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Corneal Harbingers of SYSTEMIC DISEASE 10 Tips for Improving Visual Fields, Page 62 REVIEW OF OPTOMETRY ■ VOL. 152 NO. 4 April 15, 2015 www.reviewofoptometry.com CORNEAL DISEASE ■ APRIL 15, 2015 REPORT EARN 2 CE CREDITS ■ CORNEAL DISEASE REPORT Corneal Harbingers OF SYSTEMIC ■ DISEASE VISUAL FIELD TESTING A routine slit lamp exam may reveal telltale findings of health concerns elsewhere in the body. Here are the most common to look for. PAGE 53 ■ » Firm Up Your Approach to Corneal Ectasia, PAGE 28 PRESCRIBING CHALLENGES » Slit Lamp Essentials: Perform DBD with ASP for Stubborn RCE, PAGE 36 » Seeing Red: How Ocular Rosacea Impacts the Cornea, PAGE 46 » PLUS — Beat These Modern Day Prescribing Challenges, PAGE 70 001_ro0415_fc.indd 1 4/2/15 3:57 PM NATURAL BEAUTYEN Yasmin is wearing NATURAL SHIMMER™ RO0415_Vistakon Define.indd 2 3/30/15 11:11 AM HANCED A NEW CATEGORY of contact lenses that accentuates NATURAL BEAUTY. Based on the PROVEN DESIGN of 1-DAY ACUVUE® MOIST, the #1 DAILY DISPOSABLE BRAND WITHOUT WITH The iris-inspired design of NEW 1-DAY ACUVUE® DEFINE™ Brand Contact Lenses uniquely complements every iris pattern to help make your patients’ eyes look whiter and brighter. TRY 1-DAY ACUVUE® DEFINE™ BRAND CONTACT LENSES TODAY TO PUT YOUR PRACTICE ON THE CUTTING EDGE OF NATURAL-LOOKING EYE ENHANCEMENT. 1-DAY ACUVUE® DEFINE™ Brand Contact Lenses are available with and without vision correction. As with any contact lens, eye problems including corneal ulcers can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness, or other eye problems. Consult the package insert for complete information available from Johnson & Johnson Vision Care Companies by calling 1-800-843-2020 or by visiting www.acuvueprofessional.com. 1-DAY ACUVUE® DEFINE™, 1-DAY ACUVUE® MOIST, NATURAL SHIMMER™, and LACREON® are trademarks of Johnson & Johnson Vision Care Companies. © Johnson & Johnson Vision Care Companies 2015 ACU-10336938 April 2015 RO0415_Vistakon Define.indd 3 3/30/15 11:11 AM News Review VOL. 152 NO. 4 ■ APRIL 15, 2015 IN THE NEWS Azithromycin Better A thousand-year-old Anglo-Saxon remedy for eye infections, taken from Than Doxy for MGD a medieval medical “leech book,” has been found to kill the modern-day su- A new study says azithromycin better improves signs and perbug MRSA, according to microbiol- symptoms—at a lower price. By John Murphy, Executive Editor ogists at the University of Nottingham in the UK. The researchers demon- ral doxycycline has been a improvement of clinical signs and strated that “Bald’s eye salve” kills up mainstay for treating me- symptoms. But, the percentage of to 90% of MRSA bacteria in wound Obomian gland dysfunction clinical improvement was signifi- biopsies from in vivo mouse models. (MGD), but now a head-to-head cantly better in the azithromycin They believe the bactericidal effect of clinical trial has found that oral group, with particularly more the recipe is not due to a single ingre- azithromycin works better, faster, improvement in conjunctival red- dient but a combined effect, along with cheaper and with fewer side effects. ness and ocular surface staining. the brewing methods and the container Photo: Paul Karpecki, OD In addition, patients in the doxy- material used. The researchers are cycline group had more gastrointes- continuing to investigate how and why tinal side effects (26%) than those in the ancient formula works. the azithromycin group (4%). Azithromycin is also much less The FDA decided not to approve expensive. “Since MGD is a chronic Avedro’s new drug application for its disease, multiple five-day pulse ribofl avin/KXL System for corneal treatment with azithromycin would crosslinking. This came as something be cheaper than long-term daily oral of a surprise because an FDA advisory doxycycline,” the authors wrote. panel had recommended the corneal When conservative treatment doesn’t Alan Kabat, OD, medical direc- crosslinking platform for approval in work, what’s the best medicine for MGD? tor for the TearWell Advanced Dry February. “We are disappointed with A new study finds it’s azithromycin. Eye Treatment Center in Memphis, the outcome of the review and the Tenn., says the study’s findings are implications this has for patients in The study, published in February’s welcome news. “I’d rather tell my the US suffering from keratoconus or British Journal of Ophthalmology, patients to do something once a corneal ectasia who remain in need of found that both oral azithromycin day for a week than twice a day for a therapeutic treatment for these sight- and doxycycline improved symp- a month, especially if the outcome threatening conditions,” said Avedro’s toms of MGD. However, patients will be the same,” he says. “Going CEO David Muller, PhD. on azithromycin had relatively bet- forward, I will certainly consider ter improvement in symptoms