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TIPS, TRENDS & NEWS YOU CAN USE

PROF. HOLDEN’S FINAL PAPER ARGUES TO RECOGNIZE NEAR VISION IMPAIRMENT

In the last paper he wrote before his passing, Prof. Brien Holden advocated for recognition of the estimated half a billion people worldwide who suffer from vision impairment because they cannot access reading glasses.

The paper, “Towards better estimates of uncorrected presbyopia,” published in the “Bulletin of the World Health Organization,” (Holden B., Tahhan N., Jong M., et al) argues that “formal inclusion of near vision impairment in the ICD (the WHO’s international statistical classification of diseases and related health problems) is an overdue and crucial step in dealing effectively with this common but easily mitigated disability.”

“Because it is so common, it has perhaps been overlooked as a cause of disability,” says co-author on the paper, Dr. Nina Tahhan of the Brien Holden Vision Institute. “When you don’t have glasses, you are functionally disabled. Whether vision impairment is at close range or distance, the impact on quality of life is the same.”

Prof. Kovin Naidoo, Acting CEO of the Brien Holden Vision Institute, noted that reading glasses are not only for those who read. “Even in countries where literacy is low, spectacles are essential for a range of activities such as sorting grains, weeding, cooking, sewing and caring for children,” he says.

“Impairment of near vision is at least as detrimental to quality of life as impairment of distance vision, regardless of the setting, sociodemographics or lifestyle of participants,” the authors write.

To achieve its goal to “create a world where everyone, everywhere has access to vision correction,” formal recognition of near vision impairment in the ICD is “a critical first step,” says Prof. Naidoo. ■

TIPS FOR ADHERENCE WITH DRY EYE DROPS: EDUCATE, SHOW AND PRESCRIBE

Despite prescribing a customized drop regimen to his dry eye disease patients, Connecticut optometrist Michael Cooper says there were still individuals returning off schedule as much as six months to a year later with progressive indications. Sound familiar?

After receiving nebulous answers from patients about when they administered their drops, he says he devised a simple three-step process to increase the likelihood of medication compliance and conducted an unofficial study on it, which revealed an 85% increase in medication adherence.

THE STEPS:

1. Brief education. To start, Dr. Cooper says he explains to patients, in simple terms, what specifically is occurring on their ocular surface. A sample of phrasing he says he utilizes is, “your eye surface has a sandpaper-like appearance whereas it should look smooth, like a baby’s behind, to optimize visual performance. If we do nothing to effect change, there is a chance I could see your condition progress, and it might be more difficult to treat.” Next, he says, “I’m prescribing you a custom drop plan, and I’m depending on you to work with me so we can improve the health of your eye surface and potentially prevent visual challenges.”

2. Showing pathology. Dr. Cooper says he uses animation software both during the exam and in emails to patients to show them how their dry eye disease is affecting their eye health. “Photos connect what we say to patients to what they see, so they’re pretty powerful,” he explains.

3. Prescribing specific times/methods. Dr. Cooper says he prescribes specific times and methods for patients to remember to take their drops. “I gave them two choices: take the drops at breakfast and dinner, because those are often sit-down meals where there is an increased likelihood of recall, or program drop times on your iPhone, Android, or an ‘old school’ calendar to ensure you take your drops as prescribed.”

“I think many of my peers truly want an elegant solution to remedy the issue in a swift and direct fashion,” he explains. “The unintended results of this thought process leads to patient confusion because it tends to fly contrary to our understanding of ocular pathology and the inflammatory cascade. We all need to think of and treat dry eye disease in a similar manner we manage glaucoma by coming up with ubiquitous ideas for instilling adherence and instituting a shorter follow-up schedule.” ■

AAO FELLOWSHIP GROWTH ON THE RISE

The number of American Academy of Optometry fellows is increasing, according to data presented at the AAO’s annual meeting. Why? Jason Jedlicka, O.D., F.A.A.O., associate professor, Indiana University College of Optometry and the AAO’s chair of the Membership Committee, cited three reasons:

“(1) There are more O.D.s than ever before, and as the number of O.D.s grow, so does the number who become fellows, simply as a percentage of O.D.s in practice. (2) The AAO is focused on lifelong learning and research, so those who want to practice at the highest level increasingly see the AAO as part of that. (3) With the increase in number of O.D.s and the increasing commercialization of optometry, many are trying to find ways to set themselves apart. The AAO is a place that they can gain new skills and network with like-minded O.D.s …

FROM AMD TO ENERGY DRINKS: AAO ANNUAL PRESS CONFERENCE DEMONSTRATES A WIDE BREADTH OF RESEARCH

This year’s AAO conference, held in New Orleans last month, included 20 presentations from vendors and researchers. (See “Vendor Presentations” below.) The scientific presentations included:

• EZ-Id License Plate Design. When license plates contained symbols, such as stars or triangles, 53% were accurately recalled, as compared to 33% of alphanumeric-only plates. In addition, 96% of all symbols were correctly recalled.

• Can Aquatic Lifeguards See to Protect the Public? Most (92%) of the pool facilities surveyed have no policy to verify lifeguard vision, which could be quite poor. The results highlight the need for vision standards for lifeguards, who are relied on for safety.

