Eye care is advancing at a rapid pace, and the Ophthalmology Times® EyeCon 2022 is the best place to discover opportunities in the field to bring home to your practice. 

Ophthalmology EyeCon 2022

 polled our audience with the following question from September 22, 2022 to September 28, 2022:​ 

 and was promoted on Twitter, Facebook, and LinkedIn. Results show a majority of ophthalmologists plan to attend AAO in person.

96 responses were recorded, in total. Of these:

56% responded, "Yes, I will be there in person."

17% responded, "Yes, I will attend virtually."

27% responded, "No, I am unable to attend."

Poll

Results from our recent poll regarding AAO 2022 attendance indicate that most ophthalmologists and retina specialists plan to participate in the Annual Meeting in person in Chicago, Illinois.

Poll results: Are you attending AAO in Chicago?

Johnson & Johnson Vision today announced availability of Tecnis Symfony OptiBlue IOL. its presbyopia-correcting intraocular lens (PC-IOL) powered by InteliLight technology.

This extended depth-of-focus (EDOF) lens expands presbyopia correction to more patients and joins Tecnis Synergy IOL, a high-performance hybrid lens designed for spectacle independence****, in the InteliLight portfolio. These two complementary products deliver contrast and low-light performance across the PC-IOL category.

 The InteliLight portfolio will be on display at the American Academy of Ophthalmology's 2022 annual meeting in Chicago.

Cataracts are the leading cause of preventable blindness worldwide, impacting more than 100 million eyes globally

 Cataracts are a clouding of the lens in the eye, caused by a buildup of the eye’s natural protein which changes the way the eye focuses light, therefore changing the color and clarity of vision.

 Most people will develop cataracts at some point in their life, however cataracts can be treated with surgery; modern cataract surgery is a safe and effective treatment that has a success rate of nearly 98%.

“My goal as an eye care professional is to deliver the best outcomes for my patients, and to help them get back to some of the activities many of us take for granted — driving at night, going up and down the stairs in their homes in dim light, or just going out at night and enjoying dinner at a restaurant, all with less risk”

 said Karolinne Rocha, MD, PhD, MUSC/Storm Eye Institute, Charleston, South Carolina “In my practice we’ve seen TECNIS Symfony OptiBlue IOL deliver good image contrast in the day and night, at all distances. Best of all, it has a minimized dysphotopsia profile that gives me the comfort I need to recommend presbyopia correction to more patients"

Tecnis Symfony OptiBlue IOL is powered by InteliLight, an innovative combination of three Johnson & Johnson Vision proprietary technologies: violet-light filter, echelette design and achromatic technology. The technology was first introduced in the Tecnis Synergy IOL.

 Blocks the shortest wavelengths of light that produce the most light scatter,

 helping to mitigate halo, glare, and starbursts,

 and minimize visual disturbances when driving at night.

 Helps reduce light scattering and halo intensity,

making it easier to see digital devices.1

 Corrects chromatic aberration for better contrast day and night

 and superior performance across every distance.

“We know our patients’ lives don’t stop at sunset, and neither should their confidence in being able to see clearly or drive at night,” said Nikki Sidi, vice president, Global Strategic Marketing, Surgical Vision, Johnson & Johnson Vision. “The InteliLight PCIOL portfolio delivers best-in-category* contrast and low-light performance.

 And with Tecnis Synergy for spectacle independence and TECNIS SymfonyOptiBlue for functional vision at every distance, surgeons can now choose the best in low-light performing PCIOLs, according to their patients’ needs.”

The Tecnis PC-IOL portfolio powered by InteliLight is now available for ophthalmologists to use in the U.S. and select countries in EMEA. The lenses in the portfolio, TECNIS Synergy IOL and TECNIS Symfony OptiBlue IOL, are also available in Toric II for excellent rotational stability

1 DOF2021CT4019 - Clinical investigation of rotational stability of the TECNIS™ Toric II IOL- Steele Study NXGT-202-QROS. 20 Aug. 2021.

2 World Health Organization - Priority Eye Diseases. REF 2016 OTH 0004.

3 World Health Organization. Blindness and Impairment. https://www.who.int/en/news-room/fact-sheets/detail/blindness-and-visual-impairment.

4 American Optometric Association. Cataract. 

https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/cataract?sso=y

5 Vision Health Initiative, Common Eye Disorders. Centers for Disease Control and Prevention. 

https://www.cdc.gov/visionhealth/basics/ced/index.html

6 Szanton SL, Walker RK, Roberts L, Thorpe RJ, Jr., Wolff J et al. 2015. Older adults' favorite activities are resoundingly active: findings from the NHATS study. 

