What's New in the Journals? not only reviews new publications in the peer-reviewed literature, it also comments on their relevance and suggests how you might use them in eye care practice. Follow the links to view the abstract of the paper or full text. 

 

 

  

*NEW* Pult H, Murphy PJ and Purslow C. A novel method to predict the dry eye symptoms in new contact lens wearers. Optom Vis Sci 2009:86:9 1042-1050.

What clinical signs and tests can best predict which patients are likely to experience dryness symptoms with soft contact lenses? A study from researchers at Cardiff University, published in Optometry & Vision Science, provides useful guidance.

The study investigates whether a combination of lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) plus other tear film tests and subjective evaluation before contact lens fitting could predict contact lens-induced dry eye.

Signs and tests were investigated in 33 new soft contact lens wearers. Symptoms were evaluated by the Ocular Surface Disease Index (OSDI) and subjects grouped according to their response to a Contact Lens Dry Eye Questionnaire (20 symptomatic and 13 asymptomatic). Subjects were fitted with vifilcon A (Focus Visitint) and senofilcon A (Acuvue Oasys) lenses for a 2-week period, consecutively.

Among the findings were:

·         LIPCOF non-invasive break-up time (NIBUT), and OSDI were better predictors than hyperaemia, tear meniscus height, phenol red thread test, staining, and LWE

·         Limbal hyperaemia decreased in senofilcon A lenses

·         Wearing comfort among symptomatic wearers was better with senofilcon A

·         Subjects who became symptomatic had decreased NIBUT and increased LIPCOF and OSDI at enrolment

The authors say the best test combination to predict the development of contact lens-induced dry eye is NIBUT plus LIPCOF Sum (Nasal,+ Temporal grades) and OSDI. This combination of clinical tests has been named the Contact-Lens-Predicting-Test.

 

 

CLICK HERE TO ACCESS THE ABSTRACT

CLICK HERE FOR THE OSDI QUESTIONNAIRE

 

 

 

*NEW* Vitale S, Sperduto RD and Ferris FL. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol 2009;127:12 1632-1639 .

The prevalence of myopia in the US has increased significantly since the 1970s, according to a study published in Archives of Ophthalmology.

The 1971-1972 National Health and Nutrition Examination Survey provided the earliest nationally representative estimates for US myopia prevalence. Using a similar method for diagnosing myopia, the authors examined data from the 1999-2004 survey to determine whether myopia prevalence had changed during the 30 years between the two surveys. Results showed:

• • The estimated prevalence of myopia in persons aged 12 to 54 years was 66% higher in 1999-2004 than in 1971-1972 (42% vs 25%)
  • Prevalence estimates were higher in 1999-2004 than in 1971-1972 for all levels of myopia, although overall the prevalence of severe myopia was low 
  • Prevalence estimates increased by 64% for males and 69% for females
  • The increase was greater for black individuals (33% vs 13%) than white individuals (43% vs 26%)
  • Differences in prevalence between the two surveys remained statistically significant among those with 12 or more years of formal education
  
•  

The authors observe that although myopia can be treated relatively easily with corrective lenses, the associated costs on a population basis are high. Identifying modifiable risk factors for myopia could lead to cost-effective interventional strategies, they say.

CLICK HERE TO ACCESS THE ABSTRACT OF THE PAPER

 

 

 

*NEW* Rahi JS, Cumberland PM and Peckham CS. Visual function in working adults: early life influences and associations with health and social outcomes. Ophthalmology 2009;116:1866-71. 

Impaired vision is associated with social factors such as unemployment, deprivation as well as poor health, according to a large-scale epidemiological study in the UK.

Researchers at the Institute of Child Health in London studied 9,330 adults aged 44 or 45 from the 1958 British cohort. They assessed distance, near and stereo acuities at medical examinations and recorded early life influences, and health and social outcomes in mid-adult life. They found that vision function was associated with: 

·         Unemployment resulting from permanent sickness

·         Lower socioeconomic status

·         Poorer general health

·         Low birthweight or being small for gestational age

·         Maternal smoking in pregnancy

·         Socioeconomic deprivation in childhood

The authors highlight the importance of investigating visual function in the wider context of health and social functioning. Life-course epidemiology may prove valuable in revealing how such factors contribute to chronic eye disease in adult life.

