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Watch the latest installment of our video series!

Dr. Miller: What I wish I knew before entering optometry

Know the legal aspects of myopia control 

Professional courtesy, waiving all or part of professional fees, now has become a field day for lawyers and third-party carriers-and an unwary trap for the well-intentioned doctor.

Pros and cons of offering professional courtesy

There is no question that our profession is undergoing rapid change as well as significant challenges. As a profession, we are faced with the dual responsibility of protecting our patient and maintaining our proficiency. Both of these also fall under the legal jurisdiction of the State Board of Optometry in the states in which we are licensed. Some state boards have already acted, but most have not. One that has not is California.

The underlying concern of online refractions

One of the first lessons doctors learn once they actually get into practice is that we are all in business. The business aspect of optometric practice is comprised of multiple layers and elements that are challenging at best.

Top 5 ways you break the law in your practice

Neda Gioia, OD, CNS, FOWNS, details the positive feedback gained so far from other optometrists that have been prescribing the NutriTears supplement to their dry eye patients.

AAOpt 2024: What optometrists think so far about the NutriTears supplement

Neda Gioia, OD, CNS, FOWNS, discussed a recent study on a supplement containing vitamin D, curcumin, lutein, and zeaxanthin, which showed significant improvements in dry eye symptoms within 14 to 28 days. Key secondary outcomes, such as MMP-9 scores and corneal staining, also improved by day 28 to 56. The supplement has been well-received by optometrists and high-level practitioners, and it offers an alternative to traditional eye drops, especially for contact lens users. Gioia emphasized its potential to expand beyond optometrists to include nutritionists and other healthcare providers in addressing ocular discomfort.

Editor's note: The below transcript has been lightly edited for clarity.

Hi, I'm Dr Neda Gioia. I'm a doctor of optometry, also a certified nutrition specialist. I have my own practice, Integrative Vision in Shrewsbury, New Jersey, and I'm also the president of the Ocular Wellness and Nutrition Society.
So this poster reflects the importance of this new finding with NutriTears. It was used in a publication that we just had in Frontiers in Ophthalmology, and what it did was it showed that, using this supplement, which included vitamin D, curcumin, lutein and zeaxanthin, against a placebo, it showed that tear volume and patient reports via OSDI improved 14 to 28 days. So what's great about this study, it really showed a quick effect with a supplement, and I'm proud to present this this year at Academy. The biggest secondary outcomes were MMP9 scores, cornea and conjuctival staining, and these things were also shown to have clinical significance at day 28 up to 56. So the primary endpoints met what we not wanted, as well as some of the secondary endpoints.

So after a few months of launching this product off the shelves, a lot of optometrists have already found that their patients are very open to one, using it, because it's a new supplement that they can really kind of complement to whatever therapies they already are using, as well as starting it earlier in the dry eye diagnosis. So I think it's been great, the feedback, so far. We have some really high level doctors using this in their clinics already, and so far so good. I'm excited to see more data from those new optometrists using it.
I think what we also need to understand is sometimes our other doctors–or even non doctors, because this can be also addressed with nutritionists as well, right? So if a patient has some ocular discomfort, they can recommend an over the counter supplement as well. So I don't think it is isolated to optometrists, but I do think we add the validity for our patients, but I do think it can go into a broader spectrum of practitioners. Absolutely.

Some of the other key takeaways to this supplement, I think we have to start thinking about patients that may want other alternatives outside of drops, especially if they're contact lens users. You know, when you start really thinking about how we can use this supplement in various ways, I really think it will bring value that, you get a nice add on to your toolbox, because we really need that in dry eye approach.

Neda Gioia, OD, CNS, FOWNS, details the positive feedback gained so far from other optometrists that have been recommending the NutriTears supplement to their dry eye patients.

Conference

AAOpt 2024: What optometrists think of the NutriTears supplement so far

This quiz accompanies THIS article from our December issue

c. One-third eye width, canthus to canthus

d. One-third eye fissure opening vertically

Quiz: Know the ocular effects of eyelash growth serums

A group of bright-eyed American Academy of Optometry Fellows took time to gather for a luncheon at this year’s annual meeting to discuss their recent experiences in the Academy’s Merton C. Flom Leadership Academy. The luncheon provided an opportunity for about 40 fellows to share insights and takeaways they gain from the Flom program. The Flom program was sponsored by CooperVision for 2024.

Pabita Dhungel, BScOptom, MS, of the Herbert Wertheim School of Optometry and Vision Science, who is a member of the most recent Flom cohort, said that the roundtable discussion at the luncheon provided an important opportunity to gain perspective from other members of her cohort. “The conversation reinforced vital leadership principles and fostered a sense of community and mutual support among participants,” she said.

Originally conceived as the Merton C Flom Leadership InSight program, proposed addition of virtual modules in 2020 led to a revision and expansion of the program, and was renamed the Merton C Flom Leadership Academy. The revised program was then initiated in 2021.

Flom works by identifying and optimizing personal talents as identified through the Gallup CliftonStrengths assessment, while also facilitating discussion and guides participants through individual study to identify and hone in on leadership potential. A cohort of participants are enrolled each year and are expected to complete 8 learning modules, which are led by optometric community leaders. Flom participants also meet via virtual sessions about every 6 weeks throughout the year to allow participants and course faculty to discuss the covered content.

 Some of the learning module topics include principles of effective leadership, embracing diversity in leadership, effective communication, public speaking, writing skills, and mentorship.

Dhungel recounted her time in the program as transformative by means of enhancing her leadership and communication skills, as well as strategic thinking. “The program has deepened my understanding of how to lead effectively in academic and clinical settings and has strengthened my confidence in managing complex projects and teams,” she said.

