The ABCs of OCT, p. 52 Top 10 Most Wanted Diagnostic Instruments, p. 60 Image Management ...

116 Pages·2012·24.42 MB·English

Earn 2 CE Credits: Explanations for Sudden Vision Loss, p. 72
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N e w s R e v i e w
VOL. 149 NO. 9 ■ SEPTEMBER 15, 2012
World’s First Bionic Eye
IN THE NEWS
Implant is a Success
Amendments to optometric regula-
tions will allow optometrists in British
Columbia to prescribe medications to
The patient sees only flashes of light and vague shapes,
treat glaucoma. “It’s not uncommon
for rural patients to wait over a year but it’s a start. By Cheryl Murphy, O.D., Contributing Editor
or travel hundreds of kilometers to
receive treatment,” says Surjinder Sa- Researchers in Im
hl“ppuBraometytisa ebac,n ilrOlatiobs .w ADew s.ian,is lngplo t rhicde-aiogsavciledtati eouognrcnrstoe omooafffta eotO rhmp peatteo coBdmcmrieciesteatisrtst yrihtoi ost noC tss o,. - asimuftcpecrlea csnsotfAhn uiifinuls rt s“tomtbhrraiieyno l wignlaa io tscmhtr elemady dfi.eo e”rn s tt h age: Bionic Vision Australia
timely and appropriate eye care in all Scientists at Bionic
areas of the province.” Vision Australia (BVA)
surgically implanted a
Cataract surgery may reduce the risk prototype of the bionic
of hip fractures among elderly people eye in 54-year-old Dianne
by up to 23%, according to a recent Ashworth, who suffers Artist’s rendering of the bionic eye shows the
study in Journal of the American Medi- vision loss due to reti- electrode array implant at the back of the retina.
cal Association. Researchers looked nitis pigmentosa. When
at more than one million Medicare the implant was fi rst switched on work with Ms. Ashworth to gath-
patients age 65 and older who were and stimulated last month, Ms. er measurements and feedback,
diagnosed with cataracts between Ashworth saw a fl ash of light and which will help them develop a
2002 and 2009. Results suggest cata- shapes in her previously blind eye. visual processor and build better
ract surgery may be a cost-effective The device, placed between the images using the fl ashes of light.
way to reduce the risk of falls and hip choroid and the sclera, is equipped Ultimately they will attach a pair
fractures among older adults. with 24 electrodes and a small of eyeglasses with a mounted digi-
wire that extends from the back tal camera to the device and refi ne
People who take cholesterol-lowering of the eye to a receptor behind the the vision using an implant with
statin drugs have a 57% increased ear. When stimulated, the elec- more electrodes.
risk for cataracts, according to a trodes signal the surviving retinal Scientists at BVA are already de-
new study in Optometry and Vision cells in the eye, giving the patient veloping two additional devices—
Science. Statistically, the increase in the ability to “see” once again. a 98-electrode wide-view bionic
cataract risk with statins is similar “The bionic eye technology re- eye implant and a 1024-electrode
to that associated with diabetes. lies on the patient having a healthy high acuity implant. The wide-
However, the authors emphasize that optic nerve and a developed visual view device would allow patients
the known benefi ts of statin treatment cortex,” the researchers said. who have severe vision loss to
for patients with type 2 diabetes “Patients need to have been able see the contrast between light
probably outweigh any increased risk to see in the past for this device and dark shapes, helping to aid
of cataracts. These fi ndings serve to to be of benefi t to them.” They mobility and enhance their inde-
encourage further research on alterna- expect the bionic eyes to have the pendence. The high acuity version
tive cholesterol-lowering drugs that are greatest benefi t in people with would greatly enhance central
not associated with an increased risk retinitis pigmentosa and macular vision, allowing patients to once
of cataracts, the authors wrote. degeneration. again recognize faces and even
Next, the team at BVA will read large-print books.
