
ICYMI: Daria Lemann Blumenthal, LLB, EMBA, CEO of BELKIN Laser, Ltd., discusses the company's current initiative of developing an automated one-second laser therapy for glaucoma called direct selective laser trabeculoplasty (DSLT), during the 2020 Glaucoma 360 meeting in San Francisco, California.

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Daria Lemann Blumenthal, CEO of BELKIN Laser, Ltd., discusses the company's current initiative of developing an automated one-second laser therapy for glaucoma called direct selective laser trabeculoplasty (DSLT).

Glaucoma 360: Accessible glaucoma care in 1 second (BELKIN Laser)


Kinsa Inc. has been producing a smart thermometer for a while, but amid the COVID-19 pandemic it has become more valuable as it is used to map out coronavirus hotspots since March.

And, according to a report by National Public Radio, the device is so accurate that public health expects are sitting up and taking notice.

The data obtained using the thermometer is uploaded immediately after the thermometer is used and is provided at no cost to scientists, public health officials, and the individual using the thermometer.

, can track the fever levels and changes in a person around the country. At this point, individuals with a high fever are not identified specifically.

According to Inder Singh, MBA, data have proved just how effective social distancing is. He reported that after states shut down in response to the pandemic, the levels of fever began declining with social distancing.

“It showed that people’s sacrifices at home were working,” he said. “People should know that they were helping to save others’ lives.”

Singh is CEO of Kinsa Inc., and creator of the thermometer.

Conversely, the thermometer showed that the fever levels in Arizona, a new viral hotspot, were beginning to increase because of new transmissions as early as May 29. The same type of information emanated from Florida and Texas on June 9. Recently, Oklahoma and Missouri saw similar shifts, which have been accompanied by increased cases and hospitalizations.

The key to success here is that the thermometer can pick up on the illness because it is being used early on during the first sign or symptoms recognized.

Early recognition can result in changes in the reopening plans, which in turn can result in better viral control.

Articles

Amid the COVID-19 pandemic, a smart thermometer has become a valuable tool in detecting coronavirus hotspots.

COVID-19: Smart thermometer shows real-time changes in fever levels

The spikes that are characteristic of COVID-19 are well-documented and readily recognizable. However, there has been a subtle change noted by Egon Ozer, MD, PhD, from the onset of the pandemic in January to May, when the virus ultimately engulfed New York City.

The change in the virus seemed minimal, with just 1 amino acid affected, specifically number 614, which Dr. Ozer explained, switched in a new variant for glycine that replaced aspartic acid.

Ozer is from the Northwestern University Feinberg School of Medicine, Chicago.

, this change facilitated the spiking ability of the virus to more efficiently gain entrance into human cells.

In addition to this ability to break into the cells, scientists at Los Alamos National Laboratory published their 

 that individuals with the new glycine variant have more virus in their bodies, which increases the likelihood they will be more infectious to others.

This potent variant now seems to be the dominant variant around the world.

However, recognizing it is one thing. Dealing with it is another matter.

A positive observation is that the mutation does not seem to lead to worse outcomes in patients, according to Hyeryun Choe, PhD.

“Nor did it alter the virus’s response to antibodies from patients who had the D variant,” said Choe, a professor in the Department of Immunology and Microbiology,

Scripps Research, Jupiter, Florida.This means that the vaccines being developed based on the original version of the virus will be effective against this mutation.

While the spikes that are characteristic of COVID-19 are well-documented, researchers have detected a subtle change from the onset of the pandemic in January to May, when the virus ultimately engulfed New York City. 

COVID-19 mutations: A more efficient virus



The FDA recently approved the first prescription-only topical ocular formulation of the second-generation antihistamine cetirizine for the treatment of ocular itching associated with allergic conjunctivitis.

Cetirizine ophthalmic solution 0.24% (Zerviate, Nicox Ophthalmics Inc; licensed to Eyevance Pharmaceuticals, LLC) demonstrated robust efficacy in 3 randomized, double-masked, placebo-controlled clinical trials using the Ora Conjunctival Allergen Challenge (CAC) model among patients with allergic conjunctivitis.

