Allergy season is upon us and it appears to be a pretty invasive and miserable season in that regard. There are so many things we can be doing in our practice with our patients to help them with their allergies—from pharmaceuticals to environmental management and even spectacle design (as noted in this week’s abstract). Don’t forget to be proactive in your vigilant fight of allergies in your patients.
Jason J. Nichols, OD, MPH, PhD
AOA and Optometry Cares Announce 2016 National Optometry Hall of Fame Inductees
The American Optometric Association (AOA) and Optometry Cares-The AOA Foundation congratulate three AOA member doctors of optometry who have been selected into the prestigious National Optometry Hall of Fame. Since 1998, the National Optometry Hall of Fame, administered by Optometry Cares, has recognized and honored optometrists who have made significant and long-lasting contributions to the optometric profession.
The 2016 inductees are:
Joseph Babcock Sr., OD – The late Dr. Babcock understood the need for optometry’s representation within the military. He worked to gain parity within the armed services, and was successful in securing draft deferments for optometric students. He was instrumental in the Optometry Corps bill presented to the House of Representatives, and the formation of an optometry section in the Medical Service Corps within each branch of the armed services. He was selected by President Franklin Roosevelt as advisor to the Healing Arts Educational Advisory Committee. Read more.
Richmond Lewis Scott, OD – The late Dr. Scott worked to advance the profession’s scope of practice to improve patient care. He was a strong proponent of mandatory continuing education for health care providers and was the key proponent of legislation in Indiana to require CE for optometrists. In the early 1970s, he promoted the expansion of the scope of care across Indiana, speaking at all 12 optometric societies to expand the use of pharmaceutical agents that served optometry until the passage of a new therapeutic law. Dr. Scott testified in many states at legislative hearings on therapeutic drug laws. Read more.
Louis Catania, OD – Dr. Catania was a pioneer in post-graduate residency education, and the expansion of the scope of optometry to not only diagnose, but also treat eye disease. Over a 14-year period, he provided his expertise in primary care optometry to 49 states and 32 countries in the areas of legislative, statutory, education and clinical care. Not only has he given generously of his time to his profession, he also has actively volunteered for a number of community organizations and Orbis International. Read more.
The inductees will be honored at a ceremony during Optometry's Meeting in Boston, Massachusetts, Thursday, June 30, from 7-8 p.m.
Corneal Bleb Inna Gelman, MOptom, Jerusalem, Israel
This shows a localized, elevated, dome-shaped, fluid filled bleb in the left eye of a 70 year-old male keratoconic patient who came into the specialty contact lens clinics asking for scleral or mini-scleral lenses. These lenses were ruled out due to the corneal bleb. The patient, who was post PKP as well as cataract in the left eye (1985, 1998, respectively), was fit with a RoseK2 lens with a BC of 5.8 and diameter of 8.6 mm obtaining a visual acuity of 20/20 -2. The patient wears reading glasses with an addition of +1.75 at near.
We thank Inna Gelman for this image and welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit http://www.cltoday.com/upload/upload.aspx to upload your image. Please include a detailed explanation of the photo and your full name, degree or title, and city/state/country.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Eye Microbiome Populations in CL vs. Non-CL-Wearers
From the New York University School of Medicine is an interesting article regarding microbiome populations in contact lens vs. non-contact lens-wearing individuals. The authors compared the bacterial communities of the conjunctiva and skin under the eye from SCL-wearing and non-SCL-wearing subjects. Samples were analyzed using a 16S rRNA gene-based sequencing technique (16S ribosomal RNA (rRNA) sequencing is a common sequencing method used to identify and compare bacteria present within a given sample that are difficult or impossible to study). Results reported that compared to those from non-lens wearers, dry conjunctival swabs from lens wearers had more variable and skin-like bacterial community structures with higher abundances of Methylobacterium, Lactobacillus, Acinetobacter, and Pseudomonas and lower abundances of Haemophilus, Streptococcus, Staphylococcus, and Corynebacterium. These results indicate that wearing contact lenses alters the microbial structure of the ocular conjunctiva, making it more similar to that of the skin microbiota. Consider that, as in other body sites (i.e., the gut, skin, and mouth), the eye has a normal community of bacteria that are thought to confer resistance that provides protection from invaders. This report shows differences in the eye microbiome of contact lens wearers in relation to those of non-lens wearers and has the potential to help future studies explore novel insights into a possible role of the microbiome in the increased risk for eye infections in contact lens wearers.1
1. Shin H, Price K, Albert L, Dodick J, Park L, Dominguez-Bello MG. Changes in the Eye Microbiota Associated with Contact Lens Wearing. MBio. 2016 Mar 22;7(2). pii: e00198-16. doi: 10.1128/mBio.00198-16.