7 ARVO 2020_Effect of blocking violet light in extended depth of focus IOL: SC2019CT4056.

8 Mainster MA. Blue-blocking Intraocular Lenses: Myth or Reality? 

. 2009;1:8-10. REF2014CT0140 Blocks shortest wavelengths (p.1).

9 ARVO 2019_Optical and Visual performance of violet blocking IOL: SC2019CT4025

10 Effect of blocking violet light in EDOF IOLs. JNJ ArvoAbstractMay 2020/Optical and visual performance of violet blocking IOL SC2019CT4025.

11 DOF2020CT4011: DOF Effect of blocking violet light on light scatter in Tecnis Symfony™ IOLs (v1.0).

12 InteliLight US Sales Aid. PP2022MLT5751

Articles

At the American Academy of Ophthalmology in Chicago, Johnson & Johnson Vision is spotlighting the Tecnis Symfony OptiBlue IOL, its presbyopia-correcting intraocular lens (PC-IOL) powered by InteliLight technology.

Presbyopia-correcting IOL on display at AAO

The incidence of burnout among physicians in the United States increased dramatically during the first two years of the COVID-19 pandemic, according to a published study in Mayo Clinic Proceedings.

According to an AMA news release, researchers noted that 2020 marked the end of a six-year period of decline in the overall rate of work-induced burnout among physicians. By the end of 2021, after 21 months of the COVID-19 pandemic, the physician burnout rate spiked to a new height that was greater than previously monitored by researchers.

“While the worst days of COVID-19 pandemic are hopefully behind us, there is an urgent need to attend to physicians who put everything into our nation’s response to COVID-19, too often at the expense of their own well-being,” said AMA President Jack Resneck Jr., MD. “The sober findings from the new research demand urgent action as outlined in the 

AMA’s Recovery Plan for America’s Physicians

 which focuses on supporting physicians, removing obstacles and burdens that interfere with patient care, and prioritizing physician well-being as essential requirements to achieving national health goals.”

According to the news release, the new physician burnout research builds on landmark studies conducted at regular intervals between 2011 and 2021 by researchers from the AMA, Mayo Clinic and Stanford Medicine. Together, these studies found the overall prevalence of burnout among U.S. physicians was 62.8% in 2021 compared with 38.2% in 2020, 43.9% in 2017, 54.4% in 2014, and 45.5% in 2011. Each study consistently demonstrated that the overall prevalence of occupational burnout among physicians were higher relative to the U.S. workforce.

Since 2012, the AMA has been a key driver of the national conversation on solving the physician burnout crisis and advocated for new thinking and solutions that acknowledge physicians need support, system reforms, and burden reduction. The COVID-19 pandemic exacerbated many of the drivers of physician burnout. 

 has shown that due to COVID-related stress, 1 in 5 physicians intend to leave their current practice within 2 years.

Accoridng to the news release, the AMA’s ongoing work to mitigate physician burnout, as exemplified by the Recovery Plan for America’s Physicians, strives to attack the dysfunction in health care by removing the obstacles and burdens that interfere with patient care. The AMA 

 offers physicians and health systems a choice of cutting-edge tools, information and resources to help rekindle a joy in medicine, including:

 – a collection of more than 70 award‐winning online toolkits offered by the AMA that help physicians and medical teams make transformative changes to their practices and covers everything from managing stress and preventing burnout to improving practice workflow.

 – a set of measurement resources developed by the AMA that assess burnout levels within medical organizations to provide metrics that can guide solutions and interventions that mitigate system-level burnout rates and improve physician well-being.

International Conference on Physician Health

 – a biennial meeting held this October in Orlando, Fla. that brings together the AMA, British Medical Association and Canadian Medical Association to support health and well-being in the ranks of physicians and medical students.


Joy in Medicine Health System Recognition Program

 - an AMA distinction, now in its third year, that recognizes health systems with a demonstrated commitment to pursue proven strategies that reduce work-related burnout among care teams.

 – a series created by the AMA that provides physicians and their care teams with resources to reduce guesswork and administrative burdens and focus on streamlining clinical workflow processes, improving patient outcomes and increasing physician satisfaction.

 to address the physician burnout crisis. Through our research, collaborations, advocacy and leadership, the AMA is working to make the patient‐physician relationship more valued than paperwork, preventive care the focus of the future, technology an asset and not a burden, and physician burnout a thing of the past.

Earlier this year, a survey, from The Larry A. Greene Center and the Primary Care Collaborative, found that the COVID-19 pandemic has had an adverse impact on the well-being of physicians.

