A weekly e-journal by Art Epstein, OD, FAAO

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Volume 11, Number 17

Monday, April 25, 2011

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In this issue: (click heading to view article)
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######### Off the Cuff: Lost in Translation

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######### Relationship Between Compliance with Lens Replacement and Contact Lens-Related Problems in Silicone Hydrogel Wearers
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######### Simultaneous Bilateral Versus Sequential Bilateral Cataract Surgery
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######### Topical Anesthetic Abuse Keratopathy: A Commonly Overlooked Health Care Problem
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######### News & Notes
 

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Off the Cuff: Lost in Translation

Although I have lectured extensively abroad, one thing I never thought much about is differences in language—specifically the subtle and sometimes not-so-subtle differences in the meaning of words.

I just returned from speaking in Russia and I got to meet many colleagues in Moscow and St Petersburg. I learned an interesting lesson while there. English consists of well over one million words. Russian has perhaps one-third of that. While I knew that some concepts spoken in English were much longer or shorter spoken in other languages, I didn't think much of it. In fact, as an experienced international speaker, I thought I had thoroughly mastered the nuances of both sequential and simultaneous translation, regardless of language.

During a lecture in Moscow, I was explaining how our understanding of soft lens materials has changed. I described the brilliance of chemist Otto Wichterle, who invented the first hydrogel, and how he was a visionary. As I explained the magnitude of his accomplishment, how he worked in hospitals with children who needed contact lens correction, the previously stoic Russian ophthalmologists broke out into hysterical laughter.

I stood there smiling sheepishly, trying to understand what they found so funny. The more the increasingly flustered interpreter spoke, the louder and wilder grew the laughter. I found out why later. It turns out that the translator inadvertently described Wichterle as a sadistic mad scientist who experimented on children. The more she tried to explain her way out of the miscue, apparently the funnier it became. It was the biggest laugh I got in years. Unfortunately, I was the only one in the room who didn't get it.

Editor's Note: Enjoy the holiday weekend!

Arthur B. Epstein, OD, FAAO
Chief Medical Editor
[email protected]

 



Want to share your perspective? Write to Dr. Epstein at [email protected]. Comments received may be published on OP-Blog at the discretion of the editor without attribution. Please indicate if you would like your thoughts attributed to you.

The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Publishing or any other entities or individuals.

 




Relationship Between Compliance with Lens Replacement and Contact Lens-Related Problems in Silicone Hydrogel Wearers
 
 
A total of 501 silicone hydrogel (SiHy) wearers from seven optometry offices completed surveys regarding their lens wear and any contact lens (CL) related problems which they may have experienced in the preceding 12 months to evaluate the relationship between compliance with replacement frequency (RF) and CL-related problems in SiHy wearers. File review was subsequently conducted at their optometry offices to confirm the information provided.

Forty-nine percent of respondents were wearing 2-week replacement (2WR) and 51% 1-month replacement (1MR) SiHy lenses. 67% wore their lenses for longer than the manufacturers' recommended RF (MRRF) and 60% for longer than their optometrist's recommended RF (ORRF). The mean RF was 2.6× the MRRF for 2WR and 1.5× for 1MR wearers with median values of 31 and 37 days, respectively. Twenty-three percent reported signs or symptoms consistent with potential complications relating to CL wear. This rate was significantly higher for wearers who were non-compliant with the ORRF than compliant wearers (26% versus 18%). It was also higher for those multipurpose solution users who reported never/almost never rubbing and rinsing their lenses when compared with those who did this every night (29% versus 17%).

Two-thirds of the SiHy wearers did not comply with the MRRF and 2WR wearers stretched the replacement interval of their lenses to a greater degree than 1MR wearers. Failing to replace lenses when recommended and failing to rub and rinse lenses were associated with a higher rate of patient-reported CL problems.

SOURCE: Dumbleton KA, Woods CA, Jones LW, Fonn D. The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers. Cont Lens Anterior Eye. 2011; Apr 12 [Epub ahead of print].

Simultaneous Bilateral Versus Sequential Bilateral Cataract Surgery
 
 
Consecutive patients scheduled for bilateral cataract surgery were enrolled based on appropriate inclusion criteria and randomized to be operated on in 1 session (study group) or sequentially (control group) 4 to 6 weeks apart to evaluate the refractive outcomes, complication rates, and changes in patients' functional state and satisfaction with simultaneous compared with sequential bilateral cataract surgery.

Four hundred ninety-one (94.4%) of the 520 patients completed the study. Of the eyes, 493 (247 patients) had bilateral surgery in 1 session and 506 (257 patients) in separate sessions. In the study group, 240 patients (96.0%) were treated per protocol. In the control group, 250 patients (97.3%) were treated per protocol. The refraction was within ±0.50 D of the target in 67.2% of eyes in the study group and 69.2% of eyes in the control group and within ±1.00 D in 91.0% and 90.3%, respectively. The only complication that affected postoperative visual acuity was chronic cystoid macular edema, which occurred in 1 eye in the study group (0.2%) and in 2 eyes (0.4%) of 1 patient in the control group. Ninety-five percent of patients in both groups reported being very satisfied with surgery.

The refractive outcomes, rates of complications, and patient-rated satisfaction were similar whether bilateral cataract surgery was performed simultaneously or sequentially.

SOURCE: Sarikkola AU, Uusitalo RJ, Hellstedt T, et al. Simultaneous bilateral versus sequential bilateral cataract surgery. Helsinki Simultaneous Bilateral Cataract Surgery Study Report 1. J Cataract Refract Surg. 2011; Apr 13 [Epub ahead of print].