Two of the trials that evaluated onset and duration showed that cetirizine ophthalmic solution led to statistically and clinically significantly less ocular itching versus vehicle at 15 minutes and 8 hours after treatment.

Conjunctival melanoma: Unlocking mysteries of disease



The ophthalmic solution breaks the 10-year drought since the last approval for allergic conjunctivitis treatment, with the twice-daily drops hitting the market in March 2020.

Cetirizine hydrochloride (Zyrtec, Johnson & Johnson Consumer) is recognized as the number 1 oral antihistamine allergy treatment recommended by allergists, with 23 years on the market and countless doctor and patient years of experience.

 

Based on its vast track record of therapeutic success and safety in different formulations, the industry sought to develop cetirizine as an ophthalmic solution.



Allergic conjunctivitis affects at least 30% of Americans.

 Reactions range anywhere from mild—making it merely a self-limiting nuisance—to the other end of the spectrum, when allergies become a debilitating disease, causing patients to have a significantly impaired quality of life. 

Stimuli, whether tree and grass pollens, animal hair and dander, or any number of other environmental insults, manifest in the familiar cascade of ocular symptoms that include itching, redness, chemosis, tearing, and eyelid swelling.

Thanks to the vast work being done around 

—along with fine-tuning of diagnostic and treatment algorithms—awareness among eye care specialists to diagnose and treat the “red eye” is improving. 

Allergic conjunctivitis is a frequent and substantial piece of the puzzle when it comes to finding the root cause of ocular surface disease.

Patients with allergies typically have bilateral signs and symptoms, with the most common ocular symptoms being itching, burning, redness, and tearing. 

Allergic conjunctivitis is often associated with swelling, an important area of differentiation from 

disease. Eversion of the lower lid is highly advised to assess the extent of chemosis.



Investigational topical corticosteroid demonstrates efficacy for dry eye 


In response to an allergen, the process of conjunctivitis has an early acute phase followed by a late phase. Allergens interact with immunoglobulin E, which is bound to sensitized mast cells that in turn activate increased histamine and subsequent degranulation.



The release of histamine and other proallergic mediators during the acute phase induces itching, vasodilation, and vascular leakage. This is followed by ocular redness, chemosis, and lid swelling. 

Mast cells then synthesize, releasing cytokines, chemokines, and growth factors, which kicks off a cascade of inflammatory events. 

During the final late-phase reaction, eosinophils, neutrophils, and macrophages infiltrate conjunctival tissues.

The commonly used and approved treatments for 

 include antihistamines and mast cell stabilizers, or both; and these agents act to reduce the signs and symptoms of the early-phase reaction.

Exploring off-label, investigational approaches for allergic conjunctivitis 


Cetirizine is a second-generation antihistamine (highly selective H1 receptor antagonist) that binds competitively to histamine receptor sites to reduce swelling, itching, and vasodilation. Two phase 3 efficacy studies revealed strong and similar anti-itch efficacy of cetirizine ophthalmic solution 0.24% compared with vehicle (using the CAC model).

The single-center (study 1) and multi-center (study 2), double-masked, randomized, vehicle-controlled, parallel group CAC studies were conducted over approximately 5 weeks and 4 study visits.

Patients with moderate and severe symptoms were enrolled in the trials, and study 2 required patients to have more severe allergic conjunctivitis symptoms. Subjects were screened for an allergen response at visits 1 and 2 and then randomized at visit 3. 

Approximately 100 subjects were randomly assigned in each study. The primary efficacy end points were ocular itching and conjunctival redness 15 minutes and 8 hours posttreatment, post-CAC.



Researchers eye cure, diagnostics for adenoviral conjunctivitis 

Investigators administered cetirizine 15 minutes or 8 hours before CAC, and subjects had significantly lower ocular itching at all time points post-CAC (

< .0001) compared to vehicle in both studies. 

