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| Vol. 26, #15 • Monday, April 15, 2024 |
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Off the Cuff: Dilation Reversal - Then and Now
The dilated eye exam has been the standard of care for decades, but nobody likes it whether you're the patient or the practitioner. For the patient, the light sensitivity and loss of near vision that can last for hours or even into the following day makes them dread this type of exam and, by extension, dread seeing us. More than once I've had a patient tell me they'd rather go to a dentist than be dilated. Yes, I was offended. Harrumph! For the practitioner, although we get a far easier view of the internals of the eye, especially for cataract evaluations, the patient avoidance or refusal as well as the additional time required waiting for a dilation that sometimes isn't that much better than the patient's natural pupil can be frustrating. To combat this, in 1991, Rev-Eyes (dapiprazole 0.5%- an alpha 1 adrenergic blocker) was introduced. It was supposed to hasten the reversal of the dilation to make it a far less harrowing experience for patients. Unfortunately, clinically, the side effects of redness (reported at 80%), stinging, edema, and headaches, the slow speed of recovery to normal pupil size and return of accommodation (some reports of up to 7 hours) wasn't that much improved over natural recovery, and the 21-day shelf life and expense saw Rev-Eyes discontinued in the early 2010s.
I was surprised to learn in September 2023 a new contender entered the ring. Ryzumvi (phentolamine 0.75% oph sol) is an alpha-1 and alpha-2 adrenergic antagonist working on both the sympathetic and parasympathetic pathways in an attempt to rapidly reverse pupil dilation. Preliminary studies reported onset of action at 30 minutes with maximum effect seen at 60 or 90 minutes. Ryzumvi has addressed the shelf life issue by supplying the drug as a single patient unit dose vial that ships and stores cold. It's still fairly pricey at $10 a vial, but this could and should likely be offered as an exam upgrade option to the patient. An incredibly lower side effect profile than Rev-Eyes with only a reported 12% hyperemia and 16% stinging, I'm interested to see how clinical experience with this new option pans out. I plan on bringing it into the office and hope to never hear a dental office visit preference again.
Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com.
The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.
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Effects and Potential Mechanisms of Exercise and Physical Activity on Eye Health and Ocular Diseases
In the field of eye health, the profound impact of exercise and physical activity on various ocular diseases has become a focal point of attention. This review summarized and elucidated the positive effects of exercise and physical activities on common ocular diseases, including dry eye disease (DED), cataracts, myopia, glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD). It also catalogued and offered exercise recommendations based on the varying impacts that different types and intensities of physical activities may have on specific eye conditions. Beyond correlations, this review also compiled potential mechanisms through which exercise and physical activity beneficially affect eye health.
From mitigating ocular oxidative stress and inflammatory responses, reducing intraocular pressure, enhancing mitochondrial function, to promoting ocular blood circulation and the release of protective factors, the complex biological effects triggered by exercise and physical activities reveal their substantial potential in preventing and even assisting in the treatment of ocular diseases.
This review aimed not only to foster awareness and appreciation for how exercise and physical activity can improve eye health but also to serve as a catalyst for further exploration into the specific mechanisms and key targets through which exercise impacts ocular health. Such inquiries are crucial for advancing innovative strategies for the treatment of eye diseases, thereby holding significant implications for the development of new therapeutic approaches.
SOURCE: Qiuxiang Zhang, Yuxian Jiang, Chaohua Deng, Junming Wang. Effects and potential mechanisms of exercise and physical activity on eye health and ocular diseases. Front Med (Lausanne). 2024 Mar 22:11:1353624.
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Peripapillary Atrophy Area Predicts the Decrease of Macular Choroidal Thickness in Young Adults During Myopia Progression
This study aimed to investigate the influence of peripapillary atrophy (PPA) area and axial elongation on the longitudinal changes in macular choroidal thickness (ChT) in young individuals with myopia. In this longitudinal investigation, 431 eyes-342 categorized as non-high myopia (non-HM) and 89 as HM-were examined for 2 years. Participants were examined with swept-source optical coherence tomography. The macular ChT, PPA area and axial length (AL) were measured at baseline and follow-up visits. Multiple regression analysis was performed to identify factors associated with ChT changes. The areas under the receiver operating characteristic curves were analyzed to ascertain the predictive capacity of the PPA area and axial elongation for the reduction in macular ChT.
Initial measurements revealed that the average macular ChT was 240.35±56.15 µm in the non-HM group and 198.43±50.27 µm in the HM group. It was observed that the HM group experienced a significantly greater reduction in average macular ChT (-7.35±11.70 µm) than the non-HM group (-1.85±16.95 µm). Multivariate regression analysis showed that a greater reduction of ChT was associated with baseline PPA area and the change in AL. The combination of the baseline PPA area with the change in AL was found to be effective in predicting the decrease in macular ChT, with an area under the curve of 0.741.
