Eyecare Shenanigans: Forever Chemicals (PFAs), Strabismus Higher in Twins, Legislation Updates, New Contacts, and More Optometry News

Dive into the captivating eyecare world with Dr. Darryl Glover and Dr. Jeffrey Fardink as they shed light on the latest breakthroughs and emerging trends. From the impact of VR technology on vision to intriguing findings about twins’ susceptibility to eye conditions, this conversation covers it all. Get ready to explore the interplay of technology, legislation, and scientific research in the rapidly evolving sphere of eyecare.


Dr. Darryl Glover:

Let’s delve into some eyecare headlines.

Dr. Jeffrey Fardink:

Bausch and Lomb is set to launch their multifocal-infused daily contact lens, which is thrilling news. We discussed the Florida bill last week. It was a significant move, but unfortunately, it didn’t pass. The legislature approved it, but Governor DeSantis vetoed it. 

In other news, New Jersey is introducing new legislation to secure laser privileges for optometrists. Furthermore, Apple just launched a new VR headset, which is exhilarating. We’re bound to receive a flurry of questions from our patients about that. So, those are the current headlines.

Dr. Darryl Glover:

The Florida bill could have been a game-changer, right? Regarding these VR headsets, I predict they’ll become a frequent topic in our offices. Have you started discussions about binocular vision, potential headaches, warnings, or dry eyes? What type of conversations are you having?

Dr. Jeffrey Fardink:

Indeed, I’ve had many patients who were under the impression that using VR headsets was akin to close-up work. However, it’s not exactly the case because they’re designed for distance focus. The devices incorporate distance plus lenses to accommodate your distance refractive error. Therefore, if you’re nearsighted, you need to wear your glasses.

The challenge is that wearing glasses with these headsets can be uncomfortable. I’ve been recommending that patients who intend to use VR headsets frequently should consider switching to contact lenses. This situation reminds me of the eye tests conducted at the DMV here in Virginia using screening devices where you insert your head. Many patients don’t realize that they need to keep their glasses on for this. The test measures distance vision, not near vision. So the primary issue here is the need for more education.


Unseen Chemicals in Our Contacts

Dr. Darryl Glover:

Education is always the key, isn’t it? Now, let’s dive into our first topic: the world of chemicals. Let’s discuss this, my friend.

Dr. Jeffrey Fardink:

This is a significant issue. There’s a group called Mama Ovation that does a lot of consumer testing and investigations to determine whether everyday products are safe. They sent various contact lenses from major manufacturers for laboratory testing. The results showed that many of them potentially tested positive for PFAS, which are perfluorinated chemicals containing fluorine.

They tested three main brands: Alcon, CooperVision, and Johnson & Johnson. Bausch and Lomb weren’t included in the test, which I found intriguing. Upon reading the article, it seems like one of the testers, probably an office worker, only sent in trial samples available at their location, and Bausch and Lomb must not have been available there.

We’re aware that these chemicals are hazardous and problematic. However, it’s a significant leap to declare contact lenses unsafe because they might contain these substances. I need more information. Are these chemicals leaching out? Are they being absorbed by the eye? The article suggests that these chemicals are found at much higher concentrations in contact lenses than are deemed safe in drinking water.

The Hidden Mysteries of Fuchs Dystrophy


Dr. Darryl Glover:

We also have an exciting article about Fuchs’s dystrophy. The headline is quite captivating, so let’s discuss Fuchs…

Dr. Jeffrey Fardink:

Indeed, Fuchs dystrophy is interesting. We know that patients often experience diminished vision in the morning due to more swollen corneas. But interestingly, it turns out that their refractive error fluctuates throughout the day. 

A study was conducted where patients were refracted at the end of the day using both an autorefractor and conventional subjective refraction. They were then taken to a hospital setting for overnight observation and refracted immediately upon waking, again, using both methods. A subset of patients was refracted every half hour for two hours, revealing refractive shifts.

Interestingly, in the healthy control group, there were no significant changes in refraction throughout the day. However, in the Fuchs patients, the refraction varied by up to a diopter in some patients, though generally, it was less than half a diopter for most. But in 30% of patients, there was a half to one diopter shift. This could significantly impact day-to-day functioning.

Educating Fuchs patients that their vision will improve as their corneas become less swollen and dry is vital. Still, we should also inform them that their vision might shift while wearing glasses. But, prescribing different glasses for their “just woke up” vision might be overkill given their generally poor correctable vision.

A Bug’s Life and Its Influence on Cataracts


Dr. Darryl Glover:

Indeed, a very intriguing topic. Moving on, let’s discuss the correlation between bugs and cataracts.

Dr. Jeffrey Fardink:

This topic might alarm some of our patients. It examines the presence of Demodex blepharitis in cataract patients. Many patients have reported that while they are happy with their improved vision post-cataract surgery, they often experience drier and less comfortable eyes a few months down the line.

This study identifies that Demodex blepharitis becomes more prevalent after cataract surgery. About 22% of patients were found to have Demodex prior to surgery, but a month post-surgery, this number increased to 33%. It raises questions as to what causes this increase — could it be steroid drop usage?

Dr. Darryl Glover:

With Tarsus Pharmaceuticals developing a new drug, this is quite timely. I wonder if this drug will be prescribed for all patients undergoing cataract surgery. If made part of the protocol, it could be a game-changer for the organization.

Dr. Jeffrey Fardink:

Indeed, I concur. The use of antibiotics for cataract surgery is primarily prophylactic. So, why not a prophylactic treatment against Demodex with the new drug from Tarsus? It seems logical and beneficial for our patients given the data.

The Twin Dilemma: Higher Rates of Strabismus and Amblyopia


Dr. Jeffrey Fardink:

Moving onto the last topic — strabismus in twins. This was a fascinating study that analyzed a large number of children, including identical twins, fraternal twins, and a control group of non-twin children. They studied the rates of strabismus, amblyopia, and refractive errors.

Interestingly, the rates of strabismus and amblyopia were significantly higher in both the identical and fraternal twin groups. It wasn’t just amblyopia, but also retinopathy of prematurity and strabismus that were more prevalent in the twin groups. They link this to potentially lower birth weights and early gestational terms typical with twin pregnancies.

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