Podcast: Play in new window | Download
Subscribe: Apple Podcasts | Google Podcasts | Spotify | Amazon Music | Android | RSS
Welcome to the February 2024 edition of EyeCare Shenanigans, where the future of optometry comes into sharp focus. This month, Dr. Jeffrey Fardink and Dr. Darryl Glover, dive deep into the latest breakthroughs and discussions reshaping eye care. We cover it all, from the groundbreaking study changing how we approach myopia management to the intriguing risks associated with eye color-changing procedures and the remarkable insights into how space travel affects vision. Stay ahead of the curve in the evolving world of optometry with insights that promise to enlighten, inform, and inspire.
Key Topics :
Every Diopter Matters: The Importance of Myopia Management
Dr. Darryl Glover:
Nice. Very nice. As we discuss children’s issues, we’re excited to introduce some fascinating topics. Our first topic, which we’ve titled ‘Every Diopter Matters’, is particularly intriguing—and indeed, it does. Can you elaborate on this?”
Dr. Jeffrey Fardink:
Certainly, this topic underscores the crucial role of myopia management and control. It draws from a recent lecture by a professor based on a study in Puerto Rico. It highlights the significance of myopia control and the problems it addresses. Dr. Cassie Ludwig, a Professor of Ophthalmology at Stanford, discussed retinal detachment, myopic macular degeneration, and myopic traction maculopathy. These conditions become more likely as myopia worsens, emphasizing why ‘every diopter counts.’ It’s vital to monitor and treat highly myopic patients promptly. Interestingly, unlike standard macular degeneration, high myopia-related neovascularization responds well to anti-VEGF treatments. Hence, prevention is critical to reducing the onset of these complications.
Dr. Darryl Glover:
And that’s a reminder we constantly need. It’s imperative to act when we see signs of myopia in a child. Think about the long-term impact on the child and their family. If myopia control isn’t your specialty, refer them to someone who is. The goal is to make a difference, so let’s make that connection.
Dr. Jeffrey Fardink:
This reminds me of a long-term patient, 60 years old, with a myopia of minus 22 in both eyes. He’s approaching the need for cataract surgery, which presents a significant risk of retinal detachment. Educating patients about potential complications is crucial, especially in high-risk cases.
Dr. Darryl Glover:
Absolutely. Sharing real-life cases helps our listeners apply this knowledge in their practices. It’s essential to not only treat myopia but also to educate patients about potential surgical complications. That’s the valuable insight our listeners gain from EyeCare Shenanigans.
Dr. Jeffrey Fardink:
After consulting with an ophthalmologist, we decided to perform the cataract surgery when necessary, not prematurely. It’s about finding the right timing.
Revolutionizing Myopia Control: A New Study Unveils Groundbreaking Findings
Dr. Darryl Glover:
Fantastic. Moving on, we have a topic called ‘Long-Term Shortening,’ which might sound confusing. But don’t worry, Dr. Jeffrey, let’s dive into this and clarify it for our listeners.
Dr. Jeffrey Fardink:
I understand the skepticism regarding data accuracy, especially given past concerns with research from China. However, this study, involving 30,000 patients, narrowed down to 10,000, reveals groundbreaking findings. Remarkably, 16.5% of patients undergoing myopia control treatments exhibited not just a halt in progression but an actual reduction in axial length. This finding challenges our expectations and could revolutionize our approach to myopia management.
Dr. Darryl Glover:
Indeed, discovering that many patients experienced axial length shortening was astonishing. It prompted me to review the study again, as such outcomes have rarely, if ever, been discussed before. This could be a game-changer in myopia control, warranting further exploration and validation.
Dr. Jeffrey Fardink:
Delving deeper, the data suggest an even more nuanced picture. The likelihood of axial length shortening appears to increase with age. Starting ortho-K at six presented a 2% chance of this outcome, whereas beginning at 18 showed a 50% chance. This inverse relationship between age and the effectiveness of myopia control interventions in reducing axial length is both surprising and significant.
Dr. Darryl Glover:
This insight could lead us to reconsider our myopia control strategies, potentially adopting a phased approach based on age. Current practices like using myopia control lenses for younger patients might need to be complemented with ortho-K for older patients to maximize outcomes.
Dr. Jeffrey Fardink:
The implication is that early intervention remains critical, but there’s also potential for significant impact even in older patients. This challenges the conventional wisdom that myopia control benefits diminish with age.
When Not to Prescribe: Tailoring Vision Care to Individual Needs
Dr. Darryl Glover:
Shifting gears, we’re exploring when not to prescribe. This concept might seem counterintuitive, but it’s grounded in optometry’s practicality—addressing patients’ specific needs and visual tasks. An article by Drs. Schnell and Tsao highlight this by discussing visual acuity requirements for children at different educational levels, suggesting that prescribing decisions should be tailored to the individual’s visual demands.
