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Clinical Professor Emeritus, Indiana University School of Optometry

ODs have the rare opportunity to engage as well as educate patients on hypertension. 

The optometrist’s role in diagnosing and treating hypertension

Practice management and electronic health records software company Eyefinity has integrated with Arrellio, a contact lens ordering and e-commerce platform, in order to help practices maximize contact lens sales and recover potential lost revenue.

 The integration will allow practices to automatically identify patients who are due for contact lens refills and send them personalized reorder reminders via text and email, according to a news release.

Additionally, patients can place orders directly through links that connect back to their practice.

“We continue to expand the Eyefinity Encompass ecosystem with digital tools that enhance patient experiences while driving more efficient workflows for eye care professionals," said Eyefinity President Charlie Biegel in the release.

 "This integration with Arrellio addresses a real challenge — helping practices recapture contact lens sales that might otherwise go to online competitors.”

Eyefinity Encompass users are currently able to benefit from the new integration. The platform already works to integrate with other third-party applications for cloud-based practice management and electronic health records software solutions.

 Eyefinity, a VSP Vision company, is able to provide VSP eligibilities and authorizations, contact lens ordering, image management, and industry-standard equipment through its Encompass software. Eyefinity digital marketing services, marketing-led data reports and review, and Ring analytics and artificial intelligence (AI) allow for business growth opportunities through the platform. As for improving patient care, Encompass provides an Eyefinity PatientNavigator and automatic eyewear-ready messaging. The software is protected with SOC 2 Type 2 certification, Amazon Web Services, 24/7 antivirus monitoring, and EHNAC, accredited since 2004.

As for Arrellio, patients are provided price quotes driven by data, which improves sales flows for practices, according to the company.

 A success story from a practice that utilizes Arrellio’s software is Dr. Torrey J. Carlson & Associates, which operates out of 8 locations across Tennessee. Since integrating Arrellio, the practice has documented a 26% increase in contact lens sales compared with the previous year without the software, in addition to over 1300 incremental patient orders and a 4% increase in contact lens fits.

“We were seeing more and more patients choose online retailers for their contact lenses,” said Torrey J. Carlson, owner of Dr. Torrey J Carlson & Associates, in a statement to Arrellio.

 “With Arrellio, we’re able to keep contact lens revenue within the practice.”

Another recent integration completed by Eyefinity was with Zocdoc in April. Zocdoc is a health care marketplace that helps patients find and book appointments online with health care providers, according to a news release.

“Our strategic partnership with Zocdoc creates a seamless connection between patients seeking eye care and our network of providers, reinforcing our commitment to driving practice growth and patient satisfaction,” said Biegel in the release.

 “This integration empowers practices to expand their digital presence, attract new patients, and optimize their scheduling efficiency—ultimately helping providers see a measurable return on their technology investment.”

Eyefinity also began offering its digital marketing services in April as powered by EyeCarePro, which allows eye care practices to choose from customized solutions, including a fully managed website, SEO, email marketing, online reviews, and reputation management, among others, according to a news release.

“Knowing the importance of marketing, we strive to offer fully managed services cultivated specifically for the optometric industry,” said EyeCarePro Marketing Director Liezel van der Merwe in the release.

 “We’re excited to collaborate with Eyefinity to bring our expertise to more practices and help them thrive in an increasingly competitive marketplace.”

Eyefinity partners with Arrellio to help eye care practices recapture lost contact lens revenue. News release. VSP Vision. June 16, 2025. Accessed June 16, 2025.

Meet Eyefinity Encompass. Eyefinity. Accessed June 16, 2025. 

https://www.eyefinity.com/products/solutions/eyefinity-encompass.html

Automated contact lens ordering and ecommerce that integrates with your EHR. Arrellio. Accessed June 16, 2025. 