The investigators’ assessment of conjunctival redness was significantly lower after cetirizine treatment compared to vehicle at 7 minutes post-CAC and at both 15 minutes and 8 hours posttreatment in both studies (

Numerous secondary end points, ocular and nasal, were also examined.

It should be noted that the most robust treatment differences were observed in study 2, where patients were required to have more severe symptoms in order to be included (

 < .05). Investigators identified no safety concerns for cetirizine ophthalmic solution 0.24%.



ASCRS 2020: OSD improvement in eyes implanted with trabecular meshwork bypass stents



For added comfort, cetirizine ophthalmic solution 0.24% is designed with Hydrella, which includes glycerin and hydroxypropyl methylcellulose, ingredients commonly found in lubricant drops. 

Patients in the FDA trials reported a mean comfort score of less than 1 at all time points (on a scale of 1-10, with 1 being the most comfortable). The solution is also formulated with a neutral pH of 7.0, similar to the natural tear film.



Eye-care providers now have a solution for patients with allergic conjunctivitis experiencing disruptive ocular itching. 

The drop form of cetirizine ophthalmic solution 0.24% gives eye care providers a chance to greatly improve patients’ quality of life with an effective and targeted approach. 



Ocular surface inflammation: Vicious cycle of ocular surface disruption



Notably, unlike some oral antihistamines, the new formulation did not cause drowsiness.

Cetirizine ophthalmic solution 0.24% is a strong therapeutic with an ability to quickly quell ocular itching for patients experiencing allergic conjunctivitis. 

There are no safety concerns identified with cetirizine treatment. Drop comfort is rated as “very comfortable.”


718/261-2666
Richard D Najac, MD, FACS, is a second-generation ophthalmologist practicing in Queens, New York, for more than 20 years. Dr Najac is an investor of Eyevance.

732/445-4636
Richard Teofilo Atallah, PGY-3, is a third-year medical student at Rutgers New Jersey Medical School in Newark, New Jersey,, and has no financial disclosures related to this product.

1. Meier EJ, Torkildsen GL, Gomes PJ, Jasek MC. Phase III trials examining the efficacy of cetirizine ophthalmic solution 0.24% compared to vehicle for the treatment of allergic conjunctivitis in the Conjunctival Allergen Challenge model. 

 2018;12:2617-2628. doi:10.2147/OPTH.S185835

2. Zyrtec the #1 allergist recommended brand. Johnson & Johnson Consumer Companies, Inc. Accessed May 21, 2020. http://www.multivu.com/ assets/52078/documents/Zyrtec-fact-sheet-99-original.pdf

3. Bielory L. Allergic and immunologic disorders of the eye. Part II: ocular allergy. 

 2000;106(6):1019-1032. doi:10.1067/mai.2000.111238

4. La Rosa M, Lionetti E, Reibaldi M, et al. Allergic conjunctivitis: a comprehensive review of the literature. 

5. Bacon AS, Ahluwalia P, Irani AM, et al. Tear and conjunctival changes during the allergen-induced early- and late-phase responses.

 2000;106(5):948-954. doi:10.1067/mai.2000.110930

6. Ciprandi G, Buscaglia S, Pesce GP, Bagnasco M, Canonica GW. Ocular challenge and hyperresponsiveness to histamine in patients with allergic conjunctivitis. 

1993;91(6):1227-1230. doi:10.1016/0091-6749(93)90327-c

7. Gomes PJ. Trends in prevalence and treatment of ocular allergy. 

. 2014;14(5):451-456. doi:10.1097/ACI.0000000000000100

8. Abelson MB, Shetty S, Korchak M, Butrus SI, Smith LM. Advances in pharmacotherapy for allergic conjunctivitis. 

2015;16(8):1219-1231. doi:10.1517/14656566.2015.1040760

First new therapy in nearly a decade offers another option for physicians, patients


New molecule for allergic conjunctivitis makes debut

This article was reviewed by N. Douglas Baker, MD



A new study is one of the first head-to-head clinical reviews comparing a minimally invasive 

surgery (MIGS) device with trabeculectomy in patients with primary open-angle glaucoma (POAG).

