iTrack Canaloplasty With 90° Goniotomy

I. Paul Singh, MD

Eyetube

I. Paul Singh, MD, highlights the advantages of the blinking light on the iTrack Advance (Nova Eye Medical) and the power of viscodelivery. The video shows significant blanching just from the viscodelivery, and Dr. Singh performs a 90° goniotomy. Financial disclosure: Consultant (Nova Eye Medical)

Don’t “Lump” All Lid Lesions Together

Be thorough in creating your differential diagnosis.

Jacob Lang, OD, FAAO

Modern Optometry

The term chalazion is of Greek origin, meaning hailstone, small lump, or pimple.1 In eye care, a chalazion (Figure) is a chronic cyst of lipogranulomatous material possibly caused by the obstruction of a sebaceous gland of the eyelid (ie, meibomian gland or gland of Zeis).1 Risk factors of chalazia include blepharitis, dry eye disease, eyelid dermatitis, rosacea, and conjunctivitis.1 Figure. Chalazion of the upper lid in a patient with concomitant rosacea. For such a common ocular pathology, it’s surprising we still don’t completely understand the pathophysiology of chalazia. Does a bacterial component alter the lipid composition of meibomian secretions and trigger an inflammatory response? What activates the lipogranulomatous inflammation that causes chalazia? As more attention is focused on the ocular surface and meibomian glands, researchers may find answers to these and other questions about lid lumps. A VARIETY OF LUMPS Not all lid lumps are chalazia. Clinicians must also be on the watch for neoplasms, such as sebaceous, basal, or squamous cell carcinoma, which should be included in the differential diagnosis of chalazia, especially when lesions are recurrent in the same location or have atypical features.1 Infectious etiologies, including herpes simplex virus, varicella zoster virus, molluscum contagiosum, leishmaniasis, sarcoidosis, and tuberculosis, can also mimic chalazia.1 Of note, eye care clinicians observed an increased incidence of chalazia during the COVID-19 pandemic, and some hypothesized that this uptick could be related to mask wear. Silkiss et al reported on this observation, alluding to a multifactorial nature of chalazion development.2 The proposed factors include exacerbation of dry eye disease, meibomian oil hardening, poor lid hygiene, and airflow direction changes leading to oral microbiota contacting the eyelids.2 MANAGEMENT There is little statistically significant evidence supporting the effectiveness of many common treatments for chalazia, especially comparative efficacy, at this time.1 Possible chalazion treatment options include hot compresses and other thermal treatments (eg, Systane iLux MGD Treatment System [Alcon], TearCare System [Sight Sciences], TearScience LipiFlow Thermal Pulsation System [Johnson & Johnson Vision]), topical antibiotics and/or steroids, oral antibiotics and/or steroids, probiotics, intralesional injection of corticosteroids or 5-fluorouracil, incision and curettage, tea tree oil wipes, and light therapy (ie, intense pulsed light or low-level light therapy).

Changing the Perception of the Retail Optometrist

It’s time we broaden our perspectives on the possibilities of providing care in this setting.

Harmin Chima, OD, and John Womack, OD

Modern Optometry

Picture a familiar scene in a busy eye care clinic: An optometrist assures a relieved patient they don’t have glaucoma while reviewing their OCT results in the exam lane. The OD swiftly walks to the room next door to begin expressing the meibomian glands of another patient who is undergoing treatment for dry eye disease. Ten minutes and 25 questions about dry eye later, and the optometrist is heading back to the first exam lane to check on an 11-year-old boy who has been in a myopia control treatment program for 6 months. On the way there, a patient in the optical asks whether the red or tortoiseshell frame looks better on her. Add in 10 to 15 comprehensive examinations, several of which also require a contact lens fitting, and what you end up with is a typical day at work for many optometrists. As you were reading the above, were you imagining a retail optometric setting? If not, then you’re not alone—and that’s the purpose of this article—to let our private practice and academic colleagues know that our concept of retail optometry may be outdated. RECOGNIZING OUR PATIENTS’ NEEDS We practice at a franchise group that owns and operates 88 Pearle Vision locations across the country. One of us (JW) serves as the chief medical officer, and the other (HC) as vice president of Professional Services. Our roles come with many responsibilities, one of which, fortunately, is seeing patients so that we can remain clinically relevant.