We Keep Moving Forward…Potential for an Alternative Approach to Corneal Cross Linking Using Lower Energy and Shorter Duration. Can It Work?
Researchers conducted a study to determine the cross-linking effect of a riboflavin ultraviolet-A (UV-A) corneal cross-linking treatment that is both shorter and has lower energy than the Dresden protocol.1 In a first experiment, 12 human corneas were presoaked with riboflavin and then irradiated with UV-A at 3 mW/cm after clearing the surface of riboflavin, with no added riboflavin during irradiation. Percent UV-A transmission through the corneas was measured at intervals up to 30 minutes. A second experiment involved 24 porcine corneas. Eight were de-epithelialized, presoaked in riboflavin for 30 minutes, and irradiated at 1.5 mW/cm for 10 minutes. An additional 8 were riboflavin treated and similarly irradiated, but with epithelium intact and a final 8 corneas were not treated. Young modulus (which is a measure of stiffness of a solid material) was measured in all 24 corneas at the end of the experiment. Results found that the first experiment showed essentially complete riboflavin oxidation after only 10 minutes. Based on these results, a shortened UV-A exposure cross-linking experiment was designed using a reduced UV-A fluence of 1.5 mW/cm, an endothelial exposure within safety limits in humans. With this protocol Young modulus was the same in the irradiated porcine corneas but with epithelium intact as in the untreated corneas. In contrast, Young modulus increased by a factor of 1.99 in the UV-A cross-linked corneas at 1.5 mW/cm for 10 minutes with the epithelium removed. The authors concluded that a shorter, lower energy protocol than the Dresden protocol seems to provide a significant increase in Young modulus, similar to published results with higher energy and longer exposure protocols.
The field of keratoconus management is changing at exponential rates. New technologies and new methodologies are being developed that all are allowing us to both limit the progression and better minimize the visual distress brought on by the disease. These developments further emphasize the importance of early diagnosis and intervention. The ultimate goal is preservation of vision and avoidance of keratoplasty.
1. Caruso C, Barbaro G, Epstein RL, Tronino D, Ostacolo C, Sacchi A, Pacente L, Del Prete A, Sala M, Troisi S. Corneal Cross-Linking: Evaluating the Potential for a Lower Power, Shorter Duration Treatment. Cornea. 2016 Mar 16. [Epub ahead of print]
Wraparound Eyeglasses Improve Symptoms and Quality of Life in Patients with Seasonal Allergic Rhinoconjunctivitis
Allergen avoidance is important for allergic rhinitis management. However, studies evaluating the efficiency of avoidance measures from pollens are lacking. These researchers aimed to investigate the efficiency of wraparound eyeglasses in seasonal allergic rhinoconjunctivitis (SAR).
Eligible patients with a diagnosis of SAR (n = 70) rated their symptom scores, filled the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and were randomized either to receive wraparound eyeglasses in addition to medical treatment (group 1, n = 39) or medical treatment only (group 2, n = 31) throughout the 3 pollen seasons in the years 2011, 2012, and 2013. Patients rated their symptom scores and checked the need for use of rescue medications in their diaries over a period of 4 weeks. RQLQ was reapplied 1 week and 4 weeks after randomization.
The median (interquartile range [IQR]) change from baseline over 4 weeks in the eye itching (-2.51 [-3.65 to -1.36] vs -0.88 [-1.95 to 0.43], p < 0.001), eye watering (-2.31 [-3.09 to -1.24] vs -1.60 [-2.59 to -0.21], p = 0.02), sneezing (-2.26 [-3.19 to -1.51] vs -1.68 [-2.27 to -0.56], p = 0.03), and rhinorrhea (-2.48 [-3.74 to -1.49] vs -1.59 [-2.88 to -0.87], p = 0.04) scores were significantly higher in group 1 compared to group 2. There were significantly higher improvements in ocular symptoms domain score (-1.75 [-3.12 to -1.00] vs -0.50 [-2.31 to -0.31], p = 0.002), nasal symptoms domain score (-2.25 [-4.06 to -1.50] vs -1.25 [-2.37 to -0.68], p = 0.004), and total RQLQ score (-1.98 [-2.67 to -0.88] vs -1.10 [-2.06 to -0.25], p = 0.02) and reduced need for rescue medication use in group 1 compared to group 2 at the end of 4 weeks.
The researchers concluded that standard wraparound eyeglasses can provide a safe, convenient, and effective measure for protection from pollens in patients with SAR.
Comert S, Karakaya G, Kalyoncu AF. Wraparound eyeglasses improve symptoms and quality of life in patients with seasonal allergic rhinoconjunctivitis. Int Forum AllergyRhinol. 2016 Feb 25. doi: 10.1002/alr.21737. [Epub ahead of print]