CLICK HERE TO ACCESS THE ABSTRACT OF THE PAPER 

 

 

  

  

*NEW* Nutrition counselling in the optometric practice. Optometry, 2009:80:10 587-9.

Nutrition counselling may soon be routine for optometrists in the US following new guidelines on the care of patients with age-related macular degeneration (AMD).

Among several articles on nutrition and eye health in its journal Optometry, the American Optometric Association says clinical practice guidelines to be issued early in 2010 will call on optometrists to advise patients on the benefits of proper nutrition.

The recommendations will be based on evidence from the Age-Related Eye Disease Study (AREDS) that antioxidant vitamins and minerals, taken in high doses by mouth, can reduce the progression to advanced AMD by 25% and the risk of moderate vision loss by 19% in specific patients, over a five-year period. 

The study recommended that patients at risk supplement their diets daily with the AREDS nutritional formulation 

·         500 mg of vitamin C

·         400 IU of vitamin E

·         15 mg of beta-carotene

·         80 mg of zinc oxide

 The formulation also calls for patients to take 2 mg of copper per day, because zinc supplements interfere with copper absorption. Research since the AREDS study suggests that the nutrients lutein and zeaxanthin, and the omega-3 fatty acids DHA and EPA, might also be beneficial.   

Other articles in this issue of Optometry include a review of macular pigment and healthy vision, and a summary of what patients should know about nutrition.

 CLICK HERE TO ACCESS THE FULL TEXT OF THE ARTICLE ON NUTRITION COUNSELLING CLICK HERE FOR THE FULL TABLE OF CONTENTSCLICK HERE FOR THE AREDS STUDY FROM 2001

What we think: AREDS showed that a specific high dose of antioxidants could help reduce the risk of advanced AMD for those already with moderate AMD, although there are concerns that taking high levels of supplements can cause other health problems. Use of lutein and zeaxanthin to prevent AMD is also subject to debate, particularly whether these should be taken as supplements to a balanced diet.

 

USE THIS IN YOUR PRACTICE TO:

•         Find out more about the latest thinking on nutrition and the eye

•         Discuss with patients the benefits of a healthy balanced diet

•         Advise that those diagnosed with AMD and considering supplements should also discuss this with their doctor

 

*NEW* Chu BS, Wood JM and Collins MJ. Influence of presbyopic corrections on driving-related eye and head movements. Optom Vis Sci 2009;86:11 E1267-E1275.

Driving is one of the most demanding of all visual tasks and requires special consideration in presbyopes. An Australian study published in Optometry & Vision Science reveals some surprising differences between presbyopic vision corrections when viewing and responding to driving-related traffic scenes.

Twenty presbyopes (mean age 56 years) with no experience of presbyopic correction other than single vision (SV) reading spectacles each wore: distance SV lenses, progressive addition spectacles (PAL), bifocal spectacles (BIF), and monovision (MV) and multifocal contact lenses (MTF CL).

 With each correction, subjects viewed video recordings of traffic scenes, tracked a reference vehicle, and identified peripheral targets. Digital numerical displays were included as near visual stimuli (simulating speedometer and radio). Results showed:

·         Path length of eye movements while viewing and responding to driving-related traffic scenes was significantly longer with BIF and PAL than MV and MTF CL

·         Path length of head movements was greater with all spectacle corrections  than with MV and MTF CL

·         No significant differences between daytime and night-time data 

·         Target recognition and brake response times were not significantly affected by vision correction but accuracy identifying near peripheral targets was affected

The authors say that the longer path length of eye and head movements and greater number of saccades associated with spectacle presbyopic corrections may affect driving performance by having a negative effect on attention and reaction times.

CLICK HERE TO ACCESS THE ABSTRACT OF THIS PAPER 

 

 

 

*NEW* Doughty MJ and Glavin S. Efficacy of different dry eye treatments with artificial tears or ocular lubricants: a systematic review. Ophthal Physiol Opt 2009;29:6 573-583.

Do dry eye treatments work and which type is most effective? To address these questions, researchers at Glasgow Caledonian University reviewed the outcome of 33 clinical studies published over a 20-year period.