4 REVIEW OF OPTOMETRY SEPTEMBER 15, 2012
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RO0812_Keeler Tono.indd 1 7/17/12 3:05 PM
News Review

Lawsuit Ends: Judge Rules Against
‘Falsity’ of Board Certifi cation
In late August, Judge A. How- etry. We are moving ahead, and ness that this lawsuit—and the civ-
ard Matz, of the U.S. District look forward to continuing to il war over board certifi cation—
Court of the Central District of serve the profession with a cred- has caused for the profession, as
California, released his fi nal ruling ible board certifi cation program.” well as the time and money it has
in favor of the American Board The AOS, meanwhile, accepted taken away from tackling other
of Optometry (ABO) in the false the ruling on the false advertising important problems.
advertising lawsuit brought by litigation, but did not back down In an editorial in the e-news-
the American Optometric Society from its stance against board certi- letter Optometric Physician, Art
(AOS). fi cation in general. Specifi cally, the Epstein, O.D., a founding member
At issue: The AOS alleged that AOS argued, the judge’s ruling did of the AOS (who has since retired
the ABO’s use of the term “board not alter an earlier injunction that from the organization), wrote,
certifi cation” is “false, misleading, prohibits the ABO from claiming “Mere words will not be enough
confusing, deceptive or unfair.” In its program represents competence to heal the deep wounds or nar-
its suit, the AOS argued that the above and beyond optometric row what is a still-growing divide.
ABO’s use of board certifi cation licensure. The only way is to sit down and
“convey[s] the false impression “Judge Matz did not address work through them together—
that an ABO-certifi ed optometrist whether or not the ABO is a face-to-face. We need a summit
has extensive specialized education legitimate board certifi cation where all stakeholders can openly
and training beyond optometry program,” said AOS President Pa- explore real pathways toward rec-
school and beyond that required mela Miller, O.D., J.D. “While an onciliation and discuss their future
for licensure.” injunction would have been pref- vision for our profession.”
In his decision, though, Judge erable, there is still no evidence He added, “Continuing confl ict
Matz ruled that the AOS failed that a misleading general board is a cancer that, if left unchecked,
to prove the “falsity, deception, certifi cation program in optometry will consume our organizations
materiality and injury” of ABO’s is necessary or will be required by and eventually our profession.
use of board certifi cation. third-party payers or the govern- Ultimately, we must fi nd a way
Following the judge’s ruling, the ment’s Medicare and Medicaid back to unity. We have no other
ABO claimed victory in the case. programs. As the AOS has been choice.”
“The Judge’s ruling unambigu- saying for over two years, there’s AOA President Ronald Hop-
ously states that our use of the simply no value in the ABO’s ping, O.D., M.P.H., stated, “Now
term board certifi ed is not con- program, and certainly no reason we have much bigger challenges
fusing to the public,” said ABO to pay them $1,800.” ahead of us. We can wallow in
Chairman of the Board Paul Aja- this board certifi cation turmoil
mian, O.D. “The AOS’s attempt Call for Unity while the rest of the world moves
to put a cloud over our program Following the judge’s ruling, forward or, if we are going to be
has failed. This ruling ends a bitter many optometrists on both sides successful, we can move on. We
chapter in the history of optom- of the issue bemoaned the divisive- must move on … I welcome the
participation of every optometrist
in moving our profession forward.
FDA Approves Lucentis for Diabetic Macular Edema Our future now depends on what
The FDA has approved Genentech’s Lucentis (ranibizumab injection) for the treatment of we all do together.”
diabetic macular edema. Two Phase III clinical studies showed that 34%-45% of patients How exactly will the profession
treated with monthly Lucentis (0.3mg dose) gained at least three lines of vision. In com- move forward together? Perhaps
parison with patients who did not receive Lucentis, only 12%-18% had the same result. a brand new board should be cre-
ated just for that.
6 REVIEW OF OPTOMETRY SEPTEMBER 15, 2012
004_ro0912_news.indd 6 9/7/12 5:12 PM
Advertorial
Getting Patients to Comply with Lens Replacement
By Craig Wood, OD
W
hat many patients make notations in the chart Compliance diminishes with
fail to recognize indicating the number of 2 week replacement lens
is the correlation boxes of lenses that have been wearers because they simply
between reduced contact ordered. But with the presence forget when to replace them.
lens satisfaction and over- of online ordering and big box With DAILIES® brand lenses,
extending the life of their stores selling lenses – it can be it is quite obvious that they
contact lenses. We have many hard to gauge how frequently need to be replaced daily and
patients who have grown someone is actually replacing when they aren’t, the lenses
frustrated with their contact lenses. become uncomfortable. With
lenses and inquire about monthly replacement lens
laser vision correction or I comment to the patient wearers, it is easy for people
consider giving up on lenses when they are in the exam to associate paying their bills,
all together. I like to ask chair about the presence of or using the 1st of each month
these people about their lens neovascularization or other as a reference point to remind
replacement habits, lens care microscopic changes that them to change their lenses.