Topical Anesthetic Abuse Keratopathy: A Commonly Overlooked Health Care Problem
 
 
This study evaluated the clinical course, treatment modality, factors affecting the epithelization period and visual outcome in patients with topical anesthetic abuse keratopathy. The medical records of nineteen patients with a confirmed diagnosis of topical anesthetic abuse keratopathy were retrospectively examined; occupation, initiating event, biomicroscopic findings, treatment modality, epithelization period, and best-corrected visual acuity (BCVA) were noted. The Wilcoxon signed rank test was used to compare BCVA before and after treatment; p values <0.05 were considered statistically significant.

In all, 26 eyes in 19 men aged 21–44 (mean age: 31 ± 6) years were included. Initiating events included exposure to arc welding flash (8 patients), metallic foreign body injury (8 patients), and chemical injury (3 patients). On admission to hospital, 10 patients (52.6%) reported that they were using topical anesthetics. Upon admission to the hospital, 10 patients (52.6%) self reported that they were using topical anesthetics. The remaining 9 subjects were discovered to be using topical anesthetic drops during hospitalization. Twelve patients (63.2%) were found to continue using these agents during their hospitalization. Oval corneal epithelial defect, stromal infiltrate, ring-shaped keratitis, and hypopyon were noted in 100%, 46.2%,
57.7%, and 42.3% of the eyes, respectively. Topical antibiotics (fluoroquinolones or combined fortified cephalosporins and aminoglycosides), preservative-free lubricants/autologous serum and bandage contact lens/eye patches were used for treatment. Mean epithelization period was 19.96 ± 11.16 days (range: 6–50 days). Mean pretreatment and post-treatment BCVA was 0.12 ± 0.16 (range: 0.001–0.7) and 0.66 ± 0.30 (range: 0.0–1.0), respectively (p < 0.001).

Eye care providers should be suspicious of topical anesthetic abuse keratopathy in young male manual laborers specialized in welding business and foundry work presenting with persistent epithelial defects, ring-shaped keratitis and accompanying severe ocular pain.

SOURCE: Yagci A, Bozkurt B, Egrilmez S, et al. Topical anesthetic abuse keratopathy: a commonly overlooked health care problem. Cornea. 2011;30(5):571–575.

http://www.revoptom.com/Maui2011


News & Notes
 
VEGF TRAP-EYE GRANTED PRIORITY REVIEW BY FDA FOR TREATMENT OF WET AMD. The FDA has accepted for review Regeneron Pharmaceuticals, Inc.'s Biologics License Application (BLA) for VEGF Trap-Eye for the treatment of wet age-related macular degeneration (AMD) and has granted the company's request for priority review of its BLA. Under priority review, the target date for an FDA decision on the VEGF Trap-Eye BLA is August 20, 2011. Click here to learn more.
 
ADVANCED CELL TECHNOLOGY FILES EUROPEAN CTA FOR STUDY OF EMBRYONIC STEM CELLS TO TREAT MACULAR DEGENERATION. Advanced Cell Technology, Inc. has filed a clinical trial application (CTA) with the European Medicines and Healthcare products Regulatory Agency (MHRA) seeking clearance to initiate its Phase ½ clinical trial using retinal pigment epithelial (RPE) cells derived from human embryonic stem cells (hESCs) to treat patients with Stargardt's Macular Dystrophy (SMD). According to Advanced Cell Technology, the proposed clinical trial will be a prospective, open-label study designed to determine the safety and tolerability of the RPE cells following subretinal transplantation to patients with advanced SMD, similar to the FDA-cleared U.S. trial, which is set to commence in the first half of this year. Read more here.
 
VISTAKON CONTEST GIVES TEENS A CHANCE TO CONNECT WITH SINGER CHARICE. Vistakon, Division of Johnson & Johnson Vision Care, Inc., recently announced that now through May 23, 2011, fans of 18-year-old singer Charice can enter the “ACUVUE 1-DAY Contest” for their chance to win one of three grand prizes, have their photos featured in Charice's video or win one of 35 daily prize packages. Grand prize winners receive a trip for two to Los Angeles to be featured in the music video for her new single, “One Day.” Fans can enter by clicking on the “ACUVUE 1-DAY Contest” tab on the ACUVUE Brand Page on Facebook and submit a picture, along with a one-sentence caption that conveys their dreams and aspirations for what they will do “One Day.”
 
ALIMERA ADDS BRADLEY TO BOARD OF DIRECTORS. Dr. Glen Bradley has joined Alimera Sciences, Inc.'s Board of Directors and the Audit Committee of the Board. Dr. Bradley, a consultant and advisor for ophthalmic and non-ophthalmic medical device companies, replaces Dr. Anders D. Hove. He has previously held executive positions at Novartis, AG of Basel, Switzerland and CIBA Vision Group in Atlanta and Zurich, Switzerland.
 
   

 

 


Optometric Physician™ Editorial Board
 

Chief Medical Editor
Arthur B. Epstein, OD, FAAO

Journal Reviews
Shannon Steinhäuser, OD, FAAO

Editor
Karen Rodemich

Art/Production Director
Joe Morris

Contributing Editors
• Katherine M. Mastrota, MS, OD, FAAO
• Michael Mayers, OD, FAAO
• Barry A. Weissman, OD, PhD, FAAO (Dip CL)

Editorial Board
• William Jones, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO


 

 

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