The studies all used rose bengal staining (RB) as an outcome measure, carried out using the classic 0-9 grading scale, before and after the use of artificial tears or ocular lubricants for approximately 30 days. Results include:

·         The mean pre-treatment RB score was 4.25, decreasing to 2.84 after treatment, ie a net change of −1.43

·         With artificial tears (saline, hypromellose) the net change after one month of treatment was −0.95, with carbomer gels (polyacrylic acid) it was −1.33, and with hyaluronic acid (HA) products −2.10

·         The greater change with HA was not associated with a lower final outcome score, but with higher pre-treatment scores

The authors conclude that treating dry eye with artificial tears or lubricants does improve the ocular surface condition. Assuming no improvement without intervention, 30 days’ treatment will produce an overall improvement of around 25%, with little difference between types of treatment. Whether or not a further 25% improvement would occur over a second month of treatment remains unclear.

CLICK HERE TO VIEW THE ABSTRACT OF THE PAPER IN OPO

 

 

  

*NEW* Sultan MB, Mansberger SL and Lee PP. Understanding the importance of IOP variables in glaucoma: a systematic review. Survey of Ophthalmol 2009;54:6 643-662.

Recent guidelines from the National Institute for Health and Clinical Excellence (NICE) have focused attention on the diagnosis and management of glaucoma and ocular hypertension. A major review from the US, published in the current issue of Survey of Ophthalmology, looks at some important aspects of intraocular pressure (IOP) measurement.

The paper reviews methods of IOP measurement, their validity and reliability. In particular, it summarises current knowledge of IOP changes over time and the potential impact of such changes on treatment. The authors conclude that:

 • A single IOP measurement at a single visit is a poor indicator of IOP levels throughout the day and across visits
• Some attempt should be made to assess IOP at various times during the day and across visits
• Supine IOP measurement or IOP following water drinking may also provide an indication of the range of IOP fluctuation

The authors also suggest that the choice of treatment might be influenced by short or long-term fluctuations in IOP. They conclude that more studies are needed to better understand the value of assessing these changes and their role in the progression of glaucoma.   

 CLICK HERE TO ACCESS THE ABSTRACT AND FULL TEXT OF THE PAPER

CLICK HERE FOR A QUICK REFERENCE GUIDE TO THE NICE GUIDELINES

CLICK HERE FOR THE LATEST GUIDANCE ON REFERRAL OF GLAUCOMA SUSPECTS 

 

 

Ibrahim YW, Boase DL and Cree IA. Epidemiological characteristics, predisposing factors and microbiological profiles of infectious corneal ulcers: the Portsmouth corneal ulcer study. Br J Ophthalmol 2009;93:1319-1324.  

Education is the key to reducing the rate and severity of infectious corneal ulcers, according to a new UK study published in the October issue of the British Journal of Ophthalmology.

Researchers reviewed the records of 1,786 patients with infectious corneal ulcers presenting at the eye casualty department of Queen Alexandra Hospital in Portsmouth over a 7-year period between January 1997 and December 2003. These cases accounted for 3% of total ophthalmic attendees. Among the findings were:

·         Contact lens wear was the main predisposing factor, occurring in about three in 10 patients (31%)

·         Other important risk factors included ocular diseases (24%), ocular trauma (6%) and systemic diseases (5%), or mixed factors (15%)

·         A majority of the bacterial isolates (71%) were Gram-positive bacteria

·         Nine out of 11 patients with Acanthamoeba keratitis wore contact lenses

·         Most patients (97%) sought medical help more than once

·         Only 34 patients (1.9%) had a poor visual outcome

·         Follow-up, which reflects the duration of resolution, averaged 11.5 days

The authors note that there has been a declining trend in the rate of contact lens-related keratitis since the late 1990s, although contact lens wear remains the most important risk factor. They conclude that reducing the rate and severity of infectious corneal ulcers requires continuous education of patients, and of professionals.

CLICK HERE TO ACCESS THE FULL TEXT OF THE PAPER

 

 

 

 

Davies IP and Veys J. The use of fluorescein in contact lens aftercare. Contact Lens Ant Eye 2009 32:4 187-9.  

Research among more than 2,000 contact lens practitioners attending THE VISION CARE INSTITUTE™ has shown that many practitioners do not routinely use fluorescein at soft contact lens aftercare visits.

Ian Davies and Jane Veys analysed responses from practitioners from five European countries/regions attending courses at the Institutes in Prague and Milan between July 2006 and March 2008. Participants were asked:

•         How often do you stain soft contact lens wearers with fluorescein?

•         How much corneal staining do you estimate you see in soft daily wear users?

