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Myopia- Management

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Proper screenings, treatment, management needed for this increasingly prevalent disease.

PDR: public health considerations  

The patient’s ocular history was significant for severe nonproliferative diabetic retinopathy (NPDR) in the right eye (OD) and mild NPDR in the left eye (OS), which had been diagnosed 4 years previously at his last eye exam. 

Case study:  Patient presents with severe PDR history 

A team of international investigators has found that color vision deficiency (CVD) may interfere with an eye care provider’s ability to differentiate between choroidal melanoma and choroidal nevus.

Yacoub A. Yousef, MD, is the first study author and an ocular oncologist in the Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan.

Color blindness is not an uncommon phenomenon, and reportedly 8% of men and 0.4% of women are affected; the incidence in men is higher because of the disorder’s X-linked recessive inheritance.

 Deuteranopia (red-green deficiency) is the most common form; however, total color blindness is rare.

Yousef and the investigators explained that while CVD often is overlooked, it “poses unique challenges in ophthalmology, where accurate color perception is pivotal for clinical examination and imaging interpretation.”

A few studies have highlighted the differences between health care professionals with CVD and those with normal color vision, indicating potential challenges in interpreting clinical images, leading to delayed referrals and treatment and increased morbidity and mortality rates for patients.

The investigators conducted a cross-sectional study to determine how CVD
affects physicians’ diagnostic accuracy and their ability to distinguish between
malignant choroidal melanoma and benign choroidal nevus.

They distributed a web-based survey using the professional Ophthalmology Society’s social media channels. The survey presented 3 fundus images representing a normal fundus, choroidal nevus, and choroidal melanoma. They explained that the images underwent simulation for the 3 primary types of CVD—protanopia (red color blindness), deuteranopia, and tritanopia (blue-yellow deficiency)—and were presented alongside nonsimulated versions.

Yousef's team noted a total of 41 participants were included in the study (average age, 40 years; 28 men, 13 women). Based on the results of the online Ishihara Test, the participants were confirmed to not have CVD.

The authors reported that the participants had significantly lower rates of identifying orange pigments in the simulated protanopia images compared with in the nonsimulated images (

 = .038). The participants’ ability to recognize melanotic lesions in the simulated deuteranopia images was reduced compared with in the nonsimulated images (

 = .048); however, this was not the case for tritanopia.

The participants were able to identify subretinal fluid and estimate tumor thickness in the simulated and nonsimulated images.

“Regarding the simulated images of choroidal nevi, the participants misdiagnosed nevi as choroidal melanoma in 37% of cases in simulated protanopia nevi images and 41% in simulated deuteranopia nevi images,” Yousef and colleagues wrote. “This resulted in unnecessary referrals of benign lesions as malignant, emphasizing the potential for mistaken diagnoses. Nevertheless, almost all simulated images of malignant melanoma were correctly referred for specialized oncological treatment.”

In commenting on their findings, Yousef and the investigators pointed out that CVD may impact an ophthalmologist’s ability to differentiate between choroidal melanoma and choroidal nevus. The simulated CVD conditions of protanopia and deuteranopia affected the accuracy when identifying the melanotic nature of the lesion and orange pigments, which led to challenges in correctly diagnosing choroidal melanoma and choroidal nevus, resulting in extra referrals for nevus cases.

Importantly, they noted “the possible risk of eyes with choroidal melanoma could still be determined, so most melanoma cases were referred to specialized oncologists as needed. Further investigations are needed to assess the clinical significance of these findings in individuals with CVD.”

Yousef YA, Alkhatib F, Elfalah M, et al. Assessing the impact of simulated color vision deficiency on ophthalmologists’ ability to differentiate between choroidal melanoma and choroidal nevus. 

. 2024;13(12):3626. doi:10.3390/jcm13123626

Campbell JL, Spalding AJ, Mir FA, Birch J. Doctors and the assessment of clinical photographs—does colour blindness matter? 

Balasundaram R, Reddy SC. Prevalence of colour vision deficiency among medical students and health personnel. 

Elfalah M, AlRyalat SA, Abu-Yaghi NE, et al. The impact of color vision deficiency on the capability of ophthalmologists to diagnose benign and malignant choroidal tumors. 

CVD could impact physicians' ability to identify choroidal melanoma from choroidal nevus.

Researchers find color vision deficiency may impact choroidal diagnosis

Bausch + Lomb has now launched Opal, a digital e-commerce marketplace designed to maximize efficiencies for eye care practices that is also available to their patients, in the US.

 The marketplace will streamline the ordering process for Bausch + Lomb contacts lenses, with other select OTC products to be added in the coming months, according to a news release.