Eyefinity announces integration with Zocdoc. News release. Eyefinity. April 21, 2025. Accessed June 16, 2025. 

https://www.eyefinity.com/blog/news/eyefinity-and-zocdoc-partnership

Eyefinity now offering digital marketing services powered by EyeCarePro. Eyefinity. News release. April 15, 2025. Accessed June 16, 2025. 

https://www.eyefinity.com/blog/news/eyefinity-now-offering-digital-marketing-services-powered-by-eyecarepro

The Encompass platform works to integrate with other third-party applications for cloud-based practice management and electronic health records software solutions.

Eyefinity integrates Arrellio platform to its Eyefinity Encompass portfolio

Mae Gordon, PhD, and colleagues identified an association between the diagnosis of primary open-angle glaucoma and a decrease in patients’ mental health scores. She is from the Department of Ophthalmology and Visual Sciences and the Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St Louis. They reported their findings in 

They pointed out that some patients can experience stress when they are diagnosed with glaucoma and advised that clinicians should be aware of the accompanying potential for a decrease in the patient’s mental health status.

This cohort study was an outgrowth of the phase 1 and 2 Ocular Hypertension Treatment Study (OHTS).

 This post hoc analysis included the prospective data from the OHTS trial obtained from patients with ocular hypertension who developed early POAG and had completed the National Eye Institute’s Visual Function Questionnaire-25 (VFQ) within 2 years before and within 2 years after the POAG was diagnosed. Patients completed the questionnaire every 2 years between January 2001 and December 2008. A control group was comprised of propensity-matched participants with ocular hypertension who did not develop POAG during the same period.

The study’s main outcome measure was the change in the VFQ mental health score before and after POAG was diagnosed in the group of patients with POAG compared with changes during the same period in the controls who did not develop POAG.

The investigators reported that 50 participants (21 women; 17 Black patients; mean age, 67.9 years) with POAG were included in the study. The control group included 100 OHTS control participants (37 women; 34 Black patients; mean age, 66.6 years).

Based on the questionnaire results, the investigators reported that among the participants who developed POAG, the means ± standard deviations of the mental health scores before and after development of POAG were, respectively, 94.5 ± 8.6 and 88.0 ± 13.6; this translated to a mean change of −6.5 ± 11.3. In the matched control group, the mean changes in the mental health scores before and after development of POAG were, respectively, 93.3 ± 8.9 and 92.6 ± 8.0, ie, a mean change of −0.7 ± 8.3. The mean difference in the mental health scores between and after the development of POAG in the POAG and control groups was −5.8 ± 9.4 (95% confidence interval, −9.05 to −2.60; 

The authors concluded, “These findings support the need for further studies to confirm the association between the diagnosis of POAG and a decrease in the mental health score and to develop strategies to inform patients about their POAG diagnosis without that information causing undue distress, anxiety, and depression.”

of Portuguese and Spanish researchers led by first author Jennifer Jesus, MD, found “a high occurrence of psychiatric pathologies among individuals with glaucoma.” She is from the Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.

She and her colleagues conducted a systematic review of 6 databases (CINAHL, MEDLINE, PsycINFO, Web of Science, Scopus, and the Cochrane Library) and one gray literature source (Google Scholar), covering the period from 2013 to 2024.

They identified 29 studies that included 13,326,845 subjects. “Depression and anxiety were the most common conditions identified, with depression rates ranging from 6.6% to 57% and anxiety from 12.11% to 49%. Other less frequent but still significant conditions like sleep disorders, psychosis, dementia, and posttraumatic stress disorder also were observed,” the investigators reported.

In addition, they found that the psychiatric severity was affected by sociodemographic factors, glaucoma severity, and treatment duration.

Jesus and colleagues commented, “Given the high occurrence of psychiatric pathologies among individuals with glaucoma, it is essential to develop comprehensive care strategies that address both eye and mental health needs. Multidisciplinary collaboration among ophthalmologists, psychiatrists, psychologists, and primary care physicians is crucial for developing personalized treatment plans that effectively manage both the ocular and psychological aspects of the disease.”

Gordon MO, Gao F, Burkland J, et al. for the Ocular Hypertension Treatment Study Group. Diagnosis of primary open-angle glaucoma and mental health status. 

