GKC Educates Hundreds
The first Global Keratoconus Congress (GKC), which took place from Jan. 26 to 28 in Las Vegas, NV, drew more than 500 participants including 400 registrants from 30 countries, plus 100 sponsors and exhibitors representing 31 companies.
Contact Lens Spectrum and the Lippincott, Williams & Wilkins Health Care Conference Group hosted the two-and-one-half day meeting that focused on the latest diagnostic and treatment methods for keratoconus. GKC provided international insights and access to the most advanced products and methods used in treating keratoconus. The educational program provided information for vision care professionals in all disciplines with both surgical and non-surgical options, offering 17.5 hours of COPE, NCLE and JCAHPO continuing education credits.
The first day of the educational session focused on fundamentals of keratoconus. The program began with Jay Krachmer, MD, discussing how older patients may not continue to progress in keratoconus due to their cornea becoming more rigid.
Joe Barr, OD, MS, FAAO, next discussed keratoconus diagnosis and key symptoms, touching on data from the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) study. He shared his theory that keratoconus is probably genetic (13.5 percent of CLEK patients had family history) with eye rubbing as a contributing factor. Dr. Barr also discussed whether keratoconus is actually a non-inflammatory disease and that Fleischer's ring isn't really a ring - the iron deposition extends out to the periphery.
Tim McMahon, OD, FAAO, discussed topography analysis of keratoconus. In addition to explaining different types of topography maps, Dr. McMahon revealed that keratoconus cones develop in all shapes and locations, including 10 percent to 12 percent located above the horizontal meridian. Because of this, he echoed Dr. Barr's idea that the classical terms nipple, oval and globus may be obsolete.
Eef van der Worp, BSc Optom, from the Netherlands, moderated a session on keratoconus lens designs that included Alan P. Saks, MCOptom, FAAO, of New Zealand, Mark Andr�, FAAO, Pat Caroline, FAAO, Michael Wyss, dipl. Augenoptiker, FAAO, of Switzerland, and Michael Ward, MMSc, FAAO.
Dr. Saks reviewed corneal GP lens designs for keratoconus, suggesting that practitioners get to know a few keratoconus designs intimately and stressing that you order your diagnostic lenses from the same manufacturer that made your trial set.
Mark Andr� discussed the somewhat controversial topic of soft lens designs for keratoconus, indicating that although this isn't his first choice, it can be the only choice for some patients.
Pat Caroline explained how to fit hybrid lenses for keratoconus, stressing that hybrid lens fitting is counterintuitive. Specifically, the lenses must be fit steep to prevent lens tightening. He also explained that hybrids work best for central cones.
Michael Wyss discussed large diameter GP designs. He recommended that you avoid apical bearing, make sure that mini scleral lenses move a little to avoid total adherence and instruct patients use protein removers when caring for the lenses.
Michael Ward discussed fitting piggyback lens systems for keratoconus, even if used as an aid to GP adaptation. He stressed the importance of using the highest-Dk combination possible.
Hans Bleshoy, PhD, of Denmark, Richard Lindsay, BscOptom, of Australia and Mark Soper, FCLSA participated in a panel discussion about problem solving in fitting keratoconus patients.
Pat Caroline moderated a panel discussion among Paul Rose, OD, FNZCLS, of New Zealand, Frank Widmer, OD, of Germany, William Winegar, FCLSA, and Christine Sindt, OD, FAAO, on keratoconus video case histories. The panel members discussed fitting methods for early to severe keratoconus, how much apical touch is acceptable, how to avoid late-onset tightening with semiscleral designs and when to use piggyback or hybrid designs, among other fitting considerations. The panel also debated whether axial or tangential maps are best to use and whether it's valuable to map the patient in upgaze to center inferior cones. They furthermore discussed the use of quadrant specific lens designs, which are lenses that allow you to customize the design for each quadrant to better fit the cone and are currently fit mainly in Europe.
Anthony Nesburn, MD, moderated the session What Do We Know about Keratoconus? that included M. Cristina Kenney, MD, PhD, Yaron Rabinowitz, MD, and Eberhard Spoerl, PhD, of Germany.
Dr. Kenney presented her research on corneal cells. She related that mitochondrial DNA of keratoconus patients has higher deletions and mutations than that of normal corneas. She theorized that keratoconic corneas undergo oxidative stress, which contributes to keratoconus pathogenesis. Her research also indicates that keratoconus does have a genetic component, with multiple genes involved in the common oxidative stress pathway.
Dr. Rabinowitz related his search for a molecular marker for keratoconus. He noted that the aquaporin 5 gene, which is a water transport gene related to wound healing, is suppressed in keratoconus patients. He said this is the first molecular defect ever identified in keratoconus
Dr. Spoerl explained the use of a combined riboflavin/ultraviolet A (UVA) treatment for keratoconus. The riboflavin absorbs the UV radiation to protect the endothelium, and the treatment increases crosslinking to make the cornea more rigid and stable. He noted that this treatment can only stop the progression of keratoconus.