solutions they have used, and I may see and use that as a If you ask wearers of 2 week
how often they sleep in their point of discussion. One tool I replacement lenses, they will
lenses. This can open dialogue use extensively in my practice often state they simply forget
and it’s evident that most is corneal topography. We when to replace the lenses.
patients really don’t want to obtain topographies on all
give up their contact lenses of our contact lens patients I follow the manufacturer’s
– they just want something and then compare these scans recommended replacement
that works for them. So we annually. This is a great way schedule almost without fail
take these as opportunities to for the doctor to point out and I review the replacement
educate patients on preferred subtle (and sometimes not schedule when discussing
lens replacement schedules so subtle) changes in the contact lens care with my
and appropriate lens care corneal shape and emphasize patients during the annual
solutions. the medical nature of what exam. I have also trained my
happens to the eye when staff to remind the patients
I don’t believe there is one wearing contact lenses. I of proper lens replacement
single indicator that will tell often use the evidence of when they are discussing lens
if a patient is being compliant topographical change to refit care solutions. We have our
with lens replacement. patients to a different lens. patients return for a one-week
Certainly I look at their chart contact lens check and at that
and take note of how long it In my practice the most time again reinforce when to
has been since their previous compliant patients are our replace their lenses.
visit. My staff will also daily disposable lens wearers.
SPONSORED BY
POW12033AD
RO0512_Alcon Advertorial.indd 1 4/19/12 3:41 PM
News Review

Blacks at Higher Risk for Diabetic
Retinopathy at Lower HbA1c Levels
Blacks are more likely to retinopathy is higher for blacks
develop diabetic eye dam- at HbA1c levels between 5% and
age at lower blood glucose 7%. In fact, the higher risk at an
thresholds than whites, according HbA1c level of 5.5% to 5.9% for
to a recent study in the Annals blacks was comparable to the risk
of Internal Medicine. The results at an HbA1c level of 6% to 6.4%
suggest that black people may be for whites.
more vulnerable than whites to “This indicates that black
high HbA1c levels. people may be more vulnerable to
Researchers at Beth Israel Dea- high A1c status than whites,” Dr.
coness Medical Center in Boston Tsugawa said.
evaluated the association between Blacks may be more vulnerable to higher He added, “It may be appropri-
elevated HbA1c levels and the risk HbA1c levels, and thus at greater risk for ate for doctors to more closely
for retinopathy development using diabetic retinopathy. monitor for early diabetic com-
National Health and Nutrition plications for their black patients
Survey data from 2,804 whites HbA1c level of 6.5% is diagnos- than for their white patients, and
and 1,008 blacks. tically signifi cant for diabetes, black patients with diabetes may
“We looked at the data to compared to an HbA1c level of benefi t from retinal exams at an
determine if a higher diagnostic 5% in healthy individuals. Given earlier stage of their disease.”
cutoff of A1c level should be used the evidence of inherently elevated Further research may be able
to diagnose diabetes in blacks HbA1c percentages in blacks, the to confi rm whether blacks should
than in whites, or if there should researchers initially hypothesized have a lower diagnostic threshold
be a single cutoff for all races,” that diabetic retinopathy would of HbA1c than whites, the authors
said lead author Yusuke Tsugawa, begin to manifest at proportion- concluded.
M.D., M.P.H. ately higher blood glucose levels.
Tsugawa Y, Mukamal KJ, Davis RB, et al. Should the
The World Health Organization However, the evidence indicated
hemoglobin A1c diagnostic cutoff differ between blacks and
and American Diabetes Associa- that the exact opposite was true.
whites? A cross-sectional study. Ann Intern Med. 2012 Aug
tion have recommended that an They found the risk of diabetic 7;157(3):153-9.
Im Flat Lens Offers a Clear View
age: Francesco Aieta CtdhiasinnSton cyreioteriuon t nthiimssa tnoas f ga hci nasoevhne eva eed mtne otsiicfiog rpnonaaselpc dleoe rapn? esn eeasws. tTuhhlitnery aa tssha iany dfli tia met leilme—ninso atrth emasta ofyopbcteiuc saae lp saa bliirge ohrrfta gwtiloaitnshsso,eu sstu wicmhitp haa slret itnnhsgee tsh e
“fi sh-eye” effect that results from conventional wide-angle lenses.
The ultrathin wafer of silicon and gold, created by applied physicists at the Harvard
School of Engineering and Applied Sciences, is essentially two-dimensional at just 60nm
thick. This new device operates at the range commonly used in fi ber-optic communications
and is completely scalable and simple to manufacture.