Published online June 5, 2025. doi:10.1001/jamaophthalmol.2025.1374

Gordon MO, Kass MA, for the Ocular Hypertension Treatment Study G. The Ocular Hypertension Treatment Study: design and baseline description of the participants. 

. 1999;117:573–583. doi:10.1001/archopht.117.5.573.

Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. 

Jesus J, Ambrósio J, Meira D, Rodriguez-Uña I, Beirão JM. Blinded by the mind: exploring the hidden psychiatric burden in glaucoma patients. 

https://doi.org/10.3390/biomedicines13010116

The study was an outgrowth of the phase 1 and 2 Ocular Hypertension Treatment Study (OHTS).

Canonical

Cohort study evaluates association between POAG and mental health

The optical coherence tomographer (OCT) has established itself as a standard-of-care, must-have device since its introduction over 20 years ago. When it first came to market, the time-domain resolution gave an unprecedented in vivo look at the posterior segment. Since then, OCT technology has evolved just like other ophthalmic instruments have over time. Take the fundus camera, for example. Carl Zeiss wowed the ophthalmic community in 1926 with the first commercially available fundus camera that sported a then-eye-popping 20-degree field of view.

 This pales compared with today’s imaging options, which offer a view 10 times this amount.

In a less dramatic fashion, the OCT has also moved outside of the posterior pole. Early stationary devices offered scanning protocols confined to the optic nerve and macula (ie, the most posterior 30 degrees of the retina).

 Later units such as Heidelberg Engineering’s Spectralis came mounted with 4-way swivel capability. This allowed the acquisition of more peripheral scans using a combination steering and gaze-directed technique. The addition of the 55-degree objective lens officially gave the Spectralis widefield OCT status, which is considered 50 degrees by several authors.

 Now, many other instruments offer widefield OCTs, such as the Optos Silverstone, which delivers a swept-source OCT option of any area that is viewable on a non-gaze-directed ultra-widefield (UWF) image.

The reason for obtaining peripheral OCTs (P-OCTs) lies in the clinical question to be answered: Does this apparent full-thickness retinal hole have subretinal fluid? Is this a retinal detachment or a retinoschisis? Historically, a binocular indirect ophthalmoscopy exam combined with scleral depression would help answer these questions. Now, P-OCTs provide an adjunct to this technique. Capturing these scans, however, can be tricky. Here are some tips for using the above-mentioned devices, the principles of which may apply to any instrument. Following this are some insights and lessons learned from years of employing P-OCTs.

One of the main challenges with P-OCTs is preventing image cutoff. This occurs when the B-scan is captured at such a steep scan angle that it reaches the top, flips over, and then comes back into view. This is called a “mirror” or “inverted” artifact (

 Remember that the eye is curved, so a straight-line scan oriented incorrectly will experience this effect. The key is to position the scan appropriately to minimize an inverted scan. To do this, capture the scan circumferentially (ie, horizontal for superior and inferior, vertical for temporal and nasal, and oblique to match the clock hours). The Spectralis allows a 360-degree scan orientation to prevent this from happening. Others, like the Optos Silverstone, only offer a horizontal scan option. In a study by Kurobe et al, over 50% of P-OCT scans experienced inverted artifacts with this device.

, clinical information can still be obtained.

A second consideration involves patient gaze and positioning. This isn’t an issue with the Silverstone as the P-OCT function, unfortunately, turns off for gaze-directed scans. This limits its ability to obtain scans in the most peripheral locations or in areas where artifacts such as lid interference may be present. However, it also streamlines the process. As only straight-ahead images are available, simply capture a non-gaze-directed UWF image and then select the desired OCT scanning protocol.

With the Spectralis, the 4-way pivot expands the scanning options of the retinal periphery. This is the steering and gaze-directed technique where, along with the patient’s gaze directed into the quadrant of interest, the machine swivels or tilts in the opposite direction. For example, have the patient look up if the area of interest is superior and then tilt the machine downward. This combination increases the scan angle (

). Stationary devices only allow for gaze-directed scans. Also, if the positioning stated above puts the eye closer or farther away from the instrument, consider adjusting the OCT control option for axial length. On the Spectralis, the range goes from “S” to “XL.” Therefore, select “S” if the eye is much closer to the instrument and “XL” if it is much farther away. This will enable a successful scan when there is a decreased or increased distance between the scan head and the retina.

