December 22, 2021

The most important ophthalmology research updates, delivered directly to you.
Happy Holidays from The Lens team! 🎄🎉❄️

In this week's issue

  • 50% of subjects reported subjective improvement in Sjogren’s related dry eye syndrome after fecal microbial transplant
  • When screening for glaucoma, handheld chromatic pupillometers are similar in sensitivity/specificity to visual field testing, but not as effective as OCT.
  • Cataract surgery may lower risk of dementia

Telehealth During COVID-19: Equal Access for All?


The phrase, “You’re on mute” was one of the most common phrases during the pandemic, but how has our relentless struggle with technology affected access to telemedicine appointments? This cross-sectional study analyzed 8,116 encounters (5,023 patients) to identify factors affecting patients’ likelihood to complete telephone, video, or in-person ophthalmology appointments. Compared to White patients, Black (p<0.001) or Hispanic/Latino (p=0.002) patients were significantly less likely to have a video or telephone appointment. Additionally, barriers to video appointments included older age (p<0.001), non-English speaking (p=0.01), Black race (p<0.001), or Hispanic/Latino ethnicity (p=0.005). Although this study identified groups of patients that were less likely to receive telehealth care, it did not analyze whether this lack of access had any negative impact on outcomes. Additionally, 78.3% of patients included in the study attended in-person visits only and it is therefore difficult to draw conclusions about quality of care in a field so heavily based on a physical exam. 

Prevalence of Macular Pathologies in High Myopia

JAMA Ophthalmology

The prevalence of myopia and high myopia are increasing in populations across the world. Pathologies associated with high myopia (and directly related to eye axial length) include myopic macular degeneration (MMD), posterior staphyloma, myopic choroidal neovascularization, Fuchs spot, and lacquer cracks. Given its increasing role in causing visual problems internationally, Haarman and colleagues assessed the frequency of myopic macular features in individuals with high myopia (mean refractive error -9.9) in a cross-sectional study of the Dutch Myopia Study. The prevalence of MMD was 25.9% in this population and increased with older age, lower spherical equivalents of refractive error, and greater axial length (p < 0.001 for each). Other common findings included tessellated fundus, staphyloma, and peripapillary atrophy. Overall, complications were highly prevalent, and similar to the levels seen in an analogous study on an Asian population. As there are no treatments for many of these complications, this study highlights the growing need for strategies to prevent high myopia.

Fecal Microbial Transplant in Immune-Mediated Dry Eye

American Journal of Ophthalmology

No fecal jokes here - too many smells for us ophthalmologists. It is widely accepted that the gut microbiome contributes to systemic inflammation and immune function through the generation of proinflammatory T cells. Fecal microbial transplantation (FMT) from a healthy donor has also been shown to help treat inflammatory conditions, and therefore has been theorized as a potential treatment for immune-mediated dry eye. Investigators examined the safety of FMT in patients with dry eye secondary to Sjogren's Syndrome. A total of 10 individuals underwent two separate FMTs. Their gut microbiomes, dry eye metrics, and T-cell profiles were evaluated at baseline and at the subsequent follow-up timepoints. FMT was safe and tolerable in all individuals, and positive correlations were noted between dry eye symptom severity and effector T cell metrics. In addition, 50% of subjects reported subjective improvement in dry eye symptoms 3 months after FMT. There are several limitations to this study, including the fact that we do not know the optimal dosage of FMT, nor what gut microbiome profile is optimal for the treatment of immune-mediated dry eye. Future studies should target specific deficits in gut microbiota for patients with immune-mediated dry eye.

Handheld Pupillometers to Detect Visual Field Loss in Glaucoma

British Journal of Ophthalmology

An effective and easy screening measure for glaucoma remains elusive, especially given the absence of symptoms early in the disease course. Chromatic pupillometry (which measures the pupillary response to light stimulations of different wavelengths/colors) has increasing become useful in evaluating retinal and optic nerve health because it assesses the integrity of retinal photoreceptors and intrinsically photosensitive retinal ganglion cells (ipRGC). In this prospective study, the authors sought to compare pupillary responses using a handheld chromatic pupillometer between 149 patients with confirmed glaucoma and 173 healthy controls. The sensitivity for identifying patients with glaucoma was 87.9%, the specificity was 88.4%, and area under the ROC curve was 0.94. For early/moderate glaucoma, the chromatic pupillometer had similar performance to Humphrey Visual Field but reduced compared to OCT. This study highlights the potential utility of a handheld chromatic pupillometer to detect functional vision loss in glaucoma.


Cataract Extraction and Dementia Risk 

JAMA Internal Medicine

Do the benefits of cataract surgery extend beyond the eye? Cataracts are a leading cause of blindness worldwide, and vision impairment has been shown to be a risk factor for the development of dementia. This prospective, longitudinal cohort study followed 3038 study participants aged 65 and older with cataracts until the onset of dementia. Participants who underwent cataract extraction were at lower risk of developing all-cause dementia compared to those who did not undergo cataract surgery, even after adjusting for multiple confounders. Though the exact mechanism of the association is unclear, it has been hypothesized that sensory impairment can lead to decreased cognitive stimulation, social engagement, or healthcare access, thereby increasing the risk of dementia. 


Oculofacial Plastic Surgeon Distribution in the US


Where in the world…are the oculofacial plastic surgeons? The national density of ophthalmologists has declined since 1995, and rural parts of the United States already have disproportionately fewer ophthalmologists compared to urban areas. This paradigm may impede access to care for a large portion of the population. This study attempted to characterize the supply and distribution of oculofacial plastic surgeons (OPS) in the U.S by searching the public databases of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and the American Academy of Ophthalmology (AAO). In the U.S, 89% of counties had no OPS. Two states (North Dakota and Wyoming) had no OPS representation. The average national density of OPS was 1 per 279,955 people (0.3572 OPS per 100,000 population), but the density ranged from 0 to 11.26 OPS per 100,000 population. These findings suggest that there may be areas in the U.S without an adequate supply of OPS, but more research is needed to better characterize the subspecialty needs in areas without OPS representation.

End of Month Quiz

1. Difluprednate, which was associated with resolution of anterior scleritis, belongs to what class of medications?
B. Immunosuppressives
C. Corticosteroids
D. None of the Above

2. Results from a retrospective cohort study published by Lu et. al in Ophthalmology found that the recombinant zoster vaccine (RZV) was able to protect against which disease(s)?
A. Herpes Zoster Ophthalmicus
B. Chickenpox/Varicella
C. Herpes Keratitis
D. All of the Above

3. True or False: Younger age was associated with higher medication adherence to eye drops in a study published by Khan et. al in Cornea.
A. True
B. False

4. Researchers at the University of Washington studying emergency department encounters found that, after COVID mitigation measures were implemented:
A. Encounters for corneal abrasions were unchanged
B. Encounters for nonallergic conjunctivitis decreased
C. Encounters for posterior vitreous detachments were unchanged
D. All of the above

Keep scrolling for answer or click here

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Quiz Answer: C, A, B, D
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