“In the future we can potentially replace all the bulk components in the majority of optical
systems with just fl at surfaces,” says lead author Francesco Aieta, a visiting graduate stu-
A new ultrathin, flat lens focuses light dent from the Marche Polytechnic University in Italy. “It certainly captures the imagination.”
without imparting the optical
Aieta F, Genevet P, Kats MA, et al. Abberation-free ultrathin fl at lenses and axicons at telecom wavelengths based on
distortions of conventional lenses. plasmonic metasurfaces. Nano Lett. 2012 Aug 21. [Epud ahead of print.]
8 REVIEW OF OPTOMETRY SEPTEMBER 15, 2012
004_ro0912_news.indd 8 9/7/12 5:14 PM
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RO0912_Vmax.indd 1 8/22/12 3:04 PM
News Review

Back-to-School Special
Sehvaeprpael nreedce antt ddiefvfeerleonptm oepn-ts Photo: D Co•l lSegtaet eo fU Onpivteormsietytr yo.f WNeitwh aY ork
counttroym. Heterrye s’sc hao roelcsa apr: ound the ominic M. M tthhree Le-ayveealrl,e $F4u2n1d, 1fo6r0 tghrea Bntli nfrdo,m
• Illinois College of Optometry. aino, O.D SexUpNanYd’s tCheo lclelignei co af tO thpeto Cmeenttreyr wofi ll
ICO will soon be the fi rst opto- ., M.Ed. Excellence in Low Vision Reha-
metric institution with a center for bilitation at the Wenzhou Medical
vision and aging. The college re- College in China.
cently announced the founding of Established in 2008 with an ini-
the Alfred and Sarah Rosenbloom tial three-year Lavelle Fund grant,
Center on Vision and Aging in the low vision clinic will now
honor of the doctor and his wife. expand to include new patient
Dr. Rosenbloom served as dean of Illinois College of Optometry’s new Alfred populations in order to achieve full
ICO from 1955 to 1972, president and Sarah Rosenbloom Center on Vision sustainability in three years. The
from 1972 to 1982, and remains a and Aging is named after former dean, recent grant money will be used to
distinguished professor emeritus. president and distinguished professor implement a new computer-based
The new facility will be located emeritus Dr. Alfred Rosenbloom and his system of data collection and
within the Illinois Eye Institute on wife Sarah. analysis. The funds will also pay
ICO’s campus and will be devoted for a training program at the medi-
to the vision care needs of the ag- of a geriatric care patient service cal college for faculty and staff
ing population. model, including care for many from other locations in China.
“ICO’s reputation in terms underserved individuals in assisted “With this generous support,
of current and future education living facilities and in nursing this model for the delivery of low
offers the opportunity to elevate homes.” and vision rehabilitative care can
standards and raise awareness be replicated throughout China,”
for providing professional vi- • Northeastern State University said project director Michael Hei-
sion care to this age group,” Dr. Oklahoma College of Optometry. berger, O.D.
Rosenbloom said. “This may The Practice Management Club
lead in time to the development of NSUOCO recently became the • Michigan College of Optom-
fi rst-ever recipient of the Preston etry–Ferris State University. MCO
Cup. The Student Optometric has appointed Bruce Morgan,
Leadership Network (SOLN) cre- O.D., as interim dean. Dr. Morgan
ated the award in honor of Pres- is a professor at MCO as well as
ton Smith, a fourth-year student at the director of residencies. He suc-
NSUOCO and founding member ceeds Michael Cron, O.D., who
of SOLN who died tragically in a announced his retirement last fall.
car accident last November. In addition to his 25 years of
The Preston Cup is to be award- experience as an optometrist and
ed each year to the most deserving educator, Dr. Morgan is currently
SOLN private practice or practice president of the Association of
management club. SOLN mem- Contact Lens Educators. He’s
NSUOCO Practice Management Club Vice bers who attend the annual Stu- also been involved in numerous
President Benjamin Lynch accepts the dent Private Practice Symposium accreditation processes for both
Preston Cup trophy, donated by VSP. He and Leadership Conference vote college and residency programs,
is joined by VSP’s Dana Beards (left) and on which of their fellow organiza- including serving as a member
Vision Source’s Kelly Kerksick-Frisella, tions have gone above and beyond of the Accreditation Council on
O.D. (right). during the year. Optometric Education.
10 REVIEW OF OPTOMETRY SEPTEMBER 15, 2012
004_ro0912_news.indd 10 9/7/12 5:12 PM