Over 2 years, eyes with HM exhibited a more significant decrease in ChT than those without HM. Combining the baseline PPA area with the change in AL could be used to predict the decrease of macular ChT.
SOURCE: Menghan Li, Ya Shi, Qiuying Chen, et al. Peripapillary atrophy area predicts the decrease of macular choroidal thickness in young adults during myopia progression. BMJ Open Ophthalmol. 2024 Apr 8;9(1):e001555.
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Reduced Contrast Sensitivity Function Is Correlated With Changes to Cone Photoreceptors in Simple High Myopia
This prospective study included 81 subjects, 20 with emmetropia (EM), 26 with low myopia and moderate myopia (LM/MM), and 35 with simple high myopia (SHM) to investigate contrast sensitivity function (CSF) changes in SHM and evaluate the correlations between these changes with early changes in the retinal microstructure. The area under the log CSF curve (AULCSF) and the cut-off spatial frequency (Cut-off SF) were employed as measures of CSF. Adaptive optics (AO) was employed to quantify the cone density, spacing, and regularity. The thickness and blood flow of the retinal sublayers were determined from vertical and horizontal optical coherence tomography angiography (OCTA) A-scans. Swept-source optical coherence tomography (SS-OCT) was employed to analyze the choroidal thickness (CT) and choroidal vascularity using a custom algorithm. Differences in the retinal and choroidal parameters, cone distribution, AULCSF, and Cut-off SF were compared among the three groups. Multivariate linear mixed models were used to elucidate the associations between photoreceptor morphological alterations, retinal and choroidal parameters, and AULCSF.
The AULCSF and Cut-off SF were significantly lower in the SHM group compared to the EM and LM groups. The SHM group had less cone density, larger cone spacing, and lower cone regularity than the EM and LM/MM groups. Moreover, the thickness of the inner segment of photoreceptors (IS), retinal pigment epithelium (RPE) layer and choroid were reduced, and the outer segment of photoreceptors (OS) was thicker in the SHM group compared to the EM and LM/MM groups. A longer axial length (AL) was correlated with decreased AULCSF, cone density, and cone spacing. Additionally, decreased CSF was correlated with lower cone density.
Decreased contrast sensitivity was observed in patients with SHM and cone density was significantly correlated with reduced AUCSF.
SOURCE: Jiefang Wang, Xinting Liu, Jing Huang, et al. Reduced contrast sensitivity function is correlated with changes to cone photoreceptors in simple high myopia. Front Neurosci. 2024 Mar 22:18:1274651
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Industry News
Oasis Introduces Soft Plug® Extended Duration 180-T Tapered Plug
Oasis® Medical launched the Soft Plug® Extended Duration 180-T Tapered Plug at ASCRS. The plugs are designed with a .25mm tapered end for ease of insertion into the punctal opening. They gradually widen to .6mm diameter at the top end to contribute to occlusion of the canaliculus. After insertion through the punctal opening and into the canaliculus, they degrade in approximately 180 days. Read more.
Brill Enters US Pharmaceutical Market with Corneal Esthesiometer
Brill, a new ophthalmologic pharmaceutical company headquartered in Miami, is planning to launch in May 2024 what it describes as the first and only non-contact and portable esthesiometer, the Corneal Esthesiometer Brill, an FDA-approved medical device that measures corneal sensitivity, a key biomarker to analyze the functional status of the corneal nerves. Doctors will be able to utilize the device to monitor patients across pathologies involving the corneal nerves. Read more.
Haag-Streit Slit Lamp Imaging Competition Includes Video Category
Haag-Streit launched its Slit Lamp Imaging Competition, in its sixth consecutive year. The competition judges image quality, technical execution and disease interest. New for 2024, entrants are encouraged to enter short videos taken on slit lamps, as well as images. Read more.
Announcements
iHealthScreen was awarded a U.S. patent on glaucoma detection based on AI and color fundus imaging. The iPredict glaucoma detection model provides a fully automated detection report for glaucoma that can be implemented in the primary care setting for screening and detection of early-stage glaucoma. Read more.
Sight Sciences announced MIGS study findings demonstrating the OMNI Surgical System Technology aqueous outflow restorative procedure was effective at lowering both IOP and IOP-reducing medications at two years in patients with glaucoma. Read more.
Coburn Technologies, a provider of ophthalmic lens processing systems and ophthalmic instruments, welcomed Jason Frank back to their US sales team as National Sales Manager – Coating Products. Read more.
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Journal Reviews Editor:
Shannon L. Steinhäuser, OD, MS, FAAO
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Optometric Physician™ (OP) newsletter is owned and published by Dr. Shannon L. Steinhäuser. It is distributed by the Review Group, a Division of Jobson Medical Information LLC (JMI), 19 Campus Boulevard, Newtown Square, PA 19073.
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