Johnson & Johnson Vision’s new astigmatism management software, Catalys cOS 6.0, received 510(k) clearance from the U.S. Food and Drug Administration (FDA). The software package is used in conjunction with its laser cataract surgery system to enable more accurate laser alignment.

It automatically compensates for cyclorotation, or torsional movement of the eye, according to the company.

The astigmatism software offers new features that streamline workflow by speeding up surgical processes and improving accuracy for surgeons using the Catalys Precision Laser system. According to J&J Vision, it does this by:

Minimizing manual transcription errors and data entry verification through direct input of preoperative keratometry and steep axis values data

Reducing calculation time by including calculations of arcuate incision parameters using built-in nomogram and automatic input of arcuate incision parameters in the treatment planning screen

Reducing the need for intraoperative aberrometry for toric IOL alignment with radial laser marks placed within a mean accuracy of 0.6 degrees.

Adding iris registration for automatic cyclorotation compensation

Catalys cOS 6.0 will be available in the fourth quarter of 2020.

Read more: AOA elects '20-'21 officer slate via virtual ballot

Articles

Catalys cOS 6.0 allows for more accurate laser alignment

J&J Vision receives FDA clearance for astigmatism management software

Dry eye is a topic eliciting much discussion among our colleagues. Many of us dive headlong into the topic. There has been an explosion of information about the condition in the last decade, every continuing education meeting has several presentations on the subject, and a cottage industry has sprung up concerning diagnosis and management of the disease.

For good reason. What was once considered an afterthought in our practices has been shown to be ubiquitous and has become an inevitable public health problem.

Related: Dr. Ernie Bowling discusses dry eye in the digital age

Dry eye is one of the most common ophthalmic conditions, affecting hundreds of millions of people worldwide. Dry eye affects five percent to 30 percent of the world population 50 years and older, with women representing approximately two-thirds of those affected.1 The disease is increasing in younger patients.

Dry eye has a significant impact on quality of life due to chronic symptoms of ocular pain and discomfort in addition to functional vision impairment. Dry eye can impact functional vision, interfering with everyday activities such as driving, reading, computer usage, watching television, and work performance.2 Dry eye negatively impacts mental health as dry eye patients report higher rates of anxiety and depression.3

Dry eye disease is among the most common reasons for visiting eye care practitioners and represents a substantial health and cost burden.Financially, dry eye is estimated to cost $3.84 billion per year to the healthcare system with an average annual cost of $783 per patient for treatment.4

Related: Lactoferrin levels can diagnose dry eye disease

So, it is obvious that a lot of patients are suffering with dry eye. Dry eye is everywhere, going undiagnosed/underdiagnosed/undertreated, and our patients need our help. It is in our patients’ best interests to properly recognize and treat the condition.

Still, with the abundance of information available, it is easy for one to be overwhelmed with the data available. Where to start? How do I start? Do I really need all the bells and whistles available in the marketplace to properly diagnose and treat dry eye?

Which is where this project comes in. Over the course of the next year, we will explore developing a dry eye subspecialty within your practice. We will cover the nuts and bolts of starting a dry eye clinic, using the knowledge from experienced practitioners who have done just that in their practices. We aim to provide information on where to start, how to start, and some of the pitfalls and missteps along the way so you can avoid those stumbles.

Dry eye is a great practice builder. It is an excellent entry point into medical optometric care. You can spend as much or as little as you like, based on your budget and desire, to develop your dry eye practice.

Even more importantly, you’ll be providing a much-needed service to the scores of patients in your practice who are suffering from dry eye overtly or in silence. Your patients will thank you for recognizing their problem and addressing their needs. And who knows? You may have fun along the journey.

More by Dr. Bowling: Good news is out there during COVID-19

1. Stapleton F, Alves M, Bunya VY, Jalbert, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. TFOS DEWS II Epidemiology Report. 

2. Miljanović B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. 

3. Li M, Gong L, Sun X, Chapin WJ. Anxiety and depression in patients with dry eye syndrome. 

4. McDonald M, Patel DA, Keith MS, Snedecor SJ. Economic and humanistic burden of dry eye disease in Europe, North America, and Asia: a systematic literature review. 

The condition is everywhere, and your patients need you.