and using azithromycin one week per The FDA expanded the approved signs along with fewer side effects. month in my recalcitrant MGD use for Eylea intravitreal injection The researchers randomly patients.” (afl ibercept, Regeneron Pharmaceu- assigned 110 patients with MGD to He emphasizes that oral treat- ticals) to treat diabetic retinopathy in receive either a five-day course of ment is not the go-to therapy for patients with diabetic macular edema. oral azithromycin (500mg on day patients with MGD, but rather it’s Eylea is already approved to treat wet one, then 250mg/day) or one month for patients in whom conservative age-related macular degeneration, as of oral doxycycline (200mg/day). treatment proves insufficient or inef- well as diabetic macular edema and Patients continued eyelid warming/ fective. macular edema secondary to retinal cleaning and artificial tears. Kashkouli MB, Fazel AJ, Kiavash V, et al. Oral azithromycin vein occlusions. versus doxycycline in meibomian gland dysfunction: a After two months, both treat- randomised double-masked open-label clinical trial. Br J ment groups showed a significant Ophthalmol. 2015 Feb;99(2):199-204. 4 REVIEW OF OPTOMETRY APRIL 15, 2015 004_ro0415_news.indd 4 4/2/15 4:15 PM Tonometry Done Right D-KAT Digital Keeler quality. Pulsair Desktop Smallest footprint and simple to use! Purchase a Pulsair Desktop by June 30, 2015 and get a $1,300 Instant Rebate! Intellipuff The standard for hand held mobility. Keeler Instruments, Inc. • 456 Parkway • Broomall, PA 19008 • Tel: (800) 523-5620 • Fax: (610) 353-7814 • email: [email protected] RO0415_Keeler Tono.indd 1 3/23/15 2:51 PM News Review Visual Fixation in Newborns Predicts Childhood Cognitive Development atching a baby’s eye is more soning at five years of age. than one of the joys of early According to the authors, their Cparenthood. It’s also a sign findings suggest that newborn VF is of brain development. A new study supported by brain-wide subcortical in The Journal of Neuroscience networks and represents an early found that early visual fixation pre- building block for the developmen- dicts neurocognitive development. tal cascades of cognition. Their “For many years, we have sus- study highlights the need to develop pected that such links exist,” says objective and quantitative measures Glen T. Steele, OD, FCOVD, pro- of newborn eye contact to help rec- fessor of Pediatric Optometry at A baby’s visual fixation holds clues to ognize developmental risks early on. Southern College of Optometry, and brain development as a child. To Dr. Steele, this is a very impor- chair of the InfantSee program and tant article that joins a growing Children’s Vision Committee of the In particular, the study sheds light body of work linking visual fixation American Optometric Association. on the scientific relevance of the eye ability to overall development, even contact of newborns. Researchers at including autism. He has lectured the University of Helsinki and Hel- on the development and importance Patient Takes ‘Contact Lens sinki University Central Hospital in of looking behavior, and he says the Adherence’ to a New Level Finland investigated the relationship article further emphasizes the need between newborn visual fixation for earlier identification and inter- (VF) and gaze behavior to perfor- vention in all aspects of visual fixa- mance in visuomotor and visual tion and function. “We can’t wait reasoning tasks in two cohorts with until they are three or five years old cognitive follow-up at two (n=57) to get involved, as much of their and five (n=1,410) years of age. future abilities are already deter- They determined that newborn mined in these early years,” he says. VF is significantly related to visual- Stjerna S, Sairanen V, Gröhn R, et al. Visual fi xation in human newborns correlates with extensive white matter networks motor performance at both two and and predicts long-term neurocognitive development. J Optometrist Monika Marczak, of McMur- five years, as well as to visual rea- Neurosci. 2015 Mar 25;35(12):4824-9. ray, Pa., found this contact lens that was “lost” under a patient’s lid for two and a half months. The patient hadn’t com- Scope Bill in New Mexico plained of any foreign body sensation, photophobia or decreased vision. But ptometrists in New In addition to prescribing powers, she did report mucus discharge the night Mexico may have reason the bill gives the board of optometry before and a slight swelling of the top lid. Oto celebrate soon, as a bill the “sole authority to determine “Once I stained the eye with a fl uores- expanding their scope of practice what constitutes the practice of cein sodium strip and inverted the top lid, passed in the state legislature with a optometry in accordance with the there was a thick layer of mucus deep unanimous vote on March 25.
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