The Larry A. Green Center survey found that of the physician respondents, 36% say their physical well-being has been suffered while 45% say their psychological well-being has suffered. A further 44% say that their personal burnout has reached an all-time high and 48 percent reported their office burnout is at an all-time high.

There may be some good news for ophthalmologists.

In a separate Medscape survey earlier this year, 22% of ophthalmologists reported feeling burned out, while just 3% reported feeling depressed. Only 8% reported feeling both.

However, the survey found that US physicians say a decrease in income of 11% to 50%. Ophthalmologists were among the specialists whose incomes declined by more than 50%.

The Medscape survey also asked about those on the flip side — the happiest. Plastic surgeons were at the top (41%), followed by those in public health/preventive medicine (40%) and ophthalmologists (39%).

1. Tait D. Shanafelt, MD, Colin P. West, MD, PhD, Lotte N. Dryrbye, MD, MHPE, Hanhan Wang, MPS, Lindsey E. Carlassare, MBA, Christine Sinsky, MD; Changes in Burnout and Satisfaction With Work-Life Integration in Physician Over the First 2 Years of the COVID-19 Pandmeic. Mayo Clinic Proceedings. Published September 13, 2022. DOI: https://doi.org/10.1016/j.mayocp.2022.09.002

A study has found burnout among physicians in the United States on the rise, but ophthalmologists may be bucking the trend. 

The survey, from The Larry A. Greene Center and the Primary Care Collaborative, found that the COVID-19 pandemic has had an adverse impact on the well-being of physicians.

This transcript has been lightly edited for clarity:

Hello, and welcome again to the NeuroOp Guru. I'm here with my good friend Elizabeth Fortin, MD. Hi, Elizabeth.

And today we're going to be talking about a recent article. Should visual snow syndrome have any evaluation outside of standard in clinic ophthalmologic testing? The two participants were Claire Fraser, MD, and Michael S. Vaphiades, DO. Elizabeth, maybe you could just tell us what is visual snow.

Visual snow syndrome is an array of symptoms that we see in people who describe having small flecks or dots in their visual field. So normally, it is black and white dots all over the visual field. It's often described as a TV that's out of tune, like an old TV. And it persists over time. So it has to be at least 3 months to call it visual snow syndrome. And it's often associated with other visual symptoms such as photophobia, or other and topic visual phenomena.

Yeah, so the people who we call the primary visual snow syndrome have a completely normal examination. They often describe the symptoms that I just talked about, in a very classic way. They don't have any other neurological symptoms, and their exam is completely normal, as opposed to people who have, for example, secondary visual snow, which can have other symptoms or other findings on exam.

So you agree that we should do a visual field, automated perimetry and a macular OCT on all of these people?

Of course, you have to perform a complete eye exam, including a dilated fundus exam, I believe. And in clinic in the office, it is easy to obtain an macular OCT to assess the retinal layers. Most importantly, probably the outer retinal layers in the visual field testing we should have done in all those people.

And have you ever found anything on these people?

It is very rare. If you do a good exam, questionnaire or history with these people, and then really don't have any other symptoms exist, it's extremely rare to find other findings on your exam, but it can definitely happen. But I would say it's pretty rare. Have you found any?

No, I've never found anything. So the issue is Claire Frazier says although most cases are idiopathic, there are some atomic and neurologic conditions that can mimic visual snow in the literature. And so the issue is, first of all, does that exist? And second of all, should we be doing an MRI and EEG and an ERG?

Yes, so I think like we just discussed, what's really important is to take a very good history. And you have to know first what visual snow syndrome the idiopathic version looks like, and sounds like. So you have to make sure to take a good history and do a complete exam, including what we just mentioned, meaning you have to absolutely get a visual field and a macular OCT. She also suggests that you could get a fundus autofluorescence, which I haven't been doing regularly in my practice, but I think that could be a good idea if you have any doubts about the symptoms because you wonder if some patients that have a completely normal exam could have, for example, some retinal diseases that often that's sometimes present without any findings and fundus exam. So that is a good addition that you can think about doing if you're not completely certain that you have the idiopathic version of the visual snow syndrome. But otherwise, I think if you really do a good history and exam, you should be okay, without doing any further outside-of-the-office testing.

No, I normally don't recommend it myself. What about you?

Most of the patients I see have already had an MRI. So it's very uncommon that I would see someone who hasn't had an MRI already. Probably a little bit different maybe in Canada, but I don't really recommend they have any testing. There have been some studies with fMRI and PET that showed the lingual gyrus is hyperactive I don't order any of those tests. Have you been ordering PET scans or fMRI or anything?