Why ODs should treat dry eye

Hi, I'm Dr. Melanie Denton Dombrowski. I own a practice called Salisbury Eyecare and Eyewear. It is in Salisbury, NC. And we have a YouTube channel if you want to check that out. But this video is for 

I wanted to talk a little bit about my amazing team and how I have handled keeping in touch with my team throughout this whole pandemic, COVID-19, and all the closures that have occurred because of it.

So, first of all, a little bit about my team.

My team (I have 4 of them) and I started 4 years ago. It has been quite a ride to get to this team of 4. But I can honestly say this is the best team I have ever had. They are so well trained. I have natural-born leaders within my team, and they are just kind and wonderful people who love working together, who do so very, very well. And we have worked really hard to train them both in the technical aspects and kind of the service aspects of our business. They are just great people.

When COVID-19 first started, I would say the first thing that made a difference with my team was communicating from the very, very beginning. It is so critical as a leader to talk to your team to let them know what is going on.

Admittedly, I think they saw a lot of my fear and uncertainty. But you know, I think it is OK to be vulnerable sometimes. Your team needs to see that you are a person, too. One of our great strengths is that my team, I think they will tell you that they respect me greatly, and they trust in me and know that I am doing my best for them and for our practice. So, we can have that foundation as a core but when this all started, I was very forthcoming with all of the information I knew.

Related: COVID-19 means I’m a full-time, stay-at-work mom

I knew they wanted answers right away. And I could not give that to them. But I was as open as I could possibly be. When we did have to close down again, I had personal conversations with the folks who were going to be affected more greatly than others. Then, a team conversation and I reiterated what our goals were, what our mission was at the office, and that we would be back. This has to be temporary.

The second thing I did was, and continue to do, is support them throughout. So, it is critical to me that they know the resources that are out there, that I am helping with that actively. I know nothing about the unemployment system. I know nothing about the stimulus checks, and they don’t either, but I am traveling that road with them and helping them throughout every step of the journey.

Most of the time I do not know the answer, but I think the fact that I care makes a difference.

The third thing is that we have initiated team Zoom calls. And we do that every single Friday. It is pretty short and brief. But I tell them what has happened during the week, what I have come up with; usually it is not much. It has been a lot of, “Oh, I have tried everything, and we are not getting that grant, but at least we can get together.” And I think that gives them sort of a sense of solidarity and they still feel like a team, and that they have a place on this team and that we will be back. It is just a matter of time.

Related: Video: How I have been using telemedicine amid COVID-19

The final thing, and this is still in action, still in process, is that as I reopen, I am really keeping them in mind. I understand that my team is probably a bit apprehensive, especially those who have been at home the entire time. And it is really hard to step back into an environment you have not been doing your job for like 4 or 5 weeks. You do not know this environment, it is a totally new normal.

There is, all of a sudden, these shields everywhere. We have to wear masks, our patients have to wear masks, all the rules have changed. And so, what I plan on doing is not seeing patients for those first couple of days.

Now, I have kind of a Plan A and a Plan B.

If I get the Paycheck Protection Program (PPP), they are all coming back. And we can spend a lot of time acclimating to our office, our roles, each other, and getting used to the new way of doing things.

But even if we don’t get PPP, my plan is to take several days and to spend that time with my team and make sure everyone is extremely comfortable before we get started again.

That is what I have done so far with my team and what I plan to do going forward. I would love to know what you are doing with your team, how you are choosing to lead them through this time, little tips and tricks you have for me. Feel free to comment. I would love to start that conversation, and I will see you next time.

Melanie Denton Dombrowski, OD, MBA, FAAO, shares how she stays in touch with her team during office closure during the pandemic and how she offers support.

How one OD communicates with her team amid COVID-19

It has been an incredible time for all of us. Besides the social distancing, extra personal protective equipment, Payback Protection Program (PPP) loans, and incredibly light schedules, the psychology of the pandemic has been intense. I needed a mental break from it all, and I got just that recently.

I recently attended the Georgia Optometric Association (GOA) annual conference. Rather than packing up and driving to the beach with the family, my dad and I grabbed a couple of beers and sat down in front of a computer.

Related: Biggest challenges facing optometry schools and students

Of course, it wasn’t the same. I will say, however, that the GOA did the best job it could given these unprecedented circumstances. Our longstanding emcee, Bob McCullough, OD, did another terrific job of presiding over the evening while telling some of the worst jokes humankind has ever heard. Mehrdad Saadat, OD, gave an excellent recap of our last 12 months before being elected to the highly coveted position of immediate past president of the GOA. After becoming the newly elected GOA president, Jeanne Perrine, OD, gave an inspiring speech charging us with the task of getting more ODs involved with organized optometry, and we even had none other than American Optometric Association (AOA) President Barbara Horn, OD, on hand for the swearing in of the newly elected officers.

