Diabetic Retinopathy by the Numbers a Guide to Following and Educating Patients LACRIMAL OCCLUSION ■ Who Face This Threatening Diagnosis, P
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REVIEW OF OPTOMETRY Earn 2 CE Credits: Can You Identify These Vitreous Anomalies?, p. 94 ■ VOL. 153 NO. 6 June 15, 2016 www.reviewofoptometry.com ■ JUNE 15, 2016 ■ ANNUAL 7th Annual Retina Report RETINA REPORT Diabetic Retinopathy By the Numbers ■ A guide to following and educating patients LACRIMAL OCCLUSION who face this threatening diagnosis, p. 36 • Food for Thought: Diet, Genetics and AMD, p. 48 • The Dilation Dilemma p. 54 • Managing Patients with ■ VITREOUS ANOMALIES Hypertensive Crisis, p. 58 ■ VIRAL CONJUNCTIVITIS 125 YEARS Plug the Drain with Lacrimal Occlusion, p. 70 | Claim Victory Over Viral Conjunctivitis, p. 78 001_ro0616_fc.indd 1 6/9/16 9:57 AM We call it our fundamental business truth: 1 20/200 Your success is essential to Our success. When your practice grows and flourishes, so does ours. At Johnson & Johnson Vision Care, we have operated according to this simple, but profound, principle for over 30 years. And it is the inspiration and 2 20/100 energy behind every year of our 3 decades of Global leadership in the contact lens marketplace. But history tells only a small part of the story. It is what we will do together in partnership over 3 20/70 the next 3 decades that will truly change the very meaning of vision care. Our commitment to innovation is unwavering. 4 20/50 But at the center of all of the R & D eff orts—be they technological, educational, or commercial in nature— is our commitment to advancing the eye care profession. 5 20/40 We thank you for your partnership and look forward to the continued journey together. 6 20/30 Together: Your Patients, Your Practice, Our Commitment™ RO0616_Vistakon.indd 2 5/23/16 2:58 PM WE ARE C H A N G I N G THE FUTURE OF VISION CARE TOGETHER © Johnson & Johnson Vision Care, Inc. 2016 10562277A March 2016 RO0616_Vistakon.indd 3 5/23/16 2:58 PM News Review VOL. 153 NO. 6 ■ JUNE 15, 2016 IN THE NEWS Visual Loss, Blindness IOP fl uctuations are more signifi cant in patients with pseudoexfoliation to Double by 2050 syndrome (a known risk factor for the development of glaucoma) than in those But the numbers will be lower if Americans get more with healthy, normal eyes, reports a study in the May 2016 Journal of Glaucoma. eye exams and refractions. By Bill Kekevian, Senior Editor Using a Triggerfi sh (Sensimed) contact lens sensor, researchers at he number of Americans the University of Toyama in Japan with visual impairment monitored the IOP levels of 11 subjects Tor blindness will climb to with pseudoexfoliation syndrome and more than eight million by the year 11 subjects with healthy eyes. After 24 2050—approximately twice the hours of continuous monitoring, the current number—and an addi- researchers found that participants tional 16.4 million Americans are with PE had signifi cantly larger IOP expected to have vision impairment fl uctuations, as well as greater post-CL due to uncorrected refractive error, wear central corneal thickness, than based on a National Institutes of those with healthy eyes. This larger Health analysis of six large studies. fl uctuation might be one of the reasons Several factors explain the underlying the aggravation of visual fi eld increases, including the aging of MD, PhD, director of the National loss in patients with PE, the researchers the baby boom generation and a Eye Institute, which funded the conclude. rise in systemic diseases (such as study. diabetes) that can impact patients’ Among all demographic groups, Google applied for a patent for vision. This study also shows that non-Hispanic white women will what appears to be an electronic refractive error is the leading cause represent the largest proportion of accommodating intraocular lens of visual impairment in the United people affected by visual impair- device. According to the application, States, as well as worldwide. ment and blindness, with their fi led April 28, 2016 with the US Patent But these predictions aren’t inevi- numbers rising to 2.15 million Offi ce, the device includes an electronic table. Optometrists and ophthal- visually impaired and 610,000 lens, a fl exible polymeric material that mologists can help lessen these blind. However, the highest fi lls the lens capsule, an accommodation estimated numbers by encouraging prevalence of visual impairment sensor and a controller. After the device patients to get vision screenings among non-whites will shift from is implanted, the eye and lens capsule and eye exams, according to the African Americans (15.2% in 2015 apply “accommodation forces” to the investigators. Vision screening and to 16.3% in 