• Is On-Task Behavior of 4- to 5-Year-Old Children During Story Book Time Related to Uncorrected Hyperopia? Compared with emmetropic peers, moderately hyperopic 4- and 5-year-old children show a significantly lower percentage of time in on-task looking behaviors during storybook reading time.

• Evaluation of Oxygen Under Scleral Lenses Fitted With Different Fluid Reservoir Thickness. The study confirms the validity of models suggesting that a higher level of clearance is associated with a higher risk to develop corneal hypoxia.

• Longitudinal Features of Corneal Hysteresis. Corneal hystesis (CH) decreases over time and is hastened in the setting of worsening glaucomatous field loss, higher IOP and use of prostaglandin analogue drugs. Also, CH demonstrates substantial inter-visit variability, encompassing 27% of the dynamic range of CH.

• Prevalence and Prediction of Glaucomatous 10-2 Visual Field Loss. Results indicate measurable visual field loss within the central 10° is common in glaucoma, even when 24-2 VF is mild.

• Using En Face and Circumpapillary OCT to Predict Functional Loss in Patients With Glaucoma. Both often allow the examiner to predict visual field defects and may do so in a complementary manner.

• Social Support Predicts Stress Level in Patients With AMD. Social support was a predictor of levels of perceived stress in patients with neovascular AMD.

• The Influence of Energy Drinks on Spectral Sensitivity. The drinks’ caffeine diminishes the metabolism of certain photoreceptors and neuronal structures. The neuronal noise of the bigger photoreceptors seems to be reduced the most, which causes a decrease in the chromatic visual threshold of these photoreceptors.

• Relationships Between Neural and Vascular Parameters in a Rat Model of Oxygen-Induced Retinopathy; Effects of High Dose Vitamin A (HDVA) Treatment. Rescue of retinal function by HDVA may be due to ameliorization of retinal hypoxia by promoting retinal vascular development through modulation of genes involved in angiogenesis. ■

VENDOR PRESENTATIONS AT THE AAO PRESS CONFERENCE

The annual AAO press conference included the following vendor presentations:

• TearScience: Diagnostic testing and therapy for meibomian gland dysfunction

• Smart Vision Labs: Smartphone autorefractor

• Visionary Optics: Scleral lens fitting with sMap3D

• Johnson & Johnson Vision Care: Acuvue Oasys 1-Day contact lens

• Euclid Systems: Emerald orthokeratology contact lens

• Brien Holden Vision Institute: Extended depth of focus contact lens

• Heidelberg Engineering: Widefield imaging module for Spectralis

• Konan Medical: EvokeDx NextGen VEP+ERG objective assessment of visual pathway

• Innova: Rabin Cone test

• Volk Optical: Pictor Plus portable ophthalmic camera

SHIRE ANNOUNCES POSITIVE PHASE 3 STUDY RESULTS AND PLANS TO RESUBMIT NDA FOR LIFITEGRAST

Shire recently announced positive topline results from OPUS-3, a phase 3 efficacy and safety study of the company’s dry eye therapy, lifitegrast.

Lifitegrast met the single primary endpoint for patient-reported symptoms of eye dryness (mean change in Eye Dryness Score from baseline to week 12) (treatment difference of 7.16 [95% CI], 3.04, 11.28; p=0.0007). Lifitegrast also met the secondary endpoints of symptom improvement at Days 14 and 42.

OPUS-3 compared lifitegrast to placebo administered twice daily for 84 days in patients with dry eye, a recent history of artificial tear use within 30 days of study entry and an eye dryness score (EDS) ≥40.

In the study, lifitegrast also met the secondary endpoints of symptom improvement at Days 14 and 42 (treatment difference (95% CI) 7.85(4.33, 11.37) and 9.32 (5.44, 13.20) respectively, (p<0.0001)).

Shire plans to resubmit the New Drug Application to the FDA for lifitegrast for the treatment of signs and symptoms of dry eye disease in the first quarter of 2016. If approved by the FDA, “this keeps us on track for a potential U.S. launch next year,” says Flemming Ornskov, M.D., C.E.O., Shire. ■

CAPTION: In September, VSP Global celebrated 60 years by hosting its largest multi-city mobile eye care clinic in the company’s history. The clinic included free eye exams and eye wear for 1,637 people in need. In the photo, Dr. Phenny Kwan, a frequent mobile eye care clinic volunteer, examines a young patient in Sacramento, Calif. ■

UV APP LAUNCHED TO PROMOTE EYE PROTECTION IN CHILDREN

It’s no secret to optometrists that most patients recognize the importance of sunscreen for their skin, but don’t think about protecting their eyes from harmful UV rays with sunglasses. Polaroid is hoping to change this mindset with a free app aimed at parents.

Called Polaroid UV Alert, the app increases parent awareness about the importance of eye wear protection for children, as it measures UV radiation and alerts parents when radiation reaches dangerous levels.

The app is available for iPhones, iPads and the Apple Watch and includes information on UV radiation protection, Polaroid polarized lenses and where parents can buy the lenses. ■