I left the meeting feeling more energized about optometry in general, and I also left feeling a little heartbroken that it has been so long since I have laid in-person eyes on my optometry family—and it is a family. The GOA really is just one big family. We get together whenever we can. We would do anything for one another. We agree on things and get them done. We argue, sometimes at length, as we strive to reach common ground on concerns. Hats off to Bryan and the GOA staff for pulling off a real winner—albeit a virtual one.

Related: Telemedicine in the face of COVID-19

So, when will our family convene in person again? We have all heard many, many opinions on the matter. I can also tell you that, out of all the chatter I have heard in the media regarding this question, very little of it has come out of the mouths of actual epidemiologists. So, who knows?

I hope it’s soon because I miss you all. I miss seeing you in the hallways between lectures. I miss trading drink tickets at happy hours. I miss catching up. I miss the experience of seeing someone across the room for the first time in a year and the two of us immediately starting to laugh about some funny experience that may have happened years ago. I hope to see colleagues in person soon. However, I will say that Dr. McCullough’s terrible jokes 

In the meantime, hang in there, everybody. Continue to follow the science and be confident that every day brings us one day closer to shaking hands.

More by Dr. Casella: Physical and psychological changes of opening post COVID-19

Virtual conferences not filling the gap of in-person meetings

I recently came across a paper while performing a search of the world’s peer-reviewed literature with the topic of contact lens compliance in mind. My search was precipitated by two things.

The patient I had just seen 10 minutes prior was a new patient who thought she had scratched her right eye. As it turned out, she had an ulcer that appeared to be bacterial just inferior-temporal to her visual axis. It was small, round, white, and had just a mild amount of staining with sodium fluorescein. Its location being closer to the visual axis rather than the periphery led me to suspect that it was infectious and not “sterile.”

The patient was a 26-year-old female who was not pregnant and had no known medical allergies. A frankly bleak sign was the presence of several old round scars on both corneas: evidence of prior insults. She reported noncompliance with her contact lens-wearing schedule.

I started the patient on Besivance ophthalmic suspension (besifloxacin, Bausch + Lomb) every 30 minutes in the right eye, advised her not to wear a contact lens in that eye, and invited her back the next day at 9:00 a.m.

The second thing that precipitated my search of the world’s literature on this topic was the fact that, with this occurring during a global pandemic, I had oodles of time in between patients to do so (at the time this was written, I was seeing about one patient every hour).

Related: 11 things my patient wished her previous OD had told her

So, in my quest, I came across a very timely paper out of Spain whose lead author was a cornea specialist in a hospital setting.1 The paper, “Characteristics, Behaviors, and Awareness of Contact Lens Wearers Purchasing Lenses Over the Internet,” had a title that intrigued me, especially having recently heard news that several states were dealing with entities attempting to use the COVID-19 pandemic to convince lawmakers to overturn laws banning online eye examinations for the renewal of glasses and contact lens prescriptions.2

The authors of the study sent out a questionnaire regarding contact lens hygiene to clients of an online contact lens service. Through the survey questionnaire, they collected information on demographics, knowledge of proper contact lens hygiene, and compliance. The survey took place over a 6-month period, after which the results were analyzed.

Some 1264 contact lens wearers completed the survey. The mean age of those who participated was 40.8 years, and most participants were female (71.1 percent). As one would expect, the majority (76.4 percent) were myopic. Some 63.3 percent wore monthly disposable contact lenses.

The participants who purchased their contact lenses exclusively online reported a lower frequency of eye examinations. The frequency of eye examinations was also lower among those who had begun contact lens wear on their own (without an eye doctor). The participants who had begun contact lens wear on their own were found to be less experienced.

Of the risk factors isolated from the survey, exposure to water (swimming and/or showering with contact lenses in) was common, as was use of contact lenses and/or contact lens cases beyond the recommended replacement schedule. The reuse of contact lens solution was also common.