The MicroShunt (Santen) is a subconjunctival 

 device made from polystyrene-block-isobutylene-block-styrene (SIBS) material. It is 8.5 mm in length, has a 70-μm lumen, and is highly biocompatible. It enters the anterior chamber at the trabecular meshwork level and forms an aqueous lake beneath the conjunctiva and Tenon’s capsule 3 mm to 6 mm posterior to the limbus.



Douglas Baker, MD, and colleagues have presented 1-year results from a 2-year study to assess the safety and effectiveness of stand-alone MicroShunt surgery (Figure 1) versus trabeculectomy in patients with POAG.

The randomized, single-masked study was conducted at 29 sites, 24 of which were in the United States. 

Patients were between the ages of 40 and 85 years with POAG and were on the maximum tolerated amount of 

 medications. 

The exclusion criteria were previous conjunctival incisional surgery, aphakia, angle closure, and secondary open-angle glaucomas such as post trauma, pseudoexfoliation, or pigment dispersion.

Minimally invasive glaucoma shunt delivers for patients

The primary outcome the investigators were looking for was a reduction in IOP of 20% or greater at 1 year, without increasing the number of medications from baseline. 

They measured IOP over time, number of 

 medications, adverse events (AEs), incidence of persistent hypotony, postoperative interventions, and corneal endothelial cell density.

, the conjunctiva and Tenon’s capsule were removed at the limbus as a unit. The mytomycin (0.2 mg/mL)–soaked Weck-Cel sponge was placed on the sclera and beneath the Tenon’s for 2 minutes. The initial incision in the sclera is 3 mm posterior to the limbus, and the blade enters the anterior chamber at the trabecular meshwork level.

Within the overall study population, the primary effectiveness end point was met 53.9% of the time with the MicroShunt and 72.7% of the time with trabeculectomy. 

If the focus is placed on the group with IOP 21 mm Hg or greater, the MicroShunt met the primary end point 63.8% of the time and trabeculectomy 75% of the time.

Looking at the mean IOP over time, starting at baseline at 21.1 mm Hg, at 1 year the mean in patients with the MicroShunt was 14.2 mm Hg and with the trabeculectomy, 11.2 mm Hg. The mean number of 

 medications was 3 at baseline, and after intervention at the end of 1 year, 0.6 medications for the MicroShunt and 0.3 for the trabeculectomy.

Glaucoma treatment alternatives: Thinking outside the box

There was a 5.2% loss in corneal cell density with the MicroShunt, and a 6.9% loss with trabeculectomy. Persistent ocular hypotony occurred 3.0% of the time with the MicroShunt and 9.9% with trabeculectomy. Cataract progression was seen 12.2% of the time in the MicroShunt group and 17.6% in the trabeculectomy group. 

For visual acuity, loss of more than 2 lines of best-corrected visual acuity occurred 11.1% of the time in patients with the MicroShunt and 14.5% in those who had trabeculectomy. Choroidal effusion occurred in 4.8% of those with the MicroShunt and in 7.6% with trabeculectomy.

Postoperative interventions included suture lysis and medication change, occurring in 40.8% of patients with the MicroShunt and in 67.4% of those who received trabeculectomy. There were no reports of endophthalmitis in either group at 1 year.

Microinvasive glaucoma surgery in children: Is there a role?

This was a prospective randomized study conducted in patients with primary open-angle glaucoma taking the maximum-tolerated number of 

 medications. 

Both trabeculectomy and MicroShunt implantation resulted in a reduction in IOP and supplemental glaucoma medications at 1 year.

In the MicroShunt group, 53.9% of patients experienced a 20% or greater decrease in mean diurnal intra-operative pressure from baseline to year 1. 