2050) to Hispanics polymeric material, which are detected by proper refractive correction could (9.9% in 2015 to 20.3% in 2050). the accommodation sensor. This prompts produce clinical improvements in The study even localized its pre- the controller to change the optical power up to 72% of Americans with vi- dictions by state, speculating that of the electronic lens. The device and sion impairment and 22% of those blindness will most affect Mis- polymeric material “can restore a degree with blindness, they say. sissippi (up to 1.25% by 2050) of accommodation to the eye” on par “Early detection and interven- and Louisiana (1.2% by 2050). with natural accommodation, the patent tion—possibly as simple as pre- For visual impairment, Florida reads. The device would also include an scribing corrective lenses—could will have the highest per capita antenna to wirelessly send and receive go a long way toward preventing a prevalence (3.98% by 2050) and updated calibration information. signifi cant proportion of avoidable Hawaii (3.93% by 2050) will vision loss,” said Paul A. 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Contact your preferred Keeler distributor for Check out some of these great features: details. • Converging or parallel binoculars • Integrated yellow barrier filter • 14mm Slit length / maximum • 1m Square aperture for Uveitis aperture assessment • X 6 to x 40 (5 step) or X 10 to • LED illumination X 25 (3 step) magnifications • Illumination control mounted • Blue, red-free, clear, neutral next to joystick density and diffuser filters • 3 year warranty • 360 degree continuous slit rotation Keeler Instruments, Inc. • 456 Parkway • Broomall, PA 19008 Learn more at www.keelerusa.com Tel: (800) 523-5620 • Fax: (610) 353-7814 • email: [email protected] RO0416_Keeler.indd 1 3/22/16 12:31 PM News Review Scientists Reverse Diabetic Retinopathy in Lab Study esearchers from Indiana are investigating a potential new Rintraocular treatment, based on manipulating the renin angioten- sin system (RAS), that may prevent or even reverse diabetic retinopathy. In studies using mice, it seems to be working, according to The Ameri- can Journal of Pathology. The research is based on the hy- pothesis that an imbalance between two axes of the RAS leads to de- velopment of diseases like diabetic retinopathy. The team injected a therapeutic agent known as AAV- ACE2 directly into the vitreous cavity of the eye of diabetic mice to increase angiotensin converting enzyme-2 (ACE-2) expression. The researchers’ conclusion was Long believed to be irreversible, retinal damage from diabetes could one day be reached after two experiments. The ameliorated by therapy to reduce proinflammatory cells. fi rst saw the agent administered two weeks prior to a streptozotocin The investigators found both agent without interference from the injection, which induced diabetes in strategies effectively decreased the blood-retinal barrier. Hypotheti- the mice. The second saw it admin- numbers of proinfl ammatory cells cally, this therapy could be modi- istered six months after a strep- present in the diabetic retina. fi ed to address vascular diseases in tozotocin injection, after diabetic In addition, the intravitreal ap- other systems, such as the heart or retinopathy developed. proach is designed to deliver the kidneys. Exercise Tires the Eyes as Well as the Body But caffeine perks eyes up again, research shows. legs also slows the eyes,” says co-lead investigator Nicolas Gant, trenuous exercise can damp- In this study, researchers at PhD, MSc. “This might well be the en the central nervous system the University of Auckland, New reason the tired cyclist never saw S(CNS)—an effect known as Zealand, assigned 12 cyclists to that bus coming!” central fatigue. Research published three hours of stationary cycling. This effect was reversed in in Nature now shows that this Immediately after the workout, individuals given caffeine, who fatigue also weakens the oculomo- the researchers tested saccadic eye experienced an increase in their tor muscles and reduces saccadic movements and found that the saccadic velocities by up to 11% speed. But, as one might expect, a subjects’ saccade velocity de- after exercise. shot of caffeine appears to be the creased by 8%. remedy. “It’s remarkable that tiring the (Continued on p. 8) 6 REVIEW OF OPTOMETRY JUNE 15, 2016 004_ro0616_news.indd 6 6/8/16 1:58 PM www.ogieyewear.com | 1.888.560.1060 RO0616_OGI Eyewear.indd 1 5/16/16 12:58 PM News Review Exercise Tires the Eyes as Well as the Body (Continued from p. 6) istock “The amount of caffeine BUSINESS OFFICES 11 CAMPUS BLVD., SUITE 100 we gave during exercise NEWTOWN SQUARE, PA 19073 was the equivalent of two CEO, INFORMATION SERVICES GROUP cups of coffee.