The authors found no differences in risk-awareness or compliance between those who purchased their contact lenses exclusively online versus other contact lens wearers. They did, however, find that those who taught themselves how to use contact lenses tended to have less frequent eye examinations, poorer compliance, and increased risks for adverse contact lens related events.

Related: Engineer a specialty contact lens practice

One overt characteristic of this paper that must be pointed out is the fact that this study came out of another country with obvious differences as far as laws relating to contact prescription and purchase are concerned. However, that doesn’t mean that ODs cannot extract meaningful information from it.

Those familiar with reviewing and grading scientific literature would be quick to point out that, while the sample size is sizeable, a self-reported questionnaire tends to have a lower evidence profile than, say, a double-masked randomized controlled trial with thousands of participants and a study period of several years. I would agree with that, as well. However, again, it doesn’t mean that we, in the U.S., cannot get tangible information here.

One may say off the cuff, “You can’t get contact lenses without an eye examination and a prescription in the U.S.” Yes, you can. I hate to say it, but yes, you can.

My mind almost immediately went to a young female several years ago who came in with a near total corneal ulcer from the contact lenses she bought at a flea market that a friend taught her how to wear. I immediately referred her to a cornea specialist and have never heard from her since.

ODs have an obligation to inform the public, our lawmakers, and our patients of the dangers of contact lens misuse. The potential for blinding complications is all too real.

More by Dr. Casella: Dr. Ben Casella COVID-19 wrap-up

1. Mingo-Botín D, Zamora J, Arnalich-Montiel F, Muñoz-Negrete FJ. Characteristics, Behaviors, and Awareness of Contact Lens Wearers Purchasing Lenses Over the Internet. 

. 2020 May 14. doi: 10.1097/ICL.0000000000000702.

2. Georgia Public Policy Foundation. Foundation Joins Plea for Georgia to Allow Online Vision Care. Available at: https://www.georgiapolicy.org/2020/05/foundation-joins-plea-for-georgia-to-allow-online-vision-care/. Accessed 6/10/20.

Patients, contact lenses, and the internet

Hi, everybody, I am here with Mike McDougall. He is president of McDougall Communications in Rochester, NY. And Mike has quite a bit of experience in helping people communicate, especially during a crisis.

So, Mike, can you tell me a little bit about crisis communication? What is it? And when do people use it?

 Sure, Gretchyn. Well, thanks. Crisis communication, in so many ways, is like communicating every day, except you are forced to do so in the midst of an emergency of some type. Usually, you are doing that under pressure. You are doing it under some sort of time constraint. And usually, the situation is not positive.

So, you take that into account because you need to communicate differently with your audiences. And also, you need to have different expectations for yourself and your staff when you are communicating, at that point.

 So, how would you suggest that doctors and medical professionals communicate with their patients now, during the COVID-19 pandemic, whether they are on lockdown, whether they are seeing only emergency patients, or whether they are seeing patients for regular follow-up care?

 That is a great question. I think there are a few different tips we could look toward. One is, you do need to communicate. There is a tendency in the midst of a crisis to shut down and stop communicating with those people who need to hear from you.

I heard a story just yesterday, from a contact lens wearer, who had concerns about wearing lenses during the pandemic. She told me, “I’m afraid to contact my provider because they are open for emergency services only. I don’t want to bother them.” So, there is that sense of, they will come to me if they have a question. They may not. They respect you too much, especially if you are providing emergency-only services.

So, it is your obligation to reach out to them. Make sure they are getting the information they need right now. And in fact, that is going to build even more trust in your practice, in your team for when we are through this pandemic, as well. So that is one major tip.

The second is to state what you know, at this time, right? The science is changing fast. The literature is shifting.

Things will change. Keep abreast of it, but don’t get too far ahead of yourself. Any time you make a prediction in a crisis, it is probably going to be challenged. If not 3 weeks from now, tomorrow, things are moving so fast.

So, what you can say is, “Based on what we know right now, here is my best guidance.” My best advice to you, as a patient, but again, try not to get too far ahead. You are not Nostradamus and those who choose to try to play fortune teller regret it down the road.

 Should this be the doctor communicating with patients? Should it be staff? Can you delegate it? Is it a mix, or does it not really matter?

 Well, I think it is what your patients are more comfortable with. In a time of crisis, usually, you look for a more senior opinion, to give them reassurance. But if your practice typically communicates with your patients through staff, I wouldn't change that.