Not at all because it doesn't change my management with these patients. So there's not really any treatments that has been convincingly shown to be working in these patients. So I don't do these routinely. I think it's more used for research purposes as of now. And maybe eventually we'll find a treatment that works for those those patients, but I personally haven't been doing them.

I usually show the patients the other patients who have had fMRI and PET so that they know that I believe them. But I don't order a new one on them. How about EEG. Do you order that?

So, EEG No. That's a good questions because we always wonder if there could be some patients who have for example, occipital seizures that could present with visual snow. But oftentimes, these people have other neurological symptoms, or their symptoms are intermittent, which can suggest that they have another condition such as migraine or seizures. So I don't routinely order EEG. What about you?

I do not. Some patients with occipital seizure have little circles, but they're bigger and they're not like diffuse like the snow and they have like colored blobs in them. Unless there's some other evidence of seizure activity, I've not routinely been recommending EEG, electroencephalography. How about WRG? If you do ERG on those people?

That's the same as same, pretty much the same answer. So if the exam is completely normal, again, including an OCT and a visual field, I don't normally do it. If you have a doubt also, one good way to approach these patients is to follow them in time. If you think that there is something that's not quite typical, you can see these people again, and if there's a change in their visual field or their appearance of the other retinal layer on the OCT, then you can probably think about doing an ERG. Now, again, there tends to be some finding either on the peripheral visual field and patients that have outer retinal diseases, or they can have findings on fundus exam. More specifically, if you don't have any fundus findings, if you do the fundus autofluorescence, as was suggested by Dr. Fraser, you're probably going to find something is if there's a patholody of the retina. So unless there's any of these I don't routinely order ERGs just also for a question of access, because it's not very easy, where I work to order to get an erg. What about you?

I don't order any electrophysiology unless there's something on the exam that suggests it's retinol, about a word about treatment. Are you using any treatment on does anything work?

I haven't been using treatments. So what I would say it's happened probably once or twice in people that were very, very anxious about the symptoms, and were about to change their career over the symptoms. Because of the symptoms. I haven't had any good success with them. There are medications that have been used such as Lamotrigine, sertraline, Topiramate, but I don't personally use them. What about you?

We offer it to patients, mostly the anti anxiety agents help them with the coping mechanisms. And simple reassurance plus treating their underlying normal treatments for anxiety are helpful about Diamox? I've used Dynavox. What about Acetazolamide?

So I haven't I mean, unless there are suggestions of increased intracranial pressure, I haven't I know there's no harm in doing it. But I haven't personally been using them.

And what happens to these people? They just go away. They seem not to come back after a while in my practice.

Yeah, they don't come back. After a while the symptoms don't tend to go away from my experience. I think they stay there. But, with reassurance, some people feel confident enough, and they know that they're not going to lose their vision. Oftentimes, I feel like reassurance is probably the most important part of what we're doing in the office. And, of course, you have to base your reassurance on a very complete and normal exam. And I think, oftentimes, this is enough to reassure them. I mean, maybe some end up going to my colleagues elsewhere, but I don't think so.

I don't think so either, because I don't see a lot of second and third opinions on the snow. I think the first person is probably all they need. Well, maybe you could just give the take home message then from your perspective on should visual snow have any other testing?

Yeah, so I think the take home is that you have to take a very thorough history on those patients and make sure you do have complete ophthalmic examination including a dilated fundus exam, you have to obtain an O CT of the macula and obtain a visual field testing. And if you have any doubt, there is no harm in obtaining an MRI and or an erg slash EEG depending on what the findings are. But, if you are confident enough and you have classic symptoms of idiopathic visual snow syndrome, it is okay, I believe, to do just the exam, the in-clinic ophthalmologic exam.

I agree, Elizabeth. Well, that concludes yet another adventure with the NeuroOp Guru, and we'll see you guys next week. Thanks, again, Elizabeth. Goodbye.

Videos

On this week's episode of the NeuroOp Guru, Andy Lee, MD, and Elizabeth Fortin, MD, discuss visual snow syndrome and whether it should be evaluated during standard in-clinic ophthalmologic testing. 

ICYMI: Blog offers pearls about the diagnosis, treatment of visual snow syndrome

Myze is a next generation eye care engagement platform that helps identify, treat, and manage dry eyes throughout a patient’s dry eye journey.

