A weekly e-journal
by Arthur B. Epstein, OD, FAAO
5, Number 36
September 12, 2005
the Cuff: Katrina: A Wakeup Call
In the clarity that
comes after an overwhelming natural disaster,
we are reminded of just how small we are as
individuals and how interconnected our lives
really are. As Hurricane Katrina destroyed the
city of New Orleans and damaged much of the
surrounding Gulf Coast, many of our colleagues
who practice there lost homes, practices, patients--and
for some, even more than that. Many may never
Thanks to the sage wisdom of my good friend
Dr. Brent Dulitz, who grew up in New Orleans,
I was able to see beyond the immediate devastation
to the consequences that will haunt many of
these colleagues for years to come. With no
place to practice or make a living, some of
these ODs have no choice but to seek temporary
work in other areas--including other states.
A frequent theme of this column has been the
need for national standards allowing reciprocity
of licensure throughout the United States. This
crisis underscores just how important this is
to our profession and to each and every one
of us. I understand that several state boards
have already enacted emergency endorsement for
the affected ODs. I applaud their wisdom and
kindness. I again call on all state boards that
have not yet enacted reasonable means for practicing
ODs to become licensed in their states to do
so expeditiously. There but for the grace of
God go all of us.
literature review explored the pathophysiology
of age-related macular degeneration (AMD) and
the use of rheopheresis in its treatment. There
appears to be a diffusion barrier caused by accumulation
of cross-linked proteins known as advanced macular
oxidation products (AMOPS) in AMD. Rheopheresis
allows removal of uncross-linked proteins and
facilitates antioxidant entry into Bruchs
membrane, preventing further accumulation of AMOPS.
The Multicenter Investigation of Rheopheresis
for AMD (MIRA-1), an ongoing double masked randomized
trial, should determine the efficacy of rheopheresis
in preventing the progression of AMD. The interim
results from an analysis of visual acuity data
for 43 patients are encouraging, confirming the
potential of rheopheresis as a therapeutic option
for dry AMD.
Benefits were evident immediately after treatment
and remained essentially stable throughout the
12-month follow-up period. Eyes with late-stage,
high-risk, dry AMD appeared to be at significant
risk for substantial vision loss over the 12 months
if not treated. Subgroup analysis demonstrated
that the timing of rheopheresis in the course
of a patients disease may have a pronounced
effect on outcome.
SOURCE: Pulido JS, Sanders
D, Klingel R. Rheopheresis for age-related macular
degeneration: clinical results and putative mechanism
of action. Can J Ophthalmol 2005;40:33240.
Editors Note: Rheopheresis has been tested
in several clinical trials and is looking increasingly
promising as a viable and effective treatment
and Proliferative Diabetic Retinopathy
growth factor (VEGF) is a primary mediator of
retinal angiogenesis, yet VEGF inhibition alone
has been insufficient to prevent retinal neovascularization.
It has been postulated that there are other
potent ischemia-induced angiogenic factors.
Erythropoietin possesses angiogenic activity,
but its role in ocular angiogenesis has not
In this study, both erythropoietin and VEGF
levels in the vitreous of 144 patients were
measured using radioimmunoassay and enzyme-linked
immunosorbent assay. Vitreous proliferative
potential was measured according to the growth
of retinal endothelial cells in vitro and with
soluble erythropoietin receptor.
The median vitreous erythropoietin level in
73 patients with proliferative diabetic retinopathy
was significantly higher than that of 71 patients
without diabetes. The median VEGF level in patients
with retinopathy was also significantly higher
than that of patients without diabetes. Statistical
analyses indicated that erythropoietin and VEGF
were independently associated with proliferative
diabetic retinopathy and that erythropoietin
was more strongly associated with the presence
of proliferative diabetic retinopathy than VEGF.
This study suggests that erythropoietin is a
potent ischemia-induced angiogenic factor that
acts independently of VEGF during retinal angiogenesis
in proliferative diabetic retinopathy.
SOURCE: Watanabe D, Suzuma
K, Matsui S, et al. Erythropoietin as a retinal
angiogenic factor in proliferative diabetic
retinopathy. New Engl J Med 2005;353(8):782-92.
