O.D.S REVEAL MOST MEMORABLE CASES AND THE DEVICES THAT HELPED THEM

Optometrists are experts in identifying pathology, yet without the proper diagnostic technology to aid them, the challenge of making a definitive diagnosis and determining the best treatment and management plan can become much greater.

Here, three O.D.s discuss their most memorable cases in which diagnostic technology helped.

THINNING CORNEAS PROVIDE A CLUE

A 55-year-old white female presents for her annual exam with no complaints. Ocular history reveals findings suspicious for glaucoma. Her BCVA is 20/20 OU.

During anterior segment OCT, pachymetry readings show temporally and inferiorly thinning corneas. These findings prompt me to use corneal topography, which reveals the patient has mild keratoconus!

Why hadn’t she been diagnosed before? The patient’s level of against-the-rule astigmatism didn’t fall outside the normal range via keratometry readings.

Of note: One can determine keratoconus with a high level of certainty based on nothing more than pachymetry readings, reports a study in December 2013’s Journal of Cataract & Refractive Surgery.

– Mile Brujic, O.D., F.A.A.O.

RETINA FINDINGS

An 85-year-old white female presents for a comprehensive exam with no complaints. Ocular history is positive for AMD, for which she takes an AREDS supplement. Systemic hitory is positive for rheumatoid arthritis.

Her BCVA is 20/25 OU. Dilated fundus exam shows retinal pigment epithelium surrounding the foveas, with symmetrical bulls-eye-like appearances OU. Exam via OCT confirms the absence of drusen and shows saucerization of the subfoveal area and a normal choroidal thickness measuring 260µm.

Upon questioning, the patient reveals she took hydroxychloroquine sulfate (Plaquenil, Sanofi-Aventis) roughly 40 years prior for some time, discontinuing use due to back-of-the-eye findings. The verdict: plaquenil macular toxicity.

– Diana L. Shechtman, O.D., F.A.A.O.

MILD BLURRY VISION AND HEADACHES POST CONCUSSION

A 16-year-old white female lacrosse player who sustained a concussion from the sport one month prior presents complaining of mild blurry vision and daily headaches. Past ocular history reveals spectacle use many years prior.

Entering uncorrected VA is 20/25 OU. Near vision is 20/40 OU, and ocular health is unremarkable. Autorefraction reveals +2.25-1.50x177 OD and +3.50-2.00x 013 OS. Manifest refraction is +1.75-1.25x175 20/20 OD and +2.75-1.50x 010 20/20 OS.

With the help of the phoropter and autorefractor, I was able to determine the patient’s headaches were from eye strain induced by her pre-existing refractive error that caused symptoms due to a broken down accommodative system post-concussion.

– Amanda Nanasy, O.D., F.A.A.O. ■

JOHNSON & JOHNSON VISION ANNOUNCES AGREEMENT TO ACQUIRE TEARSCIENCE

With Johnson & Johnson’s acquisition of AMO completed in February, the healthcare company dipped its toes in the dry eye disease (DED) market with Blink Tears Lubricating Eye Drops. Now, it’s about to immerse itself with its forthcoming acquisition, through AMO, of TearScience Inc. Following the expected closing, the Johnson & Johnson Vision Care arm will manage TearScience.

“Dry Eye is a significant unmet health need globally, and meibomian gland dysfunction is the cause for more than 60% of people living with this condition,” says Company Group Chairman, Ashley McEvoy, responsible for the Johnson & Johnson Vision Companies, in a company-issued press release. “The innovative portfolio from TearScience positively impacts the lives of patients around the world suffering from this chronic condition. These solutions, coupled with our existing contact lens and surgical portfolio, will allow us to help more patients with their vision needs, throughout their lifetime.”

TearScience makes devices to aid the practitioner in diagnosing, assessing and treating meibomain gland disease. Specifically, the company offers the LipiView II, with Dynamic Meibomian Imaging, Korb MGE and LipiFlow.

Johnson & Johnson’s press release states: “Dry Eye is a primary reason for discontinued use of contact lenses, and treating dry eye prior to cataract surgery is critical to achieving optimal visual outcomes, particularly when using premium intraocular lenses.”

Johnson & Johnson has not disclosed the transaction’s financial terms, though says it expects to own TearScience by year’s end. ■

’TIP OF THE WEEK’ AUTHOR DISCUSSES HOW HE KEEPS CONTENT FRESH

Internet engagement can help to maintain patients and inspire prospective ones to make appointments. As such, creating ongoing fresh content makes sense. Neil Gailmard, O.D., knows all about creating fresh content, having written a little more than 800 distinctive practice management tips for OM’s weekly e-newsletter, “Tip of the Week.” So, how does he do it?

“Managing my own practice in Munster, Ind., provides me with plenty of ideas because there are frequently problems to manage or new projects to implement. Whatever I happen to be working on often becomes the subject for a tip,” he explains. “I’ve also worked with other O.D.s as a practice management consultant, so I see the issues they are facing.”

He adds that when he has a bout of writer’s block, he picks the brain of his wife, Susan, also an optometrist, reviews practice management articles and lectures he’s given, turns to related books and reviews emails from readers.

It is Dr. Gailmard’s readers who inspired him to create the 700-page book, “Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week,” which became available in August through Amazon. (PentaVision Media, publisher of OM, oversaw the publishing.)

“I selected only the best tip articles for inclusion, eliminating outdated and redundant material,” he explains. “There is some new content as well…”

FIRST OPTOMETRY SCHOOL PLANNED FOR HAITI

To improve access to primary eye care in Haiti, the Brien Holden Vision Institute, Charity Vision, l’Universite d’Etat d’Haiti, Optometry Giving Sight and VOSH International have agreed to create the first school of optometry in the Carribbean country, with help from the University of Montreal. The group says it’s shooting for the first class to start in October.

“There is enormous goodwill toward Haiti from the North American Optometric profession and industry,” says Optometry Giving Sight (OGS) CEO, Clive Miller in an OGS press release. “We have been inspired by the incredible support we have received from all our donors and sponsors, and especially Vision Source in the USA and Essilor in Canada. In addition to their financial support, there is a strong desire to contribute knowledge and skills to help ensure that the students have access to the best resources, and that future graduates have the support and skills they need to run successful clinics and practices.”

The School of Optometry seeks to graduate 16 O.D.s annually via a five-year Bachelor of Vision Science degree. Today, three O.D.s and 58 ophthalmologists serve the 10 million people of Haiti.

If you’re interested in contributing, visit http://bit.ly/2vVQ3M3 . ■