“Opal is an all-in-one digital platform that offers faster, more convenient ordering of Bausch + Lomb products, helping to save staff time, boost patient loyalty and reduce the administrative burden for participating eye care practices,” said Yang Yang, president of Global Vision Care, Bausch + Lomb in the release. “This platform is the latest example of our continued focus on meeting the evolving needs of eye care professionals and their patients.”

Opal features order tracking and history, appointment reminders, and automated prescription reminders. The orders made through the marketplace are then delivered with free shipping directly to either patients’ homes or eye care practices. Additionally, each purchase made by a patient earns points toward the Baush + Lomb Horizon Rewards loyalty program.

“Opal simplifies administrative tasks such as order processing, inventory management and cost comparisons, to help free up resources and valuable staff time,” said Jason Tu, OD, of Vision Boutique in San Diego; past president of the California Optometric Association; and an Opal beta tester; in the release. “With such a user-friendly interface, Opal allows my patients to order their Bausch + Lomb products directly from my practice, whether they’re in the office or elsewhere. This not only enhances convenience for my patients but also supports the growth of my business. As a private practice owner, creating efficiencies in my back-office processes is crucial, and Opal significantly contributes to that.”

Select Bausch + Lomb products, including contact lenses like INFUSE, ULTRA, and Biotrue ONEday, are available through Opal can be found through a customizable catalog. OTC products available through Opal will include LUMIFY redness reliever eye drops and Blink eye drops.

Bausch + Lomb launches Opal digital marketplace in the United States. Bausch + Lomb. October 1, 2024. Accessed October 1, 2024. 

Opal, the new digital marketplace, will streamline contact lens ordering and allow patients and practices to order select OTC products, according to a news release.

Bausch + Lomb launches digital marketplace for eye care practices and patients in US

A new clinical study evaluating long-term myopia control effect and user experience in patients wearing Defocus Incorporated Multiple Segments (DIMS)-outfitted MiYOSMART spectacle lenses found that a significant amount of said patients continued to wear the lenses for as long as 8 years. Findings from the 8-year follow-up clinical study were presented by HOYA Vision Care at the 60th International Myopia Conference 2024 in Sanya, China, according to a news release.

“With myopia on the rise, it is important for eye care professionals to choose treatments to slow the progression in children based on best evidence available,” said Carly Lam, PhD, principal investigator of the study, in the release. “Previous research has shown that the DIMS spectacle lenses appear to be a safe and effective method for managing myopia among the study population. We’re looking forward to seeing the impact of longer-term use on myopia management in this pediatric population.”

According to HOYA, the randomized, controlled trial is the longest of its kind conducted and presented on the MiYOSMART lenses. Of study participants, 60% who wore the DIMS spectacles for 6 years continued to wear the lenses for as long as 8 years.

 All participants were satisfied with the benefits from the DIMS lenses, according to the release.

DIMS technology has a ring-shaped treatment area to slow myopia progression. By alternating the focus area—or the clear zone of the lens—and defocus area—the honeycomb-shaped segment of the lens—clear vision and management of myopia is obtained.

The lens has also been found to remain consistent on the myopia management front in a different study over 6 years.

“Childhood myopia is a widespread concern, and we are committed to continue fighting this problem, by using innovative solutions like MiYOSMART spectacle lenses. We look forward to the data from this important study as we continue to work to slow the progression of myopia in children and preserve their vision and eye health for the future,” said Natalia Vlasak, MD, MBA, global head of Medical and Scientific Affairs at HOYA Vision Care, in the release.

The MiYOSMART spectacle lenses have not been approved for use in the management of myopia and is currently not on the market in the US. However, HOYA has sold more than 8 million MiYOSMART spectacle lenses in more than 35 countries and regions.

HOYA Vision Care announces the results of the longest follow-up study conducted and presented on myopia management spectacle lenses worldwide. News release. HOYA Vision Care. September 27, 2024. Accessed September 30, 2024.

MiYOSMART. HOYA Vision Care. Accessed September 30, 2024. https://www.hoyavision.com/for-spectacle-wearers/miyosmart/ 

By alternating the focus area—or the clear zone of the lens—and defocus area—the honeycomb-shaped segment of the lens—the spectacle lenses achieve clear vision and manage myopia progression.

Study reports the majority of MiYOSMART spectacle lens users continue use for as long as 8 years

EyeCon 2024: Kelly Nichols, OD, and A. Paul Chous, OD, discuss multidisciplinary care and AI in diabetes management

Co-chairs Kelly K. Nichols, OD, MPH, PhD, FAAO, and A. Paul Chous, OD, MA, FAAO, highlighted Day 1 of EyeCon 2024, which emphasized collaboration between optometry and ophthalmology. The day's discussions included topics such as identifying red flags in patient care, thyroid eye disease, and advancements in refractive technologies. They noted the importance of integrating insights from both fields to enhance overall patient management, emphasizing that the shared knowledge benefits all practitioners involved in patient care.

