30 30 REVIEW OF OPTOMETRY Managing Traumatic Hyphema, p. 18 • Recognizing Pseudotumor Cerebri, p. 79 29 29 28 28 27 27 ■ VOL. 155 NO. 7 July 15, 2018 www.reviewofoptometry.com 26 26 24TH ANNUAL GLAUCOMA REPORT ■ JULY 15, 2018 25 25 24 24 ■ ANNUAL GLAUCOMA REPORT 23 23 22 22 21 21 ■ MEDICATIONS 20 20 ■ LASERS 19 19 ■ MIGS 18 18 ■ SURGERY 17 17 ■ NUTRITION 16 The most comprehensive list ever assembled. Your guide to meds, MIGS and more. 16 Begins page 23. 15 15 001_ro0718_fc2.indd 1 7/5/18 5:15 PM INTRODUCING REFRESH® REPAIR The fi rst and only artifi cial tear in the U.S. formulated with CMC, HA,* and Osmoprotectants. REFRESH® REPAIR helps promote healing of the cornea and conjunctival epithelia and improves visual performance in Dry Eye patients. Safe to use with contacts. refreshbrand.com/doc | *HA is an inactive ingredient. © 2018 Allergan. All rights reserved. All trademarks are the property of their respective owners. REF115212 05/18 RO0618_Allergan Refresh.indd 1 5/31/18 2:55 PM Earn up to 2018 MEETINGS 12 CE Credits* MEETING CO-CHAIRS: MURRAY FINGERET, OD ROBERT N. WEINREB, MD CE CONFERENCES 10th Annual EAST COAST OPTOMETRIC GLAUCOMA SYMPOSIUM September 21-22, 2018 Rittenhouse Hotel 210 W. Rittenhouse Square PHILADELPHIA, PA For up-to-date information please visit: www.reviewscecom/ECOGS2018 Please call the hotel directly at 215-546-9000 and identify yourself as a participant of the East Coast Optometric Glaucoma Symposium. 10th Annual WEST COAST OPTOMETRIC GLAUCOMA SYMPOSIUM December 14-15, 2018 Monarch Hotel 1 Monarch DANA POINT, CA For up-to-date information please visit: www.reviewsce.com/WCOGS2018 Please call the hotel directly at 800-722-1543 and identify yourself as a participant of the West Coast Optometric Glaucoma Symposium. Administered by Review Group Vision Care Education, LLC *Approval pending For up-to-date information, go to www.reviewsce.com/events call 877-451-6514 or e-mail [email protected] Review Group Vision Care Education, LLC partners with Salus University for those ODs who are licensed in states that require university credit. News Review VOL. 155 NO. 7 ■ JULY 15, 2018 IN THE NEWS New Hypertension A new study suggests the neural circuit mechanisms underlying recovery of Guidelines: Now What? eye dominance and acuity operate independently, potentially turning cur- Research suggests some screening changes that may rent amblyopia treatment on its head. The study evaluated the visual acuity of impact your care. mice for whom the ngr1 gene had been By Bill Kekevian, Senior Editor removed; the results show that, even for mice whose eye dominance remained ike diabetes, hypertension Glaucoma specialist James Fanel- impaired, visual acuity could still improve. rates in the United States and li, OD, says this research further Stephany C, Ma X, Dorton H, et al. Distinct circuits worldwide have exploded. supports the idea that optometrists for recovery of eye dominance and acuity in murine L amblyopia. Current Biology. June 7, 2018. [Epub ahead In fact, researchers estimate that “should consider systemic blood of print]. 1.3 billion people worldwide pressure a modifi able risk factor for State Senator Ed Hernandez, OD, of suffer from it.1 For most primary both glaucoma development and West Covina, Calif., recently won care physicians, this is fairly easily glaucoma progression.” the Democratic Party’s nomination handled by encouraging the patient But it isn’t a simple see-saw effect for California’s Lieutenant Governor to make lifestyle changes to control in which one goes up, causing the seat.1 He’s earned the endorsement of their blood pressure (BP), as well other to go down. One of the major several local eye care practices and as prescribing BP-lowering medica- fi ndings of the research shows that California optometrists. His website tions. But, for eye care clinicians, “extreme falls in nighttime—but boasts various health care related lowering BP can have a dangerous not daytime—systolic and diastolic goals and policies, such as champion- side effect: elevated risk for glauco- blood pressure were signifi cantly as- ing lower drug prices and passing ma. Although it is weak, research- sociated with a higher prevalence of clean water and air regulations.2 ers point to a signifi cant positive glaucomatous optic neuropathy.” 1. Thompson J. California Optometric Association ap- relationship between systemic Dr. Fanelli adds that patients plauds Dr. Ed Hernandez’s election night victory. www. coavision.org/fi les/Ed%20Hernandez%20Primary%20 blood pressure and intraocular should avoid taking BP medications Statement%20FINAL.pdf. June 6, 2018. Accessed pressure (IOP). “The relationship at night, as a nocturnal drop in BP June 7, 2018. 