sleeping in lenses was 3.1, and the most at-risk age group was 25-54.

SOURCE: Stellwagen A, MacGregor C, Kung R, et al. Personal hygiene risk factors for contact lens-related microbial keratitis. BMJ Open Ophthalmol. 2020; Sep 8;5(1):e000476.




Presumed Herpes Zoster Ophthalmicus Reactivation Following Recombinant Zoster Vaccination

A 78-year-old woman with a history of herpes zoster ophthalmicus (HZO) 20 years ago was referred for progressive corneal thinning in her left eye that started one week after her second dose of recombinant zoster vaccination.

At presentation, visual acuity was counting fingers. Corneal sensation was markedly decreased. Slit lamp examination revealed a temporal paracentral epithelial defect 1.5 × 2mm in size with 40% thinning and surrounding stromal inflammation suggestive of stromal keratitis with ulceration. The patient was started on oral valacyclovir, topical erythromycin ointment, and hourly topical lubrication. A bandage contact lens was placed and was replaced one week later with self-retained cryopreserved amniotic membrane ring. The ring was removed in the following week when the thinned area was epithelialized with no further evidence of stromal lysis.

Investigators wrote that HZO reactivation after recombinant zoster vaccination is uncommon but possible. They added that ophthalmologists should remain aware of potential risks of zoster vaccination and take special precautions in patients with HZO history.

SOURCE: Jabbour S, Shekhawat NS, Chen A, et al. Presumed herpes zoster ophthalmicus reactivation following recombinant zoster vaccination. Cornea. 2020; Sep 16. [Epub ahead of print].


News & Notes
AAOF Names 2020 Korb-Exford Dry Eye Career Development Grant Recipient
The American Academy of Optometry Foundation announced William Ngo, OD, PhD, FAAO, as this year’s recipient of the Korb-Exford Dry Eye Career Development Grant. Dr. Ngo is head of biosciences at the Centre for Ocular Research and Education, and a research assistant professor at the University of Waterloo School of Optometry and Vision Science. The $25,000 grant will help him to develop a biomarker panel to differentiate dry eye disease and neuropathic pain. Read more.

Keeler USA & Olleyes Partner
Keeler, a provider of ophthalmic diagnostic, digital, surgical and clinical products, announced its US partnership with Olleyes, a medical device company developing office and home-based diagnostic products to improve productivity in eye care with VisuALL (Virtual Reality Perimetry) VRP. VisuALL, which is designed for standardized and mobile assessment of visual fields and visual acuity, automatically analyzes the retinal sensitivity in individuals with glaucoma and other visual disorders. It enables the exam of multiple patients at a time to help increase office productivity.

  NECO Continues OSD Symposium
A four-part Ocular Surface Disease Symposium offered by the New England College of Optometry and DryEyeCoach continues with two more upcoming sessions, which qualify for two hours of COPE approved education. They are:
• October 6, 7pm Eastern: Virtual Workshop with Timothy Bossie, OD; Anita Gulmiri, OD; Jennifier Liao, OD; and Lance McNaughton, OD
• October 20, 7pm Eastern: Building a Dry Eye Specialty Practice with Walt Whitley OD; Scott Schachter, OD. Register here.

  Dr. Arnold OD to Join Eaglet Eye Team
Eaglet Eye announced that Tom Arnold, OD, accepted a consulting position as professional ambassador. "We are looking forward to Tom's assistance with our efforts to allow specialty practitioners to learn more about profilometry and Eaglet's Eye Surface Profiler," said Tom Shone, GM of Eaglet NA in a press release. Dr. Arnold wrote, "I find the ESP to be an invaluable tool for specialty lens fitting and I am happy to help spread the word." Learn more about Eaglet Eye.

  Bostonsight Grows PROSE Provider Network
BostonSight added three PROSE Provider sites and four clinical fellows to its PROSE network. With this addition, the network includes 18 sites in four countries. BostonSight PROSE (Prosthetic Replacement of the Ocular Surface Ecosystem) is a custom medical treatment model designed to save sight in individuals with ocular surface disease. During the treatment, doctors customize prosthetic devices from gas-permeable polymers for each patient’s condition and unique eye shape. Read more.

NORA Appoints New Executive and Advisory Board Officers

The Neuro-Optometric Rehabilitation Association, International (NORA) announced the appointments of its new Executive and Advisory Board members. View the new board members.

Prevent Blindness Declares October as Contact Lens Safety Month

Prevent Blindness has declared October as Contact Lens Safety Month and seeks to provide the public with information to keep eyes healthy while using contact lenses. View the CL safety info.

Aerie Announces FDA Approves Athlone, Ireland, Facility for Rhopressa Production

Aerie Pharmaceuticals announced that its sterile fill production facility in Athlone, Ireland, received FDA approval for production of Rhopressa (netarsudil ophthalmic solution) 0.02% for commercial distribution in the US. 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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