This increased to 63.8% in the group that had IOP 21 mm Hg or greater when they entered the study. There was a reduction in mean diurnal IOP, from 21.1 mm Hg at baseline to 14.2 at 1 year.

The mean number of medications decreased from 3.1 to 0.6 at 1 year and 71.6% of patients were medication free at 1 year. Incidents of AEs and corneal endothelial cell loss were similar between the 2 groups, and there were no reports of endophthalmitis at 1 year.

Genetic variants linked with onset, progression of POAG

The study provides 1-year data on the MicroShunt from 29 sites in the United States, the Netherlands, Spain, Italy, France, and the United Kingdom. Patients with POAG on maximum-tolerated medical therapy (baseline IOP, 15-40 mm Hg) and no previous history of conjunctival surgery were included. 

In the study, patients with uncontrolled POAG who underwent MicroShunt implantation achieved, on average, IOP of less than 15 mm Hg up to 1 year after surgery.


N. Douglas Baker, MD, is a consultant to Santen.

Study targets results of MIGS device versus trabeculectomy 


ICYMI: Yvonne Ou, MD, discusses her presentation on "Apps for the visually challenged," including which accessibility features of smartphones patients may find helpful, during the 2020 Glaucoma 360 annual meeting in San Francisco, California.

ICYMI: Yvonne Ou, MD, discusses her presentation on "Apps for the visually challenged," during the 2020 Glaucoma 360 annual meeting in San Francisco, California.

Glaucoma 360: Apps for the visually challenged

Outlook Therapeutics Inc. has completed patient enrollment for the NORSE 2 clinical trial as it works to develop the first FDA-approved ophthalmic formulation of bevacizumab for use in retinal indications.

Bevacizumab-vikg (ONS-5010/Lytenava, Outlook Therapeutics Inc.) is the investigational ophthalmic formulation of bevacizumab under development to be administered as an intravitreal injection for the treatment of wet AMD and other approved retinal diseases.

“We are extremely grateful to the patients and medical staff who continue to take part in this study, even amidst the effects of the COVID-19 pandemic,” said Lawrence A. Kenyon, president, CEO and CFO of Outlook Therapeutics, in a prepared statement. “The hard work and dedication shown by these individuals have made it possible for us to achieve this important milestone, which now starts the clock to the completion of the study and to our reporting of pivotal data, expected in the third calendar quarter of 2021.”

According to Outlook Therapeutics, the NORSE 2 clinical trial commenced patient enrollment in July 2019. Due to the number of patients in screening at the time of achieving the trial’s stated goal of enrolling 220 patients in the study, Outlook Therapeutics has enrolled 227 patients at 39 clinical trial sites in the United States.

The company noted that patients in the trial are being treated for 12 months.

Moreover, the primary endpoint for NORSE 2 is the difference in proportion of patients who gain at least 15 letters in best-corrected visual acuity at 11 months for ONS-5010 dosed on a monthly basis, compared with 

, Genentech), which is being dosed quarterly per the PIER regimen.

Outlook Therapeutics noted it expects to report pivotal safety and efficacy data in the third calendar quarter of 2021.

According to Mark Humayun MD, medical advisor for Outlook Therapeutics, the use of anti-VEGF therapy continues to be the standard of care for many ophthalmic diseases within the retina community.

“Given the high cost of the present FDA-approved anti-VEGF therapies, many physicians have turned to off-label repackaged bevacizumab supplied by compounding pharmacists,” Humayun said. “There is significant unmet patient need for an FDA-approved bevacizumab for use in treating retinal diseases.”

Humayun said bevacizumab-vikg, if approved, would offer clinicians a “safe and effective, on-label anti-VEGF therapy option across the spectrum of retinal care.”

According to the statement, Outlook Therapeutics intends to complete development of ONS-5010 for submission to the FDA as a new BLA under the 351(a) PHSA regulatory pathway for the treatment of wet AMD and also has plans to submit for regulatory approvals in Europe and Japan, as well as other countries.