2. Dr. Ed Hernandez for Lt. Governor 2018. www.edher- between glaucoma and systemic hy- is often when IOP tends to increase. nandez4ca.com/media. Accessed June 7, 2018. pertension is multifaceted and often Due to the nuanced nature of BP Researchers recently used binocular puzzling,” reads a report, published and IOP, the authors recommend a optical coherence tomography (OCT) in the Journal of Glaucoma.2 close partnership between eye care to measure the size of strabismus, Part of that puzzle involves and primary care for those strad- with positive results. In evaluating 15 discovering precisely what that re- dling hypertension and glaucoma. patients with strabismus and 15 controls lationship is. The authors relied on “ODs don’t interact with internal with both anterior segment OCT and population-based studies, prospec- medicine and family practice and alternating prism cover test (APCT), tive longitudinal studies and ran- the medical community as a whole they found OCT correctly identifi ed the domized clinical trials to organize enough,” Dr. Fanelli adds. “We type and direction of the deviation in all “evidence that lower systemic BP need to comanage and take an ac- 15 patients with strabismus. Imaging and lower ocular perfusion pressure tive role. It needs to be done all the was strongly correlated with the APCT are associated with greater glau- time.” measurement as well. coma prevalence and a higher rate 1. Bloch MJ. Worldwide prevalence of hypertension exceeds of glaucoma progression.” How- 1.3 billion. J American Society of Hypertension: JASH. Chopra R, Mulholland PJ, Tailor VK, et al. Use of a 2016;10(10):753-4. binocular optical coherence tomography system to evaluate strabismus in primary position. JAMA Ophthal- ever, they are careful not to imply 2. De Moraes C, Cioffi G, Weinreb R, Liebmann J. Perspective: mol. May 31, 2018. [Epub ahead of print]. new recommendations for the treatment of systemic hyperten- that treating systemic hypertension sion and their potential implications for glaucoma management. increases the risk of glaucoma. J Glaucoma. May 10, 2018. [Epub ahead of print]. 4 REVIEW OF OPTOMETRY JULY 15, 2018 0004_ro0718_news.indd04_ro0718_news.indd 4 77/5/18/5/18 111:231:23 AAMM 100% PRESERVATIVE-FREE ORDER FREE SAMPLES Go to either website and select “Request Sample” www.Zioptan.com www.CosoptPF.com Cosopt is a registered trademark of Merck Sharp & Dohme Corp and is used under license. ZIOPTAN is a registered trademark of Merck Sharp & Dohme Corp and is used under license. ZIOPTAN is licensed by Santen Pharmaceutical Co., Ltd. ©2017 Akorn, Inc. All rights reserved. P481(a) Rev 4/17 RP0118_Akon Zioptan.indd 1 12/19/17 2:42 PM News Review OCT-A Not Always Better than OCT lthough the diagnostic value viduals. The researchers measured densities,” the study said. of optical coherence tomog- “retinal thickness and retinal vessel “OCT measurement of inner Araphy angiography (OCT-A) density over the 3x3mm2 macula macular thickness shows a higher compared with conventional OCT using swept-source OCT (SS-OCT) diagnostic performance to detect measurement in glaucoma remains and OCT-A, respectively. They glaucoma and a stronger structure- inconclusive, many researchers and found the inner macular vessel den- function association than the cur- clinicians fall into the trap of as- sity was 4.3% smaller in eyes with rently used OCT-A measurement of suming that newer is always better. glaucoma compared with healthy inner macular vessel density,” the However, researchers in Hong eyes. Inner macular vessel thick- study authors conclude. Kong took a closer look at both ness was also smaller by 21.1µm, “These fi ndings may suggest that modalities and found OCT-A has compared with healthy eyes. OCT-A of the macula has a limited its limitations, leading them to When comparing the two mea- role in the diagnostic evaluation of believe conventional OCT remains surements, they found that “at 90% glaucoma.” a better option when viewing the specifi city, the sensitivity of mean macula in some cases. inner macular thicknesses for detec- Wan KH, Lam AKN, Leung CK. Optical coherence tomography angiography compared with optical coherence tomography The study includes 115 patients tion of glaucoma was greater than macular measurements for detection of glaucoma. JAMA with glaucoma and 35 healthy indi- that of mean inner macular vessel Ophthalmol. May 31, 2018. [Epub ahead of print]. “Tele-optometry” Offers Remote Exams new telemedicine company perform a prescreening exam, offi ces, which would allow home- says it can help optometrists including autorefraction, tonometry, bound licensed optometrists the Aperform virtual eye exams. fundus photography, a video slit- chance to return to their profession. Touting this concept as “tele- lamp and auto-lensmeter readings. Now optometrists “can expand optometry,” DigitalOptometrics The information would then be their practices by opening addition- hopes to provide convenience to sent to a licensed optometrist who al locations and can, in fact, be in patients seeking exams and greater would check the visual fi ndings two to three places at the same time opportunities for ODs—without the and discusses them with the patient by seeing some of their patients in acrimony that typically surrounds through a live videoconference.