Interactive voting by 2,116 practitioners choosing from four answer options revealed:

•         The UK was the only group in which over half of respondents claimed to use fluorescein at each visit, 75% saying they used it ‘always’ or ‘most of the time’

•         Most respondents, with the exception of the UK sample, did not routinely use fluorescein during soft lens aftercare  

•         Usage did not increase over the study period

•         In general, countries that reported using fluorescein the most also reported seeing the highest incidence of corneal staining

The authors argue that concerns about lens discolouration and the risk of infection from fluorescein instillation are unfounded in modern contact lens practice. Education on the value of staining is needed if more practitioners are to use fluorescein more often.

This article was published in Contact Lens and Anterior  Eye, and the full text of the paper can be accessed  on the link below, with kind permission from Elsevier. 

READ MORE

 

 

 

Atkins NP, Morgan SL and Morgan PB. Enhancing the Approach to Selecting Eyewear (EASE): A multi-centre, practice-based study into the effect of applying contact lenses prior to dispensing. Cont Lens Ant Eye 2009 32:3 103-107.

This practice –based study demonstrates that using contact lenses as an aid to spectacle dispensing can result in a higher spend on spectacles and more patients buying contact lenses. The authors recommend offering contact lenses to all suitable patients prior to spectacle dispensing to optimise the dispensing process and to provide an opportunity to try contact lenses.

 

CLICK HERE TO VIEW THE ABSTRACT AND ACCESS THE FULL TEXT

 

 

Chiu C-J, Klein R, Milton RC et al. Does eating particular diets alter risk of age-related macular degeneration in users of the age-related eye disease study supplements? Br J Ophthalmol published online 12 June 2009;

Eating regular portions of oily fish could help stave off the progression of age-related macular degeneration (AMD), according to the latest findings from the 8-year AREDS (Age Related Eye Disease Study)

A total of 2,924 eligible AREDS participants were randomly assigned to receive one of four regimes: 1) a daily oral placebo; or 2) antioxidants of vitamins C (500mg), E (400IU) and beta carotene (15mg); or 3) the minerals zinc (80mg) and copper (2mg); or 4) the antioxidants plus zinc.  Results showed:

    • Progression to both dry and wet AMD was 25% less likely among those eating a diet rich in omega-3 fatty acids (DHA or EPA).
    • A high omega-3 diet combined with a low glycaemic index (GI) carbohydrate intake reduced the risk of progression to advanced disease even further, cutting it by 50%

The authors suggest that eating two to three servings of oily fish, such as salmon, tuna, mackerel and herring every week, would achieve the recommended daily intake of omega 3, cutting the risk of both early and late stage AMD.

CLICK HERE TO VIEW THE ABSTRACT AND ACCESS THE FULL TEXT

 

 

Morgan P and Efron N. Prescribing Soft Contact lenses for Astigmatism Con Lens Ant Eye 2009 32: 97-98

An analysis of Eurolens Annual Fitting Survey data over a ten year period, shows toric lens fitting as a proportion of all soft lens fits has increased in the UK, but a number of astigmats remain not fully corrected, with visual compromise more prevalent in daily disposable wearers.

Relevance: Are we doing all we can for our astigmatic Patients? Astigmatic patients deserve the same considerations for contact lenses in terms of vision, comfort and health as do our spherical patients. Historically, we may have been limited by product availability and performance, but with the advancement of lens design and materials, astigmats can and should be offered successful contact lens options.

CLICK HERE TO READ ARTICLE 

 

Walline et al. Randomised Trial of Effect of Contact lens Wear on Self-Perception in Children. Optom Vis Sci 86;3 222-232

This study shows correcting vision with contact lenses can improve children’s self perception in areas of physical appearance, athletic competence and social acceptance, compared to spectacle wear.

Relevance: Practitioners should consider the social and visual benefits of contact lens wear when advising vision correction options for children as young as 8.

CLICK HERE TO READ ARTICLE

 

Blakeney S. Infection Control in Optometric Practice. Optometry in Practice 2009 10: 1-12

The importance of infection control goes beyond the confines of hospitals and health care institutions. This article reviews it’s relevance in optical practice, providing rationale, guidance and advice on hand hygiene, equipment decontamination and disposal of clinical waste.

Relevance: Practitioners need to ensure appropriate arrangements for infection control and decontamination in their practice. Awareness, staff training and regular auditing should be considered. 

CLICK HERE TO ACCESS NEW COLLEGE GUIDELINES