Next, start with the instrument farther away from the patient, where the near-infrared image shows a more elliptical pupil due to the patient’s gaze-directed position. Use an external fixation device if available. From here, guide the instrument into the pupil until the scan appears. Once the scan is in position, employ the automatic real-time tracking (ART) option when using the Spectralis, which captures and summates sequential B-scans for enhanced resolution. For poor fixators, this may not be possible, and acquiring scans without ART will still result in readable images. If the patient is employing the “windshield wiper” technique and driving the imager crazy, consider taking the controls and performing a “live scan.” This entails dragging and rotating the line scan as needed to obtain the needed information visually without achieving a saved scan.

Don’t expect the first scans to look straight out of a journal; it takes practice. However, the acquired knowledge will result in valuable insight into peripheral retina pathology such as retinal holes, retinoschisis, lattice degeneration, cystoid degeneration, and retinal tufts, as noted below.

Atrophic holes are not always full thickness

This makes sense when you think about it. A full-thickness “atrophic” hole doesn’t just suddenly appear. Consider the word “atrophy,” which means “wasting away.” This definition implies a timeframe by which this occurs. Therefore, there must be a degenerative process that progresses over time for the atrophic retinal hole to reach full-thickness status. If this were not the case, a more appropriate term might be a focal area of retinal “hypoplasia,” which means “incomplete development” and thus would be present from onset and not go through progressive stages.

 which shows a full-thickness atrophic hole. The worry here is that vitreous fluid now has potential access to the subretinal space, which could result in a retinal detachment. Contrast this to the partial thickness atrophic hole or retinal erosion in 

where a small amount of retinal tissue remains, which is a barrier to any overlying fluid reaching the subretinal space.

The P-OCT appearance of full-thickness retinal atrophic holes varies. Specifically, the hole’s edges may be flat or everted, and sometimes cystoid degeneration surrounds the area.

 When these are located with lattice, they rarely result in a progressive retinal detachment.

 In the American Academy of Ophthalmology’s Preferred Practice Patterns (PPP), asymptomatic atrophic holes fall into the “treatment is rarely recommended” category.

 However, the PPP does not address what the hole looks like on P-OCT. Are elevated edges more at-risk than flat ones? Do cystic spaces infer any risk? As OCT technology continues to evolve, so may its introduction into current PPP.

Not only are retinoschises more common, so are schisis detachments

After employing P-OCTs, there appears to be a greater number of clinically undetected retinoschises. The same applies to a schisis detachment, which is when an outer layer break allows intracystic fluid to reach the subretinal space, causing a localized retinal detachment (

 In fact, over 15% of presumed retinoschises by clinical evaluation showed a retinal detachment with P-OCT.

 Schisis detachments mostly remain stable with outer layer holes alone vs when outer and inner layer holes are present.

 The reason here is that there is a limited amount of intracystic fluid that can reach the subretinal space with an outer layer hole. However, an inner and outer layer hole opens the area up to the more voluminous vitreous fluid. Fortunately, the incidence of inner layer holes is low (4%), with outer layer holes having a prevalence of up to 17%.

Seeing is believing: lattice and vitreoretinal interaction

Lattice degeneration presents in about 10% of patients, with a 50% chance of bilaterality.

 Exaggerated vitreoretinal attachments and overlying vitreous liquefaction tend to occur (

). The vitreous traction can be striking with P-OCT (

). It is no wonder, then, that lattice poses a risk, albeit small, for retinal detachment.

Cystoid: the forgotten peripheral degeneration

Cystoid degeneration is often overlooked, but the entity can have clinical significance. Microcystoid degeneration, which does not involve the entire retina, is thought to be a precursor to the above-mentioned degenerative retinoschisis, where the cystic lesions coalesce (

 It can also occur with a retinal hole, meridional fold, ora serrata pearl, and cystic retinal tuft.