According to the news release, Myze enables “always available” screenings followed by frictionless access to products, services, and education. No more product overload and decision paralysis at retail locations. Myze makes treating dry eye easy, affordable, and sustainable for patients and their providers.

Currently, at least 16 million people in the United States have been diagnosed with dry eye disease of whom only 10% are being treated. And, as many as 75 million+ more may be suffering from dry eye disease or digital eye strain but have not yet been diagnosed. Dry eye is a chronic, often progressive disease that manifests early on with patient complaints of tired, red, itchy, or gritty eyes. As the disease progresses, blurred vision and potentially loss of vision can occur if not treated and managed properly. It is the #1 reason why patients see eye doctors.

Future MYZE customers will be met through partner physicians, social media, search, and other digital media channels and engaged through a very simple, yet provocative question—"How Do Your Eyes Feel?”

Users engaging with the platform will find immediate and long-term relief for their symptoms and discomfort and will do so through the MYZE suite of customized products and services.

“As physicians, we are seeing and hearing from more dry eye patients than ever before,” said Cynthia Matossian, MD, president of the American College of Eye Surgeons and chair of the Myze Medical Advisory Board.

“Throughout a combination of digital and human interventions, Myze will deliver magical moments and memorable experiences for our customers so they can achieve the best possible outcomes for their dry eyes and other ocular surface issues, Scott Tannenbaum, founder of Myze, said in the press release.

This will be achieved through a data driven dry eye screening solution that provides access to personalized, affordable, and sustainable treatment options, disease state education, and ongoing tracking and engagement, as well as access to the country’s most influential eye care professionals. Marketing technology and machine learning will also power timely reminders, daily inspiration, and ongoing support.

“After spending most days and nights staring at my laptop and phone, my eyes typically feel worn out by the end of the day. After engaging with the MYZE platform, I came to clearly understand why they hurt and how I can treat them,” Lexi, a 35-year-old computer programmer said in the news release. “”The process was easy and simple and the Myze recommended product selections were perfect for my situation.”

Leading U.S. eye care experts advance eye health focused digital platform designed to make eye care part of daily self-care routine.

 Myze launches for platform to engage 1 million dry eye patients by 2025: How Do Your Eyes Feel? 

I have previously interviewed glaucoma specialist Anthony Khawaja, PhD, MA (Cantab), FRCOphth, on the therapeutic area of precision medicine, and I was interested in talking with him again to revisit the rapidly developing field and discuss the latest promising research. Here is our interview.

CR: Why is there a need for precision medicine in ophthalmology?

AK: Because the way we currently practice medicine is very much evidence based, which, as I will describe, has its shortcomings. We all know that the highest-quality evidence comes from randomized controlled trials. For example, the ocular hypertension treatment study [randomly assigned] people with ocular hypertension who did not have glaucoma to eye pressure lowering or no eye pressure lowering.2

Those whose eye pressure was lowered had a dramatically reduced chance of converting to glaucoma over the subsequent 5 years. This means that if we treat everybody with ocular hypertension, fewer people will convert to glaucoma.

However, around 90% of untreated people did not convert to glaucoma. Therefore, if we treated everybody with ocular hypertension, as [findings from] the randomized controlled trial might suggest is a good idea, then we would be treating many people unnecessarily: some would benefit but others would receive treatment they did not need. And, of course, some people will develop [adverse] effects to the treatment, and treatments have costs to the health care providers and to the patients, depending on the health care setting.

Another similar example is the United Kingdom Glaucoma Treatment Study (UKGTS), [whose data] showed that treatment with latanoprost can halve the chance of established open-angle glaucoma getting worse, compared with placebo.3 This, again, suggests that if all patients were the same—if everyone was average—then treating them would be a good idea.

But not everybody is the same and three-[fourths] of people in the placebo group in this study did not measurably progress over the 2-year study period. This suggests that some people who fulfil our diagnostic criteria for glaucoma might not actually need treatment.

On the flip side of that, 15% of the people who received latanoprost progressed, meaning that they perhaps needed a different treatment or a more intensive treatment strategy. The overall message here is that evidence-based medicine is great to tell us what is best to do on average, but not what is best for an individual patient.

There is a great picture of Barack Obama from when he was launching the Precision Medicine Initiative in 2015.4 He stood by a model of DNA, the double helix, since one of the key enablers for personalising our approach to managing patients lies in genetics and genomics: leveraging an individual patient’s genetic code to better understand how they will individually respond to different treatment strategies.

One reason that this is an exciting time for personalised or precision medicine is that measuring the genetic code has become so cheap: You can have it done at a local high street pharmacy in the UK for less than £150 [$174].