In fact, that could signal that something is wrong, right? Suddenly, it is elevating it to the doctor to the partner in the practice. Hey, what is happening here? I think it is good to see them but don’t completely delegate up or down. If anything, you want to provide some sense of normalcy, as well.

And make sure your staff is still involved. They are going to be there when this pandemic ends, we hope, and you want to make sure that personal trust and connection remains.

 What about frequency? Should you stick with a regular cadence? For example, if you send out a monthly email newsletter to your patients, should you continue to do that? Or should you send something more frequently in times like this, during this pandemic, to keep your patients up to speed on what is going on?

 It is a great question. It is going to be a bit subjective. One, if you do have a current cadence, stick with it. Because I think that, again, will provide some degree of normalcy to your patient base who is used to hearing from you. And everything is not COVID-19 related right now, so they still benefit from your counsel and advice as you would normally give it. Too though, I would caution against over communicating.

 I think all of us have received emails from every single brand we have interacted with in the past 35 years who have suddenly found my email address and told me how much they value my service or my business, I should say. So be cautious.

But don’t disappear from their life suddenly and then pop back up. They don’t need to hear from you once a day. If you do want to keep a rhythm up that is more frequent than say, email communications, for those practices that have social media accounts, that is a great way to do it.

 That is great advice. Do you have any final tips to offer to medical professionals who are seeing patients out there and really don’t know how to handle crisis communications?

 Sure. I think one thing is to make sure your staff understands the rules of the road right now. That is, your partners and the rest of your team. I know there has been a drive toward more telemedicine. Stick within that framework.

You need to be very careful, especially when you are communicating on social media, that you are not dispensing medical advice to the masses over social. You can get yourself in a world of hurt and create other crises you were not expecting. So, have very clear parameters on what you can and cannot do when you are online communicating.

And more than anything else, again, reassure your patients and let them know you are going to be there for them now, and when they come back.

 That is really great advice, Mike. Thanks so much for sharing some of those tips for these professionals who really don’t know what to do when something like this hits. They don’t want to give out too much information, they don’t want to give out not enough, as you said. So, this is really helpful. Thanks so much for joining us today.

How doctors should handle crisis communication during COVID-19

As COVID-19 sweeps the globe, businesses and organizations have shuttered their doors and taken meetings online. The America Optometric Association (AOA) is no exception. The organization conducted Optometry’s Meeting 2020 virtually, where they elected a new Board of Trustees via virtual ballot.

Results of the 2020-2021 Board of Trustees election are as follows:

President William T. Reynolds, OD (Kentucky)
President-elect Robert C. Layman, OD (Ohio)
Vice President James P. DeVleming, OD (Washington)
Secretary-Treasurer Ronald L. Benner, OD (Montana)
Immediate Past President Barbara L. Horn, OD (South Carolina)

Terri A. Gossard, OD (Ohio)
Curtis A. Ono, OD (Washington)

 is ongoing from June 24-27. It will host its 

Related: AOA announces 2020 award winners

AOA elects '20-'21 officer slate via virtual ballot

Improve quality of care, achieve business goals and stay up to date on the latest COVID-19 advancements with 

 COVID coverage. Written by top doctors and experts in the optometric field, we offer trustworthy and knowledgeable insights into cutting-edge and timely eyecare topics. Check back daily and make us your ultimate guide to practice management in the time of COVID-19.

Bookmark our COVID-19 page to explore our latest COVID-19 coverage:

https://www.optometrytimes.com/clinical/covid19

Those who develop COVID-19 antibodies after becoming infected may not keep them for more than a few months, 

, and antibodies are less likely to stick around in those who showed no symptoms to begin with.1

Previous studies found that most who became infected with COVID-19 developed antibodies. Health departments around the world have been administering antibody tests as a way to prove a person has already had the coronavirus.

Scientists in the Wanzhou district of China studied 37 people who became infected with the coronavirus and showed symptoms and 37 people who became infected and showed no symptoms, according to the study published in the online journal 

Some 8 weeks after recovery, antibody levels fell to undetectable levels in 40 percent of asymptomatic people and 13 percent of symptomatic people.

Neither T cells nor B cells were measured in the study.

Researchers tested for two types of antibodies: immunoglobulin G (IgG) and immunoglobulin M (IgM).

The decrease in detectable antibodies was sharp after 8 weeks, with a 71 percent median drop for IgG levels in the asymptomatic group and a 76 percent median drop in the symptomatic group, according to the study.