The NORSE 1 clinical trial completed enrollment in August 2019 and is on pace to report topline data in August 2020. The clinical trial enrolled a total of 61 treatment naïve and previously treated patients at 9 sites in Australia.

According to the company, NORSE 1 will provide initial safety and efficacy data for ONS-5010 in wet AMD patients for ONS-5010 dosed monthly compared with ranibizumab dosed using the PIER alternative dosing regimen of 3 monthly doses followed by quarterly dosing.

In a statement, Kenyon also noted that the company is preparing to initiate the NORSE 3 open-label study, which is meant to ensure enough patients have been exposed to ONS-5010 to meet the requirements for Outlook Therapeutics’ planned BLA submission next year.

“We expect to commence NORSE 3 in the fourth calendar quarter of 2020,” he said in the release.

The NORSE 3 open-label safety study will be conducted to ensure the adequate number of safety exposures to ONS-5010 are available for the initial regulatory filings.

In total, about 180 patients are expected to be enrolled in several different vascular and inflammatory retinal diseases where an anti-VEGF drug can be used as a therapeutic option. Patients in NORSE 3 will receive 3 doses of ONS-5010 over 3 months.

“We believe there is a sizeable market opportunity for ONS-5010 which, if approved, will be a cGMP-produced, responsibly priced, on-label ophthalmic formulation of bevacizumab to treat retinal diseases—an option that is not currently available,” Kenyon concluded in a release. “We are dedicated to bringing ONS-5010 to market as quickly and efficiently as possible so that patients can benefit from the safety and reliability of an FDA-approved product.”

Patient enrollment for the NORSE 2 clinical trial has been completed, with safety and efficacy data expected to be reported in the third quarter of 2021. 

Company seeks first FDA-approved ophthalmic formulation of bevacizumab for use in retinal indications

This article was reviewed by Donald S. Fong, MD, MPH



Research is focusing on topical medication adherence and visual field progression in open-angle glaucoma (OAG).

At the 2020 meeting of the American Glaucoma Society (AGS), Donald S. Fong, MD, MPH, of Kaiser Permanente Southern California (KPSC), presented a study designed to assess the effect of treatment adherence to topical 

medications on visual field progression, using data from clinical practice. 





Not surprisingly, the study found that poorer medication adherence was significantly associated with a faster rate of visual field decline.

Elevated IOP is the only modifiable risk factor to reduce the risk of progression in OAG, and first-line treatment is typically topical ocular drops to lower IOP.

“Low medication adherence may increase the risk of damage from 

, but there is a lack of quantitative data on the relationship between treatment adherence and glaucomatous visual field progression,” Fong said.



Emerging therapy for open-angle glaucoma 


To address the lack of data, Fong and colleagues examined records from KPSC, an integrated health system that provides comprehensive care to over 4.6 million members.

Fong noted several benefits of utilizing this population.

“In our integrated health system,” he said, “KPSC members receive their prescriptions from a single source, and patients tend to be long-term members of the health plan.”

He explained that this allows for tracking patient refills, and makes long-term followup possible. The population is also representative of the state of California for racial diversity.




For the study, patients meeting inclusion criteria were stratified by severity of baseline visual field measurements, using readings from 6 months before and after the index date. 

For patients that had no visual field measurements in the time frame, their baseline disease severity was designated as “missing.”

Adherence was measured by proportion of days covered, which was determined as the number of days that the patient was supplied with medication, divided by the number of days in the period of interest.

Patients who received multiple medications were considered adherent if 1 or more of their medications was filled, and adherence was reported in categories of low, moderate, and high.



 Pharmacologic treatment an option for open-angle glaucoma



The investigators hypothesized that the interaction between adherence and time would be positive. In other words, for a given follow-up time, patients with better adherence would have better mean deviation (i.e., less severe disease).

