Corneal Neuropathy Can Be Reversed …

HOT TOPIC

Diabetics Experience Remission of Corneal, Peripheral Neuropathy After Weight Loss Surgery

According to a new study in The Ocular Surface, bariatric surgery was shown to improve the metabolic control of diabetes and weight loss and, surprisingly, enhance the eye’s corneal nerve microstructure and sensitivity and reduce neuropathic symptoms, suggesting a potential reversal of small and large fiber neuropathy after bariatric surgery.

The study assessed any progression or remission of corneal and peripheral neuropathy in patients with type 2 diabetes undergoing bariatric surgery. It included patients who had known type 2 diabetes for at least 5 years and who were scheduled for bariatric surgery. Participants were assessed before, as well as at 12, 26, and 52 weeks following bariatric surgery. Status of neuropathy was assessed using noninvasive in vivo confocal microscopy of the cornea and corneal sensitivity measurements.

A total of 29 participants, with a mean BMI of 44.7 and history of 11 years of diabetes, were assessed. The study researchers discovered that corneal sub-basal nerve fiber length significantly increased from baseline to 52 weeks, and corneal sensitivity threshold also increased; thus, they concluded that bariatric surgery led to an improvement in metabolic control of diabetes and weight loss, along with corneal nerve microstructure, corneal sensitivity, and neuropathic symptoms, suggesting a reversal of both small and large fiber neuropathy.

My Two Cents

Yet another example of how taking better care of your systemic health benefits the entire body—especially the eyes! My research doesn’t show increased rates of corneal nerve issues in patients with diabetes; however, it seems more likely to me that these patients, especially those who are significantly overweight, would have higher rates of these issues.

OUTSIDE THE LANE

VBMs Under Scrutiny for Coverage and Reimbursement Abuse

The American Optometric Association (AOA) and its affiliates are intensifying their efforts to address abuses by vision benefit managers (VBMs) through a multifaceted approach involving state legislators and federal investigators. At the 2024 American Legislative Exchange Council meeting, the AOA’s State Government Relations Center (SGRC) presented VBM policies that have negatively affected the doctor-patient relationship within eye care. This presentation highlighted how the largest vertically integrated companies dominate the market, much to the surprise of the non-ECPs in attendance. These few companies can force doctors into unfavorable contracts to avoid losing their patients or practice. During the meeting, the AOA emphasized the importance of creating state-level legislation to minimize or stop harmful VBM actions, such as fee setting on noncovered services, mandating the use of a specific lab, steering patients, and creating “provider tiering” based on various “pay-to-play” schemes.

Not only did the AOA encourage state-level advocacy, but it also engaged with the National Conference of Insurance Legislators to discuss these specific issues. At the same time, a US Senate panel launched a third federal investigation into VBM abuses, reflecting a growing national scrutiny at both the state and federal levels. The AOA’s dedicated advocacy aims to ensure coverage and reimbursement fairness for health care providers, protect patient access across the country, and safeguard optometric practices from these seemingly detrimental VBM policies.

According to the AOA, the ongoing federal investigations and state-level advocacy efforts underscore the critical need for comprehensive reforms to address VBM abuses and ensure a fair and equitable health care system for all stakeholders.

My Two Cents

Nothing more needs to be said than the usual, “Thanks, AOA, for having our backs.” (Also, this should be a gentle reminder to send in your AOA and state association dues.) Indeed, no one else has our backs like the AOA does, and we should all be happy to cut that check to them, as they are the security guards of our profession.

CAN YOU RELATE

The second wave of conference season starts next month! As an optometry student, one of my fears was how to keep up with everything coming out in the field and how I would know when to use it. As a *cough* no longer new optometrist, I have found these conferences are, by far, the most effective way for me to learn what’s new in our not-so-little world of eye care. Hearing from our experienced colleagues and company representatives gathered in the same small geographic area spreading the gospel of eye care has given me the confidence that if something is available, I’ll learn about it and its proper use at these meetings.

The incredible thing about these conferences is that no matter your preference, there’s a meeting out there for you. Are you interested in a huge format with a special emphasis on optical and the business side of eye care? Check out one of the Vision Expos (Vision Expo West happens September 18-21). What about a meeting that prides itself on offering the most cutting-edge clinical and research CE and is nonstop from beginning to end? The Academy of Optometry meeting in Indianapolis this November is for you. And if you’re looking for a more interactive and intimate meeting that boasts being the place “where modern optometrists meet to shape the future of eye care,” well that would be MOD Live in Nashville September 27-29.

Of course, there are local, state, and regional meetings occurring simultaneously. And who could forget the destination CE events that allow us to travel worldwide while learning about the organ that is the center of our professional world?

Many in our profession feel that letting doctors receive some of their CE online or virtually would mean the end of these meetings. Quite the opposite—judging by the number of new and specialty niche meetings, it seems as if in-person CE has never been stronger!