The findings call into question the idea of “immunity passports,” which some countries want to issue to people who test positive for antibodies. These people would be allowed to go back to work and travel because they are supposedly immune to the virus.

“Together, this data might indicate the risks of using COVID-19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups, and widespread testing,” the authors wrote.

1. Long Q, Tang X, Shi Q, Li Q, Deng H, Yuan J, Hu J, Zhang Y, Lv F, Su K, Zhang F, Gong J, Wu B, Liu X, Li J, Qiu J, Chen J, Huang A

 Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. 

https://www.nature.com/articles/s41591-020-0965-6

COVID-19 antibodies can disappear in non-symptomatic individuals

® COVID coverage. Written by top doctors and experts in the optometric field, we offer trustworthy and knowledgeable insights into cutting-edge and timely eyecare topics. Check back daily and make us your ultimate guide to practice management in the time of COVID-19.

Bookmark our COVID-19 page to explore our latest COVID-19 coverage: 

https://optometrytimes.now.sh/clinical/covid19

New research suggests headache may be a key symptom of COVID-19 that predicts clinical development in patients.

Findings from an observational study of more than 100 patients show headache onset may occur during the presymptomatic and/or symptomatic phases of COVID-19 progression and sometimes mimics tension or migraine headaches.

Related: Safe & effective ocular triage in the COVID-19 era

Headache is considered a primary symptom of COVID-19. The study of 214 COVID-19 positive patients showed that approximately 13 percent of participants experienced headache and 5 percent experienced anosmia (loss of the sense of smell).

Appearance of headache, itself, was associated with shorter symptomatic periods, while headache in conjunction with anosmia was associated with a shorter hospitalization period for COVID-19 positive patients.

In a subset of participants, headache persisted even after COVID-19 had resolved.

Investigators of the study note that understanding the pathophysiology of headache in COVID-19 could improve understanding of migraine and other headache disorders.

Related: COVID-19 antibodies can disappear in non-symptomatic individuals

"It seems that those patients who start early on, during the asymptomatic or early symptomatic period of COVID-19, with headache have a more localized inflammatory response that may reflect the ability of the body to better control and respond to the infection by SARS-CoV2," says lead investigator Patricia Pozo-Rosich, MD, PhD, head of the Headache and Craniofacial Pain Unit at Vall d'Hebron University Hospital. She presented the findings at the American Headache Society (AHS) Annual Meeting 2020, which was held virtually on June 13.

Novel coronavirus SARS-CoV2 penetrates the cells through ACE2 receptors, which exist throughout the body.

“SARS-CoV2 enters the body through the nasal cavity, and it probably penetrates the nervous system in the periphery through afferent branches of the olfactory and trigeminal nerve,” Pozo-Rosich says.

The virus travels to the lungs and, later, enters the bloodstream, which generates systemic inflammation that may turn into a cytokine storm. Research shows identified cortical hyperintensities and olfactory bulb hyperintensities in patients with COVID-19, suggesting that the virus directly infects the central nervous system.

Related: How doctors should handle crisis communication during COVID-19

Interleukin-6 (IL-6), one of the main inflammatory molecules, appears related to COVID-19 and because of this, has become a therapeutic target. Levels of IL-6 may be lower and tend to be more stable in patients with both COVID-19 and headache than in patients with COVID-19 only.

Researchers observed 130 patients (51 percent women; mean age, 54 years) with COVID-19 who were attended by neurologists at Vall d’Hebron. Within this group, 74.4 percent of patients experienced headache.

Those with headache tended to be younger than those without headache (mean age, 50 years versus 63 years, respectively) and tended to be women (58.6 percent versus 29.4 percent).

Approximately one-third of patients with headache had a history of migraine. Most patients reported mild to moderate pain that resembled tension-type headache. In those participants with severe pain and migraine-like presentations, headache usually began during the asymptomatic phase of COVID-19.

The headache preceding typical COVID-19 symptoms was distinct from the patients’ usual migraine, alluding to the possibility that headache related to COVID-19 is mechanistically different than migraine.

“It is possible that headache is a manifestation of COVID-19 CNS invasion or cytokine storm, though further data is needed,” Pozo-Rosich said.

The first patient’s headache resolved with resolution of other COVID-19 symptoms, while the second patient continued to have headaches for two weeks after resolution of typical COVID-19 symptoms. Moreover, the first patient did not have migrainous features with her continuous headache.

