Off the Cuff: Putting a Name to the Face

During the International Society of Contact Lens Specialists' 36th Congress in San Diego, I had the opportunity to tour the aircraft carrier USS John C. Stennis. The ship is an amazing piece of technology, and just being onboard made me proud.

The Stennis resembles a small floating city--but first and foremost it is a warship. That was clear from every no-nonsense aspect of the ship. It was awe-inspiring to stand on the deck and imagine aircraft taking off and landing on so short a runway while the ship is tossed around in rough seas.

The technology and design of the ship were impressive, but the crew made the greatest impression on me. In these troubling times, a day rarely passes without the disturbing news that a member of this country's armed forces has been killed in the line of duty. While media coverage comfortably distances us from actual battles, we need to remember that many of those who defend us are barely older than children.

We owe a tremendous debt of gratitude to these American sons and daughters and to their families. They make our way of life possible, and they defend the freedoms that we often take for granted. Regardless of one's political beliefs, losing even one young life is a tragedy that should sadden us all.

Arthur B. Epstein, OD, FAAO Chief Medical Editor optometricphysician@jobson.com

Case in Point: Conjunctival Concretions (Ocular Lithiasis)

A 51-year-old Hispanic male presented with a chief complaint of chronic ocular irritation OD > OS. He reported that his eyes were consistently dry, scratchy and red. Artificial tears, recommended by another eyecare practitioner, had offered little relief.

Best-corrected visual acuity was 20/20 OD and OS. Biomicroscopy revealed minimal hyperemia OU. Vertical "tracking" of the superficial corneal epithelium was apparent with fluorescein staining OD. The latter finding prompted eversion of the upper lid, which revealed numerous yellow concretions embedded within the palpebral conjunctiva. These concretions were also noted inferiorly OD and in the upper and lower left lid, although to a far lesser degree.

Conjunctival concretions (or lithiasis) consist of small white or yellow nodules superficially buried beneath the palpebral conjunctiva. Histologically, they are composed of mucinous secretions mixed with degenerated epithelial cells. Contrary to popular thought, very little calcium is associated with concretions. The etiology is generally idiopathic, but it may be associated with chronic forms of allergic or infectious conjunctivitis.

Patients with concretions are typically asymptomatic, but pronounced cases such as this one may induce a foreign body sensation that is exacerbated by blinking. Lithiasis generally does not require treatment unless the patient experiences pain or chronic epithelial disruption. Mildly symptomatic patients may be palliated with artificial tear solutions and/or ointments. In more severe cases, however, excision is preferred. This may be accomplished in-office by applying an anesthetic-soaked cotton-tipped applicator over the area and using a small-gauge (25g to 27g) needle to excavate and extract the small calculi. Subsequent use of an antibiotic-steroid ointment (e.g., Tobradex) helps minimize iatrogenic inflammation and prevent infection.

--Case study courtesy of Alan G. Kabat, OD, FAAO, Associate Professor, Nova Southeastern University College of Optometry, Fort Lauderdale, FL.

Fluoroquinolone Susceptibility and Therapeutic Response of Bacterial Keratitis

A prospective cohort study by Baylor College of Medicine, Houston, estimated how a corneal isolate's minimal inhibitory concentration for a fluoroquinolone agent affects the rate of clinical response of bacterial keratitis to fluoroquinolone therapy.

The study included 663 individuals with suspected bacterial keratitis. All patients underwent diagnostic corneal scraping and were treated with topical 0.3% ciprofloxacin solution or ointment. Of 407 patients with culture-confirmed bacterial keratitis, improvement and cure rates with ciprofloxacin monotherapy were estimated for 391 who had in vitro ciprofloxacin susceptibility of the principal corneal isolate. Main outcome measures were slit lamp biomicroscopic assessment for clinical improvement of corneal inflammation and clinical cure with complete reepithelialization.

Compared to those with more sensitive isolates, adjusted rates of improvement and of cure were reduced, respectively, by 43 percent (95 percent confidence limits, 8 percent, 64 percent) and by 29 percent (95 percent confidence limits, 0 percent, 49 percent) among corneal infections having a ciprofloxacin minimal inhibitory concentration above 1.0 micro g/mL. Researchers concluded that corneal infection by relatively ciprofloxacin-resistant bacteria responds more slowly to ciprofloxacin therapy, and that antibacterial susceptibility testing of corneal cultures may predict the fluoroquinolone therapeutic response rate of bacterial keratitis.

SOURCE: Wilhelmus KR, Abshire RL, Schlech BA. Influence of fluoroquinolone susceptibility on the therapeutic response of fluoroquinolone-treated bacterial keratitis. Arch Ophthalmol 2003;121(9):1229-33.