Accuracy for Measuring IOP in Children
study compared intraocular pressure (IOP) measurements
by Perkins tonometer and Tono-Pen in young children
with primary congenital glaucoma (PCG). Clinical
records of 28 eyes of 16 children with primary
congenital glaucoma who underwent examinations
at Soroka University Medical Center, Israel,
between January 1999 and July 2002 were reviewed.
Children were examined under general anesthesia.
The mean IOP was 18mmHg +/- 6 mmHg with the
Perkins tonometer and 22 mmHg +/- 8 mmHg with
the Tono-Pen. In 18 post-surgical eyes, IOP
was less than 21 mmHg with the Perkins tonometer.
The other 10 eyes with IOP greater than 21 mmHg
with the Perkins tonometer underwent surgery.
In eyes with IOP greater than 16 mmHg (Group
A, 18 patients), a significant difference was
found between the Perkins and Tono-Pen measurements,
even although the values were strongly correlated.
In contrast, eyes with IOP less than 16 mmHg
(Group B, 10 patients) no statistically significant
difference or good correlation were obtained.
A difference of 5.8 mmHg +/- 3.8 mmHg and 0.6
mmHg +/- 1.7 mmHg between Perkins and Tono-Pen
readings, respectively, was found in Groups
A and B. Tono-Pen readings disagree with Perkins
tonometer measurements for measuring IOP in
children with PCG who present with IOP greater
than 16 mmHg tending to overestimate IOP. A
further study with a similar population is necessary
to confirm these results.
SOURCE: Levy J, Lifshitz
T, Rosen S, et al. Is the tono-pen accurate
for measuring intraocular pressure in young
children with congenital glaucoma? J AAPOS 2005;9(4):321-5.
Visual Prognosis of Infantile-Onset High Myopia
children with infantile-onset high myopia (spherical
equivalent above -5.00D prior to age five) were
included in this study. All children received
initial full-correction glasses at the mean
age of 3.52 years. Cycloplegic refraction, axial
length and best-corrected visual acuity were
collected every six months. The mean follow-up
time was 9.36 years.
Tendency toward progression or regression of
myopia appeared to be related to the degree
of refractive error. Lower grades of high myopia
(-5.00D to -7.75D) showed a greater tendency
to progress than those with the highest initial
myopic refraction level (-11.00D or greater).
The latter group exhibited a more substantial
regression rate than those with lower initial
refraction level. About 80 percent of infantile-onset
high myopes demonstrated a final best-corrected
vision of greater than 20/40, with 37 percent
revealing best-corrected vision better than
Clinical course of infantile high myopia is
different than school myopia. Usually, higher
degree of high myopia showed a stable state
or even possible regression, whereas the lower
grades of high myopia revealed a strong tendency
SOURCE: Shih YF, Ho TC,
Hsiao CK, Lin LL. Long-term visual prognosis
of infantile-onset high myopia. Eye 2005;Aug
12 [Epub ahead of print].
Thickness in Glaucoma Progression
study determined whether central corneal thickness
(CCT) is a significant predictor of visual field
and optic disc progression in open angle glaucoma.
A total of 101 eyes of 54 glaucoma patients
were tested with static automated perimetry
and confocal scanning laser tomography every
six months. Progression was determined using
a trend-based approach called evidence of change
(EOC) analysis. Visual field progression was
also determined using the event-based glaucoma
change probability (GCP) analysis using both
total and pattern deviation.
Lower CCT was associated with worse baseline
visual fields and lower mean IOP in the follow-up.
In the longitudinal analysis, CCT was not correlated
with the EOC scores for visual field or optic
disc change. In the GCP analyses, there was
a tendency for groups classified as progressing
to have lower CCT compared to non-progressing
In this cohort of patients with established
glaucoma, CCT was not a useful index in the
risk assessment of visual field and optic disc
SOURCE: Chauhan BC, Hutchison
DM, Leblanc RP, et al. Central corneal thickness
and progression of the visual field and optic
disc in glaucoma. Br J Ophthalmol 2005;89(8):1008-12.
DEVELOPED BY ODS TO HELP COLLEAGUES
AFFECTED BY HURRICANE KATRINA.