More by Brooke Beery: 29th annual Optometry Student Bowl held virtually in 2020

Headache a key symptom of COVID-19

Editor in Chief and Content Channel Director Gretchyn M. Bailey, NCLC, FAAO, shares news updates for June 15, 2020.

Videos

Optometry Times® news summary 6/15/20

ptometry service, aligning with eyecare practices across the nation, has responded to the COVID-19 pandemic with numerous action steps targeted at protecting the visual welfare of our patients and to “flatten the curve” of infection in our beloved New York City. My optometry staff practices in Manhattan, Queens, Brooklyn, and Harlem. New York City and state, epicenters of infection, demanded swift and demonstrative barriers to infection spread.

Top of mind is that the coronavirus responsible for COVID-19 infection, has been isolated in the tear film and is responsible for viral conjunctivitis.1 Therefore, it is of the utmost importance to protect eyecare patients and providers from exposure.

Outlined are my team’s efforts to truncate infection spread in our centers and city.

All nonessential examinations and testing in the optometry department have been postponed. Doctors of optometry and seasoned ophthalmic technician staff individually review every patient scheduled for routine and follow-up care. Those appointments for interocular pressure (IOP) checks, retinal optical coherence tomography (OCT), epiretinal membrane progression, cataracts, macular degeneration, dry eye and select diabetic cases are postponed.

Each patient is counseled on ocular safeguards and follow up and receives recommendations on how to maintain eye health under our current pandemic restrictions.

All onsite visits have been designated to problem-based assessments to limit patient time within the centers. Those patients who attend in-person appointments are triaged based on the urgency of the reason for their visit. Video consultations are held whenever possible, via secure platforms, in order to reduce onsite visitations. These virtual appointments help to limit the risk of infection for patients and staff across multiple high-risk environments, including local and mass transit.

Accepted patients, once onsite, are screened with a battery of symptom questions, have their temperatures measured, are face masked, and are sent to the optometry suites where hand and spectacle washing are mandatory prior to sitting in the examination chair. Examination chairs are covered with full-barrier shields (head rests, arm rests, and seats are covered with plastic barrier sleeves). Patients are not permitted a companion in the exam room unless they are of pediatric age, need translation services, or require an aide for comprehension, impaired hearing, or other identified disabilities. Doctors and technicians are masked (surgical or KN95) and gloved.

All eye contact procedures (Goldmann applanation tonometry, gonioscopy, other) and non-contact tonometry (NCT), are not performed unless absolutely necessary for diagnosis or case management. Disposable tonometer tips, Tono-Pen (Reichert) or Icare tonometry is preferred. If used, tonometer tips are rotated and disinfected between use. Tonometer tips are covered after disinfection with a plastic shield.

Breath shields were added to all slit lamps and binocular indirect instruments.

Exam rooms are rotated between exams and thoroughly wiped down with commercial disinfectant wipes (desks, slit lamp and table, keyboards, phoropter, handheld instruments, occluders, and near cards). Barrier shields are changed. Indirect lenses are washed with mild soap and water and dried with a clean, soft, optical-grade cleaning cloth. Microscope oculars are cleaned. We are investigating, with our dental service, the use of electrostatic units to disinfect exam rooms between patients.

There is a plan to reduce clinician staffing in a way that rotates teams and minimizes exposure risks from public transport. While one team works from home, recharges, and recovers in quarantine, the other works onsite. This has made instant communication between colleagues paramount. To facilitate broad and rapid communication, colleagues were added to a secured messaging platform so that every team member can remain abreast of rapidly changing information, be it patient-centric or service-centric.

To transition to telehealth, physicians enrolled in Health Insurance Portability and Accountability Act (HIPAA)-compliant messaging and video platforms. Patients were encouraged to register on a patient portal for bidirectional communication and patient-uploaded-to-chart imaging. Online, telehealth, learning services prepared by optometry schools, state associations, private practices, and other eyecare outlets were consulted (thank you, optometry!) for best-practice tips for optometric/ophthalmologic telehealth examinations.

To offset the impact of staffing shortages and absences, team members expanded their normal responsibilities to support those areas needing additional support, such as pharmacy, nursing triage, calling COVID-19 isolated or quarantined patients, and monitoring for worsening or unresolved symptoms.