One genotyping study that is going to start in the UK soon, called the Our Future Health study,5 will measure common variations in the genetic code in 5 million adults at a cost of around £20 [$23] each. This 1 test can inform us about how best to manage people at risk of not only common blinding eye conditions but also cardiovascular disease, dementia, breast cancer, prostate cancer, and almost any medical condition you can think of. This demonstrates that we are at a very exciting point in time in precision medicine and I think we are going to see big changes within the next decade.

What specific benefits can precision medicine bring to glaucoma patients?

We usually assess a person’s personal risk according to how bad their glaucoma is when they first present, but we tend to have to monitor them for at least a couple of years before we can fully or better understand that risk.

Genetics will help us stratify our patients right from the outset, to better identify those who will be on a downward trajectory in 5 years’ time, so we can treat them better, and those who will have barely changed in 5 years—the really low-risk patients who we can spare [from] the costs and [adverse] effects of treatment, freeing up precious health care resources and giving the glaucoma specialist time to focus on patients who have a much higher risk of going blind.

Given the rapidly increasing number of [patients with] glaucoma and our limited health care resources, we need these kinds of innovations. This is not a hope but an absolute must. Secondly, we have so many different glaucoma treatments now: many classes of drops, different forms of laser, [and] different forms of surgery from very minimally invasive to highly effective but much more invasive and risky.

However, we are not very good at predicting who will respond well, and we tend to treat patients in a trial-and-error manner. It is rare that a patient comes to severe long-term harm from this—[adverse] effects are often temporary—but it does not provide patients with a great experience and is also a massive waste of resources.

There is growing evidence to suggest we can predict using genomics who will respond well to treatment such as selective laser trabeculoplasty. Work is…ongoing, so watch this space!

What research are you most excited about at present?

I am really excited about genetic data, not just from patients with glaucoma versus patients without glaucoma, but also from patients with established glaucoma, where we know what their treatment pathway has been, their response to treatments, and their vision loss trajectory. Once we have these large data sets, we can start to accurately validate prediction algorithms that incorporate genetics for clinically meaningful outcomes such as risk of progression, rate of progression, and response to different treatments.

Another exciting area is modifiable risk factors for glaucoma. Knowing which lifestyle factors influence glaucoma risk has been a challenge, as studies have tended to be small and results inconsistent. But now, with large studies such as the UK Biobank,6 we are better able to ask these questions.

We recently brought together a multidisciplinary collaboration of nutritionists, nutritional epidemiologists, statistical geneticists, ophthalmic epidemiologists, and glaucoma specialists from multiple institutions around the world, such as Harvard [University], Mount Sinai, the Pasteur Institute, and beyond.

The first thing we looked at was caffeine, partly because all the investigators enjoy consuming caffeine. We were interested to know whether it influences the pressure in the eye and the chances of having glaucoma.

A high genetic risk of glaucoma is in some ways a proxy for how well developed the aqueous fluid outflow channels are: If they are not adequately developed, such that they are starting to fail at an older age, then the outflow channels cannot handle the additional aqueous that is produced as a result of consuming more caffeine. This pushes up the pressure and increases the chance of developing glaucoma.

Interestingly, we found that there does not seem to be a strong association in the population overall, other than when you focus on people at high genetic risk of glaucoma. So only in the high-risk people, who can be determined with inexpensive genotyping tests, [is] high caffeine intake associated with a higher eye pressure and a greater chance of having glaucoma.

What does this mean for patients? Currently, if a patient’s glaucoma is well controlled, I certainly would not advise them to stop consuming caffeine or reduce their caffeine intake. But if a patient is getting worse despite best medical or surgical treatment, then I think they need to know this information. I would say that, although it is not proved, if you do consume a lot of caffeine, you may wish to consider reducing or stopping, given what we know.

It may work, it may not work; but certainly if I was a patient and I was getting worse despite all best efforts, this is the type of information I would like to know. In the future, I think we will be giving people lifestyle advice according to their genotype.

Where does artificial intelligence (AI) fit in?

We have used AI to look at retinal photographs of patients in the UK Biobank. Doing this, we processed around 80,000 photographs in less than a day, assessing whether there are features of glaucoma and measuring the vertical cup disc ratio. This is something which would take a decade for human graders to undertake.