“Our study is the first to use real-world data to quantify the impact of non-adherence on 

 progression,” Fong said. “We demonstrated that treated 

 patients who were more adherent showed less loss of visual function. We need to improve patient adherence to medications because higher adherence will delay glaucoma progression and loss to a patient’s quality of life.”

626/851-6107
Dr. Fong has no financial disclosures related to this subject.

Research is seeking benefits, options for open-angle glaucoma patients

Study targets topical medication adherence, visual field progression


Physicians, just like the patients we serve, are facing an unprecedented emotional burden from the COVID-19 pandemic. 

First-line responders are at especially high risk of experiencing psychological hardship from the burden of disease, death and anxiety, whereas physicians not on the front lines are feeling the strain of worried patients, financial hardship and uncertainty about the future.

Increased emotional stress during this time may also increase the risk of physician depression. An estimated 300 to 400 physicians take their own lives each year.



Could pandemic impact well-being of ophthalmologists?

Emotions, just like viruses, are contagious. Psychologist and author Steven Cohen, Psy.D., notes that doctors, just like all others, are at risk of internalizing the negative feelings of the people around them. 

Physicians who work in a daily atmosphere of severe emotional distress and fear must take special precautions to avoid being overwhelmed by negative emotions.

According to Cohen, the first step to managing emotional distress is to simply acknowledge and examine our emotional reactions. 

Physicians often experience guilt, anxiety or shame when we experience powerful emotions like sadness or anger. This discomfort prompts us to try to repress these feelings. 

Cohen says that it’s essential to acknowledge and reflect on these feelings. The simple act of labeling our emotions can be a powerful tool in coping with these feelings.

AMA, ACP leaders spotlight 'emerging ethical lessons' from COVID-19 

This is especially important when we experience the emotional impact of patient death. Physicians who lose patients report feelings of self-doubt, failure, guilt and powerlessness. Physicians also report sadness after a patient’s death, including experiencing insomnia and crying.

Traditionally, grief in medical training has been considered weak or unprofessional, and doctors have been encouraged to keep their feelings inside. 

Rather than openly expressing grief, physicians instead use compartmentalization, isolation and distraction to avoid our negative emotions.

The problem with these techniques is that they are emotional barriers that prevent us from addressing our feelings. Instead, we must practice healthy coping mechanisms such as acknowledging our feelings and accepting support from others.

Technology makes physicians more efficient, reduces burnout

Physicians are often reluctant to share our negative emotions with others. Sometimes we choose not to share the negatives in our life because we don’t want to burden our friends or partners. 

This noble intention can cause a relationship rift because it does not allow others in our life to offer support. 

Ultimately, that leads to our own isolation. It is critically important to open up about our feelings with those closest to us—a family member or trusted friend or colleague.

In some cases, we may need to reach out to a professional to help us cope with powerful emotions. Asking for help is not a sign of weakness. It takes more courage to ask for help than it does to suffer in silence. And getting help makes us stronger so we can help others.

We must remember that we are not alone. Physicians are incredibly resilient—you do not get through medical school, internship and residency without incredible fortitude. We will get through this as well. We just need a little help from our friends, family, each other and, perhaps, a good psychologist.

American College of Physicians offers recommendations to keep pandemic flexibilities

, is a family physician in Fort Myers, Florida, and the author of

 “Physician Wellness: The Rock Star Doctor’s Guide.”

Medical practitioners face emotional burden, other hurdles from pandemic

Strategies for coping with physician depression during COVID-19



ICYMI: Dale Heuer, MD, (retired) professor, chair of Ophthalmology and Visual Sciences at the Medical College of Wisconsin, discusses the importance of ophthalmologists identifying and providing more aggressive treatment care for patients with low/high risks of developing glaucoma, during the 2020 Glaucoma 360 conference in San Francisco, California.

Dale Heuer, MD discusses the importance of ophthalmologists identifying and providing more aggressive treatment care for patients with low/high risks of developing glaucoma.