The American Optometric Institute
(AOI), the Missouri non-profit corporation
established by the AOA, has established
an Optometric Disaster Relief Fund
designed to provide immediate financial
relief for all ODs who have experienced
the loss of or severe damage to
their practice and/or home as a
result of Hurricane Katrina. It
is estimated that more than 400
optometrists are in dire need of
immediate financial assistance.
They may not be able to rebuild
for several months and thus have
no means of generating income. The
AOI will provide each optometrist
who completes a brief grant application
with a $2,000 grant for critical
and urgent needs such as food, clothing
and shelter. The AOA Board of Trustees
is providing the initial capital
for the AOI Optometric Disaster
Relief Fund so the organization
can begin providing financial help
immediately. ODs who wish to contribute
to the fund can fill out the contribution
form at www.aoa.org.
Gifts to the Optometric Disaster
Relief Fund are tax deductible.
For more information, contact Julie
M. Mahoney at 800-365-2219, ext.
176 or at firstname.lastname@example.org.
HYBRID CONTACT LENS RECEIVES FDA
CLEARANCE. SynergEyes, Inc.
has received FDA clearance to market
its SynergEyes A hybrid contact
lens for the correction of hyperopic,
myopic and astigmatic refractive
errors, including the correction
of presbyopia. The lens features
a high-Dk rigid gas permeable center
with a hydrophilic, non-ionic soft
skirt, it can correct ametropia
from -20.00D to +20.00D with up
to 6.00D of astigmatism. The companys
patent-pending HyperBond junction
technology provides an interface
between the soft and rigid portions
of the lens for extended durability.
SynergEyes plans to launch the new
lens in select markets during the
fall of 2005; over the next six
months, it will expand its family
of contact lenses to include hybrid
lenses designed specifically to
treat keratoconus, presbyopia and
patients with post-surgical vision
correction needs. For more information,
call 877-733-2012 or go to www.synergeyes.com.
NATIONAL AOA ADVOCACY CONFERENCE
SCHEDULED FOR OCTOBER. The first
national AOA Advocacy Group Conference
for optometry will be held from
October 6 to 9, 2005 in St. Louis,
MO. The goal of the conference is
to share information and provide
potential solutions for addressing
serious state and federal legislative
issues, trends in the eyecare marketplace
and health policy issues using all
the entities within the Advocacy
Group. These include the State Government
Relations Center, the Federal Relations
Committee, the Eye Care Benefits
Center, the Healthy Eyes Healthy
People Committee, the Professional
Relations Committee and the Political
Action Committee. For more information
on the conference, go to www.aoa.org/x4121.xml.
RX OUTREACH MATERIALS NOW AVAILABLE.
The Centers for Medicare and Medicaid
Services recently unveiled new outreach
materials to help physicians and
patients prepare for the implementation
of the Medicare prescription drug
program, which becomes effective
January 1, 2006. AOA members and
their patients can find information
on the prescription drug program
only been up and running a
few short weeks. Yet, it’s
already clear that the Check
Yearly. See Clearly.(SM) marketing
campaign is opening consumers’
eyes to the benefits of regular
eye exams. Call the Vision
Council of America at 800-424-8422
today or visit checkyearly.com
for your free promotional
Arthur B. Epstein, OD, FAAO
Shannon Steinhäuser, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Joseph Sowka, OD, FAAO
• Andrew Gurwood, OD, FAAO
• Murray Fingeret, OD, FAAO
• William Jones, OD, FAAO
• Paul Karpecki, OD, FAAO
• Ron Melton, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO
• Randall Thomas, OD, MPH, FAAO
HOW TO SUBMIT NEWS
or FAX your news to: 610.492.1039.
HOW TO ADVERTISE
For information on advertising in this e-mail
newsletter or other creative advertising opportunities
with Optometric Physician, please contact
publisher Rick Bay (email@example.com)
or sales managers James Henne (firstname.lastname@example.org),
Michele Barrett (email@example.com),
or Kimberly McCarthy (firstname.lastname@example.org).
HOW TO CHANGE YOUR SUBSCRIPTION
To change your subscription, reply to this message
and give us your old address and your new address;
type "Change of Address" in the subject
line. If you do not want to receive Optometric
Physician, reply to this message and type
"Unsubscribe: Optometric Physician" in the subject
line. If you enjoy reading Optometric Physician,
please tell a friend or colleague about it.
Anyone can sign up for a free subscription by