Genetic data are available for everyone in the UK Biobank, so this allowed us to carry out the largest genome-wide association study for vertical cup disc ratio,7 identifying many new genetic markers for glaucoma. These genetic markers were very predictive for glaucoma prevalence in the independent EPIC-Norfolk study [European Prospective Investigation Into Cancer in Norfolk Prospective Study; NCT03424668].8

The other thing with AI is that it will complement genetic prediction models. Currently, using all our clinical skills, OCT [optical coherence tomography] scans, and visual fields, we can only phenotype a patient so far. There are extra clues in their genetic markers that will tell us about that patient’s profile, their prognosis, their susceptibility to disease, and their response to different treatments.

There are also hidden signatures that humans cannot currently interpret, while AI can. So I think that AI assessment of imaging in particular is going to give us some extra clues that can further help personalize the care of our patients.

I think we will have started pilot programs in which health care users meeting quite broad criteria are genotyped, which will inform personalized care strategies. For glaucoma, it might be a personalized screening strategy.

For example, patients with the top 10% risk of glaucoma might be advised to start having annual eye checks at the age of 40, whereas the bottom 10% will not have any specific eye tests and will just go to the optometrist opportunistically. People who are somewhere in the middle might start at the age of 50 and be screened every 2 years.

In 10 years, the best management is going to be an intersection of genomic prediction models and AI models.

Anthony Khawaja, PhD, MA (Cantab), FRCOphth

Khawaja is an associate professor at University College London Institute of Ophthalmology and honorary consultant ophthalmic surgeon at Moorfields Eye Hospital NHS Foundation Trust in London, UK. He is supported by a UK Research and Innovation Future Leaders Fellowship and an Alcon Research Institute Young Investigator Grant. He reports acting as consultant to Aerie, Allergan, Google Health, Novartis, Reichert, and Santen and has received lecturing fees from Grafton Optical and travel support from Théa.

Genotyping and artificial intelligence are together starting to predict the progression of glaucoma in individual patients, sparing them from suboptimal treatments and adverse effects. Recent research efforts are exploring modifiable risk factors such as caffeine consumption.

The need for precision management in glaucoma moves field forward

Sheryl brings a wealth of editorial experience to MJH Life Sciences’ Eye Care Network, having engaged with the readers and the greater ophthalmic community of 

for more than 20 years. As Group Editorial Director, Sheryl’s purview extends across the print and digital network of 

Ophthalmology Times, Ophthalmology Times Europe, Modern Retina 

 Prior to ophthalmology, Sheryl previously covered the fields of audiology and confectionery science/technology/manufacturing.

Sheryl is also passionate about the mission, vision and values of Ophthalmic World Leaders (OWL) and recently completed her term on its Board of Directors. She continues to volunteer as Editor-in-Chief of the organization’s 

Magazine. In 2013, she was honored with the group’s inaugural Rising Star Award.

In addition, she has served as a judge for 

 Health Care Heroes Awards program as well as the Jesse H. Neal National Business Journalism Awards.

Learn what's new from Hunter Cherwek, MD, Vice President of Clinical Services, Orbis International, and Rick Weisbarth, OD, FAAO, Vice President of Professional Affairs at Alcon U.S. Vision Care in this interview with Sheryl Stevenson, Group Editorial Director – Ophthalmology Times®. The in-person program relaunched during a recent 2-week training session at the Alcon Experience Center in Fort Worth, Texas.

After a brief hiatus during the pandemic, the Flying Eye Hospital program returns. 



 

Orbis in-person training taking flight once again

California Gov. Gavin Newsom this week vetoed AB 2236, which would have reduced the medical education, clinical, and surgical training requirements to become licensed in California to perform eye surgery.

The proposal would have allowed optometrists to perform anterior segment laser and minor procedures which involve the use of a scalpel or injections.

“I am not convinced that the education and training required is sufficient to prepare optometrists to perform the surgical procedures identified,” Newsom wrote in the veto to the general assembly. “This bill would allow optometrists to perform advanced surgical procedures with less than one year of training.

In comparison, Newsom noted in the statement that physicians who perform these procedures must complete at least a three-year residency program.

“For this reason, I cannot sign this bill,” Newsom wrote.

During a panel discussion at the Eyecelerator event at the American Academy of Ophthalmology’s 2022 annual meeting at McCormick Place in Chicago, Stephen McLeod, CEO of the AAO, noted that Newsom’s veto helps to ensure patient safety.

Several other groups had stepped up to oppose the measure.

In opposing AB 2236, the California Medical Association pointed out that the measure did not require adequate training to assure competency of candidates who would be certified to perform these procedures, and actually has loopholes that undermine the training requirements of the bill.

The American Society of Retina Specialists and Safe Eyes America had also stepped up to voice their opposition prior to a vote on the proposal, pointing out that a reduction in surgical licensing requirements would be detrimental to patient surgical outcomes and safety.