Another cohort member, Melissa Rice, OD, FAAO, of Cincinnati Children’s Hospital, stated that Flom has both helped her become a better leader and to recognize leadership skills and coach colleagues as well. “Anyone can gain something from Flom, even those not in a leadership title,” she said.

Dhungel also emphasized her positive experience with the program and urged those considering it to take the leap. "If you're considering the Merton C Flom Leadership Academy, I highly recommend it,” she said. “The course is thoughtfully designed to develop core leadership skills specific to the field, such as effective communication, team management, and strategic thinking. It's not just about building competencies; it also connects you with like-minded professionals and mentors who support your growth and help you gain confidence in navigating both academic and clinical environments. The program’s insights and networking opportunities can be a game-changer for your career trajectory.”

Merton C Flom Leadership Academy. American Academy of Optometry. Accessed November 13, 2024. https://aaopt.org/education/professional-development/flom-leadership-academy/

Approximately 40 fellows to share insights and takeaways they gain from the Flom program.

AAOpt 2024: Merton C Flom Leadership Academy luncheon provides insights and takeaways on the program

Dr. Glenda Aleman discusses the importance of diversity in practices and how LEO is attracting more Latinos to the industry.

VEW 2024: Cultural competency in optometry

At Vision Expo West 2024, Glenda Aleman, OD, participated in a panel called, "Cultural competency in eye care," wherein she and other panelists discussed the power of diversity in a practice. Other panelists included Larry Jones, OD; Linda Shi, OD; and moderator Charissa Lee, OD, MBA, FAAO. You can watch the full recording of the panel 

Aleman also discussed the impact of Latinos en Optometry (LEO), an organization rallied around increasing the density of Latinos in optometry by encouraging students to consider eye care as a profession.

Dr. Glenda Aleman discusses the importance of diversity in practices and how Latinos en Optometry is attracting more Latinos to the industry.

Video Series

Click here to see our latest poll results: Have you or do you plan to implement myopia control into your practice?

This poll is for optometrists and eyecare professionals, only. It will close on Friday, September 10, 2021.

Poll: What percentage of your patients exhibit blepharoptosis?

Small hyperreflective retinal foci (HRF), identified on 

 images, mirror neuroretinal activated microglia that are involved in the pathogenesis of 

. HRF with specific features referred to as aggregates of activated microglial cells, may represent local neuroretinal inflammation that can be monitored on OCT images,

Elisabetta Pilotto, MD, and colleagues reported. She is from the Department of Neuroscience - Ophthalmology, University of Padova, Padova, Italy.

The investigators undertook a study in which they evaluated retrospectively the presence and amount of small HRF in the eyes of patients with different macular atrophic phenotypes, that is, bilateral geographic atrophy (GA), unilateral GA and macular new vessels (MNV) in the fellow eye, and extensive macular atrophy with pseudodrusen (EMAP), a rare and aggressive variant of atrophic AMD.

They defined HRF as “isolated punctiform elements of small dimensions, 30 μm or smaller, with intermediate reflectivity (similar to that of the nerve fiber layer) and without a shadow cone.” The foci were measured on near infrared reflectance (NIR) and blue wavelength fundus autofluorescence (FAF) images.

The HRF were manually identified, counted, and analyzed to identify correlations with the best-corrected visual acuity (BCVA), GA lesion size, some GA features (multifocal versus unifocal GA; presence versus absence of foveal sparing) and central retinal thickness (CRT), the investigators explained.

A total of 46 patients were included and classified as follows: 26 with bilateral GA group, 16 with unilateral GA and MNV in the fellow eyes, and 4 with EMAP group.

The patients with EMAP were younger compared to patients with bilateral and unilateral GA, ie, 63.5 ± 6.8 years vs. 80.4 ± 8.4 years (p=0.0004) and 83.3 ± 6.1 years (p= <0.0001), respectively.

The evaluated factors that did not differ significantly among the groups were the mean BCVA, mean GA area in the NIR and FAF images, foveal-sparing and multifocal versus unifocal GA distribution, and the mean CRT.

The GA areas were wider on the NIR images than the FAF images in all groups, and significantly so in the bilateral and unilateral GA groups: 11.7 ± 7.6 mm2 vs. 10.6 ± 7.1 mm2 (p = 0.0087) and 7.8 ± 9.2 mm2 vs. 7.7 ± 9.4 mm2, p = 0.004, respectively.

Significantly more HRF were present in the unilateral GA group compared to the bilateral and EMAP groups: 47.4 ± 7.1 vs. 31.6 ± 7.3 and 28.0 ± 4.9, respectively; p < 0.0001 for both comparisons), The bilateral GA and EMAP groups had similar numbers of HRF (p = 0.1960).

A correlation was found only between the numbers of HRF and the CRT, that is, a positive correlation with the bilateral GA group and a negative correlation with the unilateral GA group.

“The increase in the small HRF, which mirrors retinal microglial activation, characterizes eyes with unilateral GA and MNV in the fellow eye) but not eyes with bilateral GA or EMAP,” the investigators commented.

They emphasized that the role of activated microglia in the retina of eyes with GA should be investigated further with consideration of “actual and new therapeutic strategies with which to reduce either the development or progression of the atrophic macular changes.”

Pilotto E, Parolini F, Midena G, Cosmo E, Midena E. Small hyperreflective retinal foci as 

 imaging feature of resident microglia activation in geographic atrophy. Exp Eye Res. 2024;248:110064; 

https://doi.org/10.1016/j.exer.2024.110064

Study authors defined hyperreflective retinal foci as “isolated punctiform elements of small dimensions, 30 μm or smaller, with intermediate reflectivity (similar to that of the nerve fiber layer) and without a shadow cone.” 

Pamela J. Miller, OD, FAAO, JD, FNAP

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