Dr. Jeffrey Fardink:
Their case studies present scenarios where non-prescription was chosen based on the patient’s visual acuity and demands. For instance, a four-year-old with minor refractive error and acceptable vision might not immediately need correction, whereas the decision for an eight-year-old might differ based on their activities and visual requirements.
Dr. Darryl Glover:
Each case underscores the importance of a nuanced approach to prescribing. While I might have chosen to prescribe in both cases, the discussion reminds us of the value in considering the patient’s lifestyle and needs above all. This dialogue between optometrists enriches our practice by sharing diverse perspectives on patient care.
Innovative Eye Color Changing Procedures: Risks and Rewards
Dr. Jeffrey Fardink:
That’s right. So, to quickly recap the two procedures we discussed: the first one, corneal tattooing, involves bathing the cornea in ink and then using either a needle or a laser to create small holes in the cornea for the ink to be absorbed. The second procedure is even more invasive, involving an incision into the cornea to implant a small iris implant over the natural iris, which is colored. This approach seems even riskier to me, with potential complications like angle closure and glaucoma. It’s pretty astonishing.
Dr. Darryl Glover:
Yeah, Jeffrey, you have to appreciate the creativity. You liked the title, “Color Me Back,” right? I thought it was clever.
Dr. Jeffrey Fardink:
I love it. You always bring something special to the table, Dr. Glover. While I come with articles, you bring creativity every time.
The Future of Optometry: Myopia Control Glasses
Dr. Darryl Glover:
Moving on to our next topic, which might not have as catchy a title but is equally important—myopia control glasses.
Dr. Jeffrey Fardink:
No worries there. The manufacturer has coined some intriguing names for us to consider. They’re utilizing diffusion optics technology, or DOTs, to control myopia through lenses. This involves SightGlass, another option in the realm of myopia-control glasses. Similar to myopia control contact lenses, we’re discussing peripheral diffusion optics and myopia blur optics to achieve a myopia control effect. These glasses feature small dots throughout the mid-periphery and periphery of the lens, offering contrast diffusion to aid in myopia control. These lenses, while they may look a bit different due to their small lenticules or varying properties, appear more practical than some other options I’ve seen. They’re employing a slightly different technology as well. It’s fascinating to observe these glasses in action. Dr. Glover, have you encountered any patients who have used these or similar glasses?
Dr. Darryl Glover:
With advancements like MiSight from CooperVision, we’re seeing significant strides in optometry. But when companies like Luxottica introduce innovations such as the Ray-Ban Meta Smart Glasses, which I’m currently wearing, it’s a game-changer. It’s crucial for companies to not only advance but also collaborate to elevate the field further. The future of optometry looks promising, and I anticipate we’ll witness many exciting developments in the coming years.
Dr. Jeffrey Fardink:
Absolutely. Having a variety of options at our disposal enriches our practice and the care we can offer our patients.
Cosmic Eyes: Understanding the Effects of Space on Vision
Dr. Darryl Glover:
Moving on, we have another fascinating article, and I must say, the title of this one caught my attention. We’re diving into “Cosmic Eyes.”
Dr. Jeffrey Fardink:
As I’ve mentioned before, I’m a proponent of practical optometry. However, discussing astronauts and the impact of space on their vision is not something we encounter every day. Nevertheless, it’s an intriguing subject that eye care professionals should be aware of, especially since patients may inquire about it. We’re exploring the effects of prolonged space flights on vision, specifically Space Associated Neuro-Ocular Syndrome (SANS), which shares similarities with Idiopathic Intracranial Hypertension on Earth. This condition, characterized by issues like papilledema and choroidal folds, frequently affects astronauts, resulting in changes such as optic disc edema and hyperopic shifts.
A recent study examined seven astronauts before and after their missions on the International Space Station. The findings revealed significant ocular changes, including optic disc edema in five astronauts, globe flattening in five, nerve fiber layer infarcts in five, thickening in six, and hyperopic shifts ranging from half to 1.75 diopters in six astronauts. These shifts are noteworthy, and while most changes were reversible, some persisted.
Dr. Darryl Glover:
That’s a considerable shift towards hyperopia.
Dr. Jeffrey Fardink:
Indeed, it is. And as we contemplate sending humans on a one-way trip to Mars, ocular health becomes a critical consideration. What ocular complications might arise during or after such a journey? Another recent article raised concerns about radiation-induced cataracts, a topic I’ve pondered for years. The potential for astronauts to develop posterior subcapsular cataracts due to space radiation is a significant risk. This raises the question: should preventive cataract surgery be considered for astronauts bound for Mars? It’s a topic worth discussing, as it could impact their visual health on such a monumental mission.
