Last week's editorial about online spectacle sales generated a massive number of comments – so much so that I still haven't been able to get through all of them. I also followed the discussion generated by this issue on several fronts.

First, let me tell you what will not save your practice: hiding frame-markings behind price or inventory labels, asking patients not to use smart phones to scan or image frames or anything that reeks more of merchant than professional. Do this, and I can guarantee that you will damage existing patient relationships — the ones that might actually keep you afloat.

Another thing: don't keep trying to convince yourself that people won't purchase eyeglasses online. It's hogwash. I have friends who have purchased Porsche 911's online. And please, no more suit analogies. Yes, I know people like to try on suits, but oddly, clothiers have done a better job convincing their customers that suits are a custom experience than we have with eye care. Besides, millions of suits — including very expensive ones — are sold online each year.

How about opening your own online shop? Companies like Essilor and VSP are offering a variety of e-commerce solutions. Some are better than others, but realize that without intense marketing support, you will likely be competing with your own brick-and-mortar self. If you think you are going to effectively compete with 1-800; Wal-Mart; or the myriad frame, lens and discount eyecare vendors, I wish you luck.

Some have proposed climbing up the ladder by offering premium product, top-notch service coupled with state-of-the-art technology. Add in obviously caring about patients (what we used to call bedside manner) and this becomes an excellent strategy; however, don't place too much weight on trying to preserve profit by selling premium frame lines. Online vendors will be competing among themselves and they will be aggressively targeting this segment. That said, there will always be room at the top for a few smart survivors.

So is there a best solution? It is likely the one you heard during optometry school from a wise old instructor. Most of us were told to sell services and not to try to profit on the hardware. Trust that I know just how unlikely that seemed then and how impossible it seems now, but the only thing we have that no one can really compete with is our knowledge, our skills and our ability to change people's lives for the better. We are in the midst of a tsunami of change. The sooner we realize it, the better. More to come.

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

 

 

This study evaluated the concentration of allergic mediators in tears of children with seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) compared with controls. Twenty children with allergic conjunctivitis (17 SAC, and 3 PAC) and 16 healthy children were included. Tear samples were collected using a Merocel sponge (Oasis, 0525), and immediately eluted by incubation in elution buffer and subsequent centrifugation at 20,000rpm for 30min at 4°C. Concentrations of histamine (HIS), tryptase (TPS), eosinophil chemotactic factor (ECF), major basic protein (MBP), eosinophil cationic protein (ECP), eosinophil-derived neurotoxin (EDN), IgE and E-selectin were measured using enzyme linked immunosorbent assays (ELISA). Data were compared with the Mann-Whitney U test, and multivariate analyses were also performed.

Tear levels of TPS, MBP, ECP, IgE and EDN showed significant differences in children with SAC and PAC compared to controls.

The simultaneous analyses of allergic mediators in the tears of children with SAC and PAC showed a significant elevated concentration in EDN, ECP and MBP in allergic group and decreased levels in IgE and TPS. Statistical analyses showed a diagnostic accuracy of 94.4% using the eight molecules panel.

This study attempted to estimate the incidence of and identify the risk factors for late-onset open-angle glaucoma (OAG) after uncomplicated pars plana vitrectomy (PPV). All patients who underwent PPV at the Edward Harkness Eye Institute between January 1998 and January 2004 had at least 6 months of follow up and did not have pre-existing glaucoma or reason for secondary development of glaucoma were included.

Of 285 vitrectomized eyes that met enrollment criteria, 11.6% (n = 33) developed glaucoma after vitrectomy. In the matched case-control analysis, the only variable that had a statistically significant association with the development of OAG was cataract extraction (CE), as compared with phakic status at the last follow up (odds ratio = 16.4; 95% confidence interval, 2.1–127.4). There was no difference in OAG development between eyes that had CE before or at the time of PPV and those that had it after PPV. The overall incidence of OAG development after PPV among all eyes, phakic eyes, and non-phakic eyes was 11.6%, 1.4% and 15.0%, respectively. The difference in incidence between phakic and nonphakic eyes was statistically significant.

Lens extraction is a strong risk factor for the development of late-onset OAG after uncomplicated PPV. While the overall incidence of OAG development after PPV is substantial, it is more so among eyes that have had CE. The absence of substantial OAG incidence in phakic patients points toward a combined mechanism for late-onset post-PPV OAG involving PPV and CE at any time. Preoperative PPV counseling should include the risk of glaucoma development in addition to cataract development and the connection between the two. Patients who have undergone PPV, and especially those who also had CE in the same eye, should be carefully monitored for glaucoma.

Keratometry and objective refraction, uncorrected visual acuity, visual acuity with rigid gas permeable (RGP) contact lens, high-order aberrations and letter contrast sensitivity before and after RGP application were measured in 22 keratoconus patients to evaluate quality of life and visual functions in patients with keratoconus wearing RGP contact lenses. Vision-related quality of life was examined by the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25)

The average spherical equivalent in the study group was –7.28 (± 5.53), the average keratometry was 50.04 D (± 4.24) and the average corneal astigmatism –3.44 Dcyl (± 2,72). The uncorrected visual acuity was 0.20 (± 0.18), the corrected visual acuity 0.78 (± 0.22). The improvement of visual acuity after RGP fitting was statistically significant. The RGP fitting didn't cause significant changes in high order aberrations and in contrast sensitivity. The NEI-VFQ overall score was 79.2. Keratoconus was associated with lower scores in these categories: dependency, mental health and ocular pain.

Keratoconus is a disease that may have a marked impact on the quality of life because it affects young adults in their active years. The use of RGP correction can significantly improve visual acuity, but, at least in this study group, did not lead to significant improvement in contrast sensitivity and corneal aberrations.