	Click here for more information. Now There is a "TheraTears" for Every Dry Eye Need: TheraTears in preservative-free single-use containers saturates dry eyes and provides the dosing that is ideal for very dry eyes. TheraTears in a bottle contains the same disappearing preservative found in Genteal® and is designed for eyes that need occassional or maintenance treatment. TheraTears Liquid Gel is a thicker version of TheraTears, perfect for nighttime or for those who need a longer-lasting protective film during the day. TheraTears Nutrition for Dry Eyes provides omega-3s from flaxseed and fish oil for eye comfort upon awakening and continued eye comfort throughout the day. Genteal is a registered trademark of Novartis Ophthalmics.

Pulsatile Ocular Blood Flow Analysis in Normal and Treated Glaucomatous Eyes

This prospective, cross-sectional study by Boston's Tufts School of Medicine evaluated pulsatile ocular blood flow (POBF) analysis in normal subjects and glaucoma patients by comparison of POBF measurements with functional, as determined by visual field (VF), and structural, as determined by optical coherence tomography (OCT) measures.

Researchers studied 41 eyes of 24 consecutive glaucoma patients and 20 eyes of 10 healthy subjects; they performed POBF analysis on all subjects at the same visit as VF testing and OCT retinal nerve fiber layer (NFL) thickness measurement. They compared the mean results of normal and glaucomatous eyes for each method, and tested correlation between measurements obtained with each modality, as well as the discriminating power, using receiver operator characteristic curves.

The mean POBF (standard deviation [SD]) in the normal group was 1,010.4 (292.8) microl/min and 989.3 (305.5) microl/min in the glaucoma group. Results showed significant differences between groups for VF mean deviation and pattern SD and OCT mean NFL thickness, but showed no correlation between POBF parameters and intraocular pressure, VF or OCT variables except for intraocular pressure in glaucoma group. The area under the receiver operator characteristic curves was higher for VF indexes and OCT mean NFL thickness than POBF parameters for distinguishing between normal and glaucomatous eyes. The study's authors determined that the wide range of normal values and the low discriminating power of POBF between normal and glaucomatous eyes limits the clinical use of the device for glaucoma patients.

SOURCE: Aydin A, Wollstein G, Price LL, Schuman JS. Evaluating pulsatile ocular blood flow analysis in normal and treated glaucomatous eyes. Am J Ophthalmol 2003;136(3):448-53.

	Four Seasons Resort & Club Las Colinas, Dallas October 2-5, 2003 12 Hours of COPE-Approved CE Cost: $325.00 Call 1-866-658-1772 for more meeting and registration information. Golf - Compliments of Essilor Labs Conference extra...attend tour/meeting 2 to 5 p.m. Friday at Essilor and receive one free night complimentary hotel stay.

NEWS & NOTES

	THE "WHO’S WHO IN OPTOMETRY": ANNOUNCING THE 2004 BLUE BOOK OF OPTOMETRISTS PRE-PUBLICATION SALE. The 2004 Blue Book of Optometrists is bigger and better than ever--with more than 30,000 optometrists listed nationwide and indexed by name, state, specialty and optometric school, para-optometric programs, national associations, vision research centers, trades shows and much more. This invaluable resource is now being offered at the pre-publication price of $99.00. To order your copy of the 2004 Blue Book of Optometrists, simply go to www.jobsoneducation.com/orderpub/bluebook.asp.
	NATIONAL OPTOMETRY HALL OF FAME INDUCTS NEW MEMBERS. The National Optometry Hall of Fame will induct five new members during a ceremony at 12:00 pm, on Thursday, October 23, at the Cleveland Convention Center in downtown Cleveland, during the 2003 East West Eye Conference. This year's inductees are: H. Ward Ewalt, OD, the first Optometric Consultant to the Surgeon General of the United States Army; Irving Fatt, PhD, an innovator of rigid gas permeable and hydrophilic contact lenses; Richard L. Hopping, OD, DOS, DSc, past president of the American Optometric Association; George W. Mertz, OD, a pioneering researcher in contact lenses; and Harold A. Solan, OD, MA, COVD, chief emeritus of the SUNY Learning Disabilities Clinic. Each inductee achieved this honor as a result of a lifetime of dedicated service to patients and to the profession of optometry. For more information on the National Optometry Hall of Fame, call 800-999-4939 or visit www.ooa.org or www.eastwesteye.org.
	ACADEMY 2003 DALLAS. The American Academy of Optometry's annual meeting takes place in Dallas from December 4 to 7, 2003. The theme for Academy 2003 is "The Future in Sight: Today's Research, Tomorrow's Practice." Join your colleagues from around the world to learn about the most up-to-date research in vision science and its application for the progressive practice of tomorrow. Pre-registration ends on November 23. Register by October 31 and save $50 for all four days; in addition, your registration will be mailed to you in advance, so you can bypass registration lines at the meeting. To register online (using a credit card), go to www.one-stop-registration.com/aao. For more information, call the AAO registrar toll-free at 866-320-3203.

	It's 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 materials.