The opportunity for my team to offer care from home has granted respite to doctors and technicians during this stressful time. Our Member’s Health Assistant Program clinicians have been available throughout the crisis for personal mental health check-ins and Group Zoom consultation sessions. This service bonded staff across job functions and helped the organization unite in the common goals of our facilities, city, and state.

Willcox MD, Walsh K, Nichols JJ, Morgan PB, Jones LW. The ocular surface, coronaviruses and COVID-19. 

. 2020;103(4):418-424. doi:10.1111/cxo.13088

Managed patient flow, sanitizing, and HIPAA-compliant communication among new protocols

Committed to safety: One OD’s COVID-19 response

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institute of Health (NIH), established a network of clinical trials in hopes of enrolling thousands of volunteers to participate in early COVID-19 vaccine testing.

Related: Headache a key symptom of COVID-19

 has set up a secure method of volunteering for local studies. Anyone over the age of 18 may participate. If chosen, participants will be subjected to injections or infusions containing the study product or a placebo. Most studies require traveling to the research site for 10 or more visits over a span of 1 to 2 years.

The COVID-19 Prevention Trials Network (COVPN) consists of 4 existing NIAID-funded clinical trials networks including:

Infectious Diseases Clinical Research Consortium

Together, they create a functional unit of “Operation Warp Speed,” an initiative led by the U.S. Department of Health and Human Services (HHS) to organize the development and distribution of COVID-19 diagnostics, therapeutics, and vaccines.

“Establishing a unified clinical trial network is a key element of President Trump’s Operation Warp Speed, which aims to deliver substantial quantities of a safe, effective vaccine by January 2021,” says Alex Azar, HHS Secretary, in a statement.

“Starting this summer, this new network will leverage existing infrastructure and engage communities to secure the thousands of volunteers needed for late-stage clinical trials of promising vaccines,” he says.

The network is projected to operate more than 100 clinical trial sites throughout the United States and the world.

Interested persons can learn more about the different stages of vaccine research and the new network’s COVID-19 vaccine and monoclonal antibody studies by visiting 

https://www.coronaviruspreventionnetwork.org

Thousands of participants needed for research.

NIH launches clinical trials network: COVID-19 vaccine underway

requency doubling technology (FDT) has been around for decades with visual field testing.1 The science centers around frequency.2 The target of an FDT visual field has a low spatial frequency (the target is relatively large), and it undergoes a counterphase flicker with a high temporal frequency (the flicker happens rapidly).2

As the target is a grading of light and dark bars, the high temporal frequency flickering results in an illusion that twice as many bars are perceived as actually exist. One could say they are “doubled.” The magnocellular pathway of the visual system is responsible for this illusion.2,3 This pathway could suffer more damage in early glaucoma4 and isolating it with a targeted visual field may be of benefit.

A study5 published earlier this year lends credibility to FDT visual fields as good indicators of the presence or absence of glaucoma as measured in a large screening population. This retrospective cohort study had a large sample size (N=5076). Subjects consisted of people who participated in a “comprehensive health checkup service” during the course of a year.

Some 2024 participants completed an FDT visual field and also underwent fundus photography. In addition, 3052 patients underwent photography without completing a visual field. These subjects served as the control group. Subjects with a known diagnosis of glaucoma were excluded, and mean age of participants was the fifth decade of life. Those who had abnormal findings on their visual fields and/or photography were advised to undergo a complete eye exam. Subjects then reported (within 2 years of their first visit) if they had been diagnosed with glaucoma.

In the group with FDT testing and photography, 23 reported having been diagnosed with glaucoma during the 2-year time frame. That number accounted for 1.14 percent of that study group. Of those 23 individuals, 20 (or 87 percent) had abnormal findings on their FDT visual fields. Twelve of the 23 (or 52.2 percent) had abnormal results with photographs.

In the group having undergone fundus photography alone, 15 individuals reported having received a diagnosis of glaucoma within the 2-year follow up period. Of these individuals, 9 (or 60 percent) had abnormal findings on their fundus photographs. The age-adjusted glaucoma detection rate was significantly higher for the group who underwent FDT visual field studies and fundus photography as compared to the group of the study who only underwent fundus photography.

Investigators concluded that FDT field have the potential to improve glaucoma detection when performed in conjunction with fundus photography.

Frequency doubling technology may become the new holy grail of glaucoma imaging.