A key takeaway from the sessions was the emphasis on recognizing herpes simplex as a potential cause of unilateral red eye in hospitalized patients, a point raised by ophthalmology cochair Peter J. McDonnell, MD. This advice is particularly valuable for optometrists, reinforcing the need for vigilance in diagnosing ocular conditions.

Looking ahead to the following day, they expressed excitement about sessions on dry eye as well as multidisciplinary approaches to managing diabetes. 

Kelly K. Nichols, OD, MPH, PhD, FAAO, and A. Paul Chous, OD, MA, FAAO, co-chairs of EyeCon 2024, discussed the first day of the conference, which featured talks on thyroid eye disease, refractive technologies, and red flags in patient care. 

Mark Dunbar, OD, FAAO, emphasizes the critical role optometrists play in the collaborative care of diabetic eye disease.

EyeCon 2024: Taking a multidisciplinary approach to diabetic eye care

At the EyeCon meeting in Fort Lauderdale, Mark Dunbar, OD, FAAO, of the Bascom Palmer Eye Institute will be presenting on the importance of a multidisciplinary approach to managing diabetes. Joined by diabetes care expert and EyeCon co-chair A. Paul Chous, OD, MA, FAAO, Dunbar will emphasize the critical role optometrists play in this collaborative effort. 

As frontline providers, optometrists are often the first to recognize signs of diabetic retinopathy in their patients. But Dunbar stresses that their responsibilities extend far beyond just identifying eye health issues. "As optometrists, we do a great job of educating our patients on blood sugar levels, diet, and exercise—things that are typically part of primary care," he explains. 

The key, according to Dunbar, is maintaining open lines of communication with the other healthcare providers involved in a patient's diabetes management, including endocrinologists, primary care physicians, nurse practitioners, and physician assistants. "We're in the middle, and our job is to relay information back and forth—what we're seeing in the eyes, and what the primary care team is telling the patient about controlling their diabetes," said Dunbar. 

Dunbar notes that building these collaborative relationships, especially for young optometrists starting their practices, can be challenging. Patients may have difficulty accessing specialists or be limited by their insurance coverage. But he believes it's a critical step, as primary care providers are actively seeking optometrists they can trust as resources for their diabetic patients. In his EyeCon presentation, Dunbar plans to share practical tips for optometrists, such as the key questions to ask new diabetic patients to assess their level of disease management and engagement. He'll also discuss strategies for helping patients navigate the complexities of the healthcare system, drawing on the expertise of his co-presenter Chous. By fostering a true multidisciplinary approach, Dunbar is confident optometrists can play an invaluable role in improving outcomes for the millions of Americans living with diabetes. Attendees of the EyeCon meeting will come away with a roadmap for strengthening these vital partnerships.

Conference

Ultimately, the goal is to help optometrists better understand which cases require urgent or emergent attention versus those that are more benign and can be managed over time.

EyeCon 2024: Inside neuro-ophthalmic dilemmas

Leonard Messner, OD, professor of optometry at the Illinois College of Optometry, presented at EyeCon 2024. The presentation, titled "Neuro-ophthalmic dilemmas: To refer or not to refer," was co-presented with Kelly Malloy, OD, and aimed to provide an overview of the types of neuro-ophthalmic cases optometrists may encounter in their practices. 

Messner explains that the goal was to help optometrists better understand which cases require urgent or emergent attention versus those that are more benign and can be managed over time. On the benign side, he discusses cases of "pseudo-papilledema," where the optic nerve appears elevated but is simply an anatomical variation that requires no further investigation. In contrast, true cases of papilledema, indicative of elevated intracranial pressure, necessitate neuroimaging, lumbar puncture, and appropriate management. 

A key strategy Messner emphasizes for seamless co-management of these patients is establishing strong working relationships with providers in the area, such as neurologists and neuro-ophthalmologists. Effective communication is crucial to ensure all members of the care team are on the same page, avoiding redundancy and breakdowns in care. He suggests optometrists take the time to delineate responsibilities with these specialists, perhaps over a meal, to build comfort and trust. 

When it comes to strengthening relationships with ophthalmologists, Messner reiterates the importance of clear communication to determine each provider's role. He advises optometrists to respect patients' time by avoiding unnecessary referrals and ensuring efficient, coordinated care that prioritizes good outcomes. By fostering these collaborative relationships, optometrists can better navigate the complex landscape of neuro-ophthalmic conditions and provide the best possible care for their patients.

Angelina Tran, OD

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