 Contrast this to typical cystoid degeneration, which takes on a “saw-tooth” pattern and spans the entire retina (

Although noncystic retinal tufts typically do not lead to retinal detachment, cystic retinal tufts can. Retinal tears around cystic retinal tufts are estimated to cause 10% of rhegmatogenous retinal detachments.

 Making this distinction clinically is difficult and is much easier with P-OCT (

As technology continues to advance, it may not be long before the entire peripheral retina can be captured using OCT technology. Therefore, put your OCT to work in the periphery now and stay ahead of the learning curve with interpretation.

Chen A, Dang S, Chung MM, et al. Quantitative comparison of fundus images by 2 ultra-widefield fundus cameras. 

. 2021;5(5):450-457. doi:10.1016/j.oret.2020.08.017

Nissen AHK, Vergmann AS. Clinical utilisation of wide-field optical coherence tomography and angiography: a narrative review. 

. 2024;13(4):903-915. doi:10.1007/s40123-024-00905-2

Choudhry N, Golding J, Manry MW, Rao RC. Ultra-widefield steering-based spectral-domain OCT imaging of the retinal periphery. 

. 2016;123(6):1368-1374. doi:10.1016/j.ophtha.2016.01.045

Kurobe R, Hirano Y, Ogura S, Yasukawa T, Ogura Y. Ultra-widefield swept-source optical coherence tomography findings of peripheral retinal degenerations and breaks. 

. 2021;15:4739-4745. doi:10.2147/OPTH.S350080

Cheung R, Ly A, Katalinic P, et al. Visualisation of peripheral retinal degenerations and anomalies with ocular imaging. 

. 2022;37(5):554-582. doi:10.1080/08820538.2022.2039222

Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. 

. 2003;136(1):155-160. doi:10.1016/s0002-9394(03)00144-2

Flaxel CJ, Adelman RA, Bailey ST, et al. Posterior vitreous detachment, retinal breaks, and lattice degeneration Preferred Practice Pattern. 

. 2020;127(1):P146-P181. doi:10.1016/j.ophtha.2019.09.027

Byer NE. Perspectives on the management of the complications of senile retinoschisis. 

. 2002;16(4):359-364. doi:10.1038/sj.eye.6700191

Cereda MG, Corvi F, Cozzi M, Pellegrini M, Staurenghi G. Optical coherence tomography 2: diagnostic tool to study peripheral vitreoretinal pathologies. 

. 2019;39(2):415-421. doi:10.1097/IAE.0000000000001953

Kim J, Choi KS. Peripheral lattice degeneration imaging with ultra-widefield swept-source optical coherence tomography. 

. 2023;37(6):485-489. doi:10.3341/kjo.2023.0074

Incorporating peripheral OCTs into your practice provides valuable insights that may alter your clinical diagnosis.

Taking your OCT outside of the posterior pole

Clinical-stage biotechnical company Qlaris Bio recently announced the development of a novel preservative-free, fixed-dose combination (FDC) therapy, combining QLS-111 and latanoprost.

This new QLS-111 and latanoprost fixed-dose combination (QLS-111-FDC) is in development for the treatment of primary open-angle glaucoma (POAG), ocular hypertension (OHT), and normal-tension glaucoma in patients whose optimal intraocular pressure (IOP) control may remain “unachievable” due to needing to lower episcleral venous pressure (EVP). QLS-111 targets EVP, the only remaining component of IOP left unaddressed by currently approved treatments.

“Combining QLS-111 with latanoprost in a preservative-free fixed-dose combination is a very promising and exciting advancement,” said Alex Huang, MD, PhD, associate professor at the Shiley Eye Institute at UC San Diego Health, in a news release.

This new QLS-111 and latanoprost fixed-dose combination (QLS-111-FDC; Qlaris) is in development for the treatment of primary open-angle glaucoma, ocular hypertension, and normal-tension glaucoma in patients whose optimal intraocular pressure control may remain “unachievable” due to needing to lower episcleral venous pressure.

Richard Meetz, OD, MS, FAAO

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