AB 2236 would have allowed optometrists to perform anterior segment laser and minor procedures which involve the use of a scalpel or injections.


California governor vetoes bill that would have reduced licensing requirements to perfom eye surgery

The company announced the availability of Fortisite, which includes a patent-pending compounded combination of tobramycin 1.5% and vancomycin 5%.

ImprimisRx today announced the availability of Fortisite, which includes a patent-pending compounded combination of tobramycin 1.5% and vancomycin 5%.

According to a news release from the company, compounded topical antibiotic formulations may be appropriate to prescribe for patients with clinical needs that are unmet by FDA-approved drug products. Fortisite, which includes a compounded combination antibiotic formulation (tobramycin 1.5% and vancomycin 5%) in solution, is tested for both potency and sterility before it is dispensed, and uniquely, is stable at refrigerated temperatures (5°C) for up to 180 days.

The company noted that formulations are currently available for individual patients through the ImprimisRx 503A national mail order pharmacy. Once available through the ImprimisRx FDA-registered and FDA‑inspected 503B outsourcing facility, which is expected in the first half of 2023, physicians will be able, for the first time, to stock a fortified or high-concentration compounded antibiotic in their offices for the immediate treatment of patients-in-need.

In addition, consistent with its commitment to patient access, ImprimisRx will provide a robust Patient Access Program and a 100% replacement guarantee for any expired 503B Fortisite product, ensuring all U.S. eyecare professionals can continuously stock Fortisite formulations in their offices without the additional expense associated with expired product replacement.

Eyecare professionals interested in learning more about Fortisite can visit the 

(Booth #4416) at the American Academy of Ophthalmology meeting.

ImprimisRx launches  compounded Antibiotic Formulation 

Visus Therapeutics Inc. today announced that it has expanded its pipeline via the acquisition of all patents and other assets of ViewPoint Therapeutics Inc.

Visus CEO Ben Bergo announced the information today during a presentation at the Eyecelerator meeting at the American Academy of Ophthalmology conference in Chicago.

Founded in 2014, ViewPoint discovered and developed alpha-crystallin aggregation inhibitors as investigational non-surgical treatments to correct protein misfolding in the lens. Protein misfolding reduces lens elasticity and clarity leading to presbyopia and cataract, the leading causes of visual disability worldwide.

Presbyopia is an inability to see near objects clearly, due to a loss of lens elasticity, that begins in the 40s and inevitably worsens with age. As protein misfolding worsens, cataracts, or clouding of the lens, may develop that can affect all vision-related activities. Alpha-crystallin aggregation inhibitors are intended to restore elasticity and lens clarity, potentially reversing presbyopia and cataracts without the need for surgery.

“Visus is currently conducting two Phase 3 pivotal studies of its preservative-free eyedrops, Brimochol PF and Carbachol PF, for the treatment of presbyopia,” Bergo said.

According to Bergo, the ViewPoint assets will enhance his company’s pipeline.

“The ViewPoint assets are a natural complement to this late-stage program and will enable the company to further expand its pipeline targeting the leading causes of age-related vision loss,” he said.

Eric D. Donnenfeld, MD, a founding partner of Ophthalmic Consultants of New York, a clinical professor of ophthalmology at New York University Medical Center and chairman of Visus, medical advisory panel, noted that more than a third of the world’s population have presbyopia or cataracts, a number likely to grow as the population ages.

“A non-surgical approach to treating and possibly preventing cataracts and presbyopia could improve the quality of life of millions of people, globally, and would be a disruptive addition to the management of our patients, Donnenfeld said in the news release.

Rhett M. Schiffman MD, MS, MHSA, noted in the news release that the company has

already demonstrated that intraocular delivery of alpha crystallin aggregation inhibitors reverses age-related cataracts in primates, forming confidence that this approach may be effective in humans.

“It may even be possible that intervening in presbyopia may not only restore near vision but prevent the development of cataracts in many patients,” Schiffman said in the news release. “The ViewPoint acquisition provides an extensive library of potent drug candidates with highly desirable pharmaceutical properties for ocular delivery.”

Library of ViewPoint drug candidates will accelerate development of novel alpha-crystallin chaperone compounds as a non-surgical treatment for age-related cataracts.

California governor vetoes bill that would have reduced licensing requirements to perfom eye surgery

ImprimisRx launches compounded Antibiotic Formulation

Visus Therapeutics expands ophthalmic drug development portfolio with acquisition of ViewPoint Therapeutics' assets

Ophthalmology EyeCon 2022