Karla Zadnik, OD, PhD, discussed flat vs. steep fitting GP lenses in keratoconus, concluding that scarring is more related to disease severity than to fitting decisions and that you should base your fitting on vision, comfort, wearing time and what's happening to the cornea.
Dr. Barr discussed corneal scarring and vision in keratoconus. He reported that the CLEK study shows we can't conclude that flat fitting lenses cause more scarring, but lens wear is implicated as a causal pathway for corneal scarring. Scarring does impact visual acuity even if it's not located in the line of sight. Dr. Barr also reported on the use of reverse geometry lenses for keratoconus in that they can reduce coma and improve vision.
Tim Edrington, OD, MS, FAAO, discussed the benefits of using the first definite apical clearance lens (FDACL) to measure the cornea and serve as a fitting guide in keratoconus.
A number of presenters discussed the use of scleral lenses for keratoconus. Perry Rosenthal, MD, Rob Breece, OD, Henry Otten, Optometrist BSc, FAAO from the Netherlands and Ken Pullum, FCOptom, DipCLP from England offered fitting tips for corneo-limbal, mini scleral and scleral designs. Emphasis was placed on fluorescein analysis, given that topography data doesn't extend out far enough to fit sclerals, and on how to avoid lens adherence.
David Schanzlin, MD, discussed surgical approaches to keratoconus, including penetrating keratoplasty, lamellar keratoplasty and Intacs. He reminded attendees that the goal of surgery is to strengthen the cornea and restore the possibility of a good contact lens fit. Dr. Rabinowitz discussed different methods for inserting Intacs, and also stressed that patients need to be counseled about the purpose of the surgery.
Buddy Russell, FCLSA, offered suggestions for how to fit contact lenses following Intacs inserts, suggesting that piggyback fits may help with comfort.
Loretta Szczotka-Flynn, OD, MS, discussed contact lens fitting following penetrating keratoplasty and other surgical alternatives. She explained how different types of sutures may affect lens fitting and that you should be mindful of Dk when fitting such patients.
Carla Mack, OD, discussed coding and reimbursement issues for keratoconus. She emphasized that coding is the practitioner's responsibility and that all practitioners in a multi-doctor practice should code consistently.
Dr. Zadnik discussed the unique personality characteristics that are common among many keratoconus patients. She said practitioners should make it a goal to help such patients to not think about their keratoconus all the time.
Many of the GKC's sponsors held seminars to educate attendees about products and technology available in diagnosing and managing keratoconus. Sponsor presentations were given by Blanchard Contact Lens, Contamac, Bausch & Lomb, SynergEyes, Inc., X-Cel Contacts, Precision Technology Services, Ltd., Valley Contax, the Contact Lens Manufacturers Association and the National Keratoconus Foundation.
Information from the GKC meeting will appear in greater detail in future CLS articles. The second GKC will take place from Jan. 25th to 27th, 2008.
Contact Lens Conference Honors Pioneers
The 33rd Annual Invitational Bronstein Contact Lens Seminar honored two pioneers in the contact lens field.
Charles H. May, OD and Robert B, Mandell, OD, PhD, were honored at this year's event held Jan. 26 to 28 in Scottsdale, AZ.
Dr. May was honored for his work in lens design associated with orthokeratology, or corneal molding. Dr. Mandell was recognized for his research in corneal topography, pachymetry and corneal response to contact lens wear.
The conference is named after its founder, contact lens pioneer Leonard Bronstein, OD. It's one of the largest contact lens-only meetings in the country, if not the world, according to conference chair John Rinehart, OD.
For the Record
In the January issue, on p. 9 in the news article CLMA Recognizes Labs, Practitioners, Blanchard Contact Lens, Inc. and Tru-Form Optics, Inc. (TX) - 2 locations were omitted from the list of laboratories awarded the CLMA's Certificate of Manufacturing Excellence for the years 2007 and 2008. Both companies received the recognition concurrently with all other companies.
Also in the January issue, on p. 26 of the article Contact Lenses 2006, the text should have said, At the manufacturer level, the worldwide contact lens market is about $4.56 billion with about $3.3 billion in spherical lens sales and $1.26 billion in specialty lens sales.
Contact Lens Spectrum regrets the errors.
Allergan Launches Next-Generation Artificial Tear
Allergan, Inc. has launched Optive Lubricant Eye Drops, an artificial tear with an advanced dual action formula that works on both the ocular surface and at the cellular level to provide long-lasting relief from dry eye symptoms, according to Allergan.
Optive offers a new technology platform for the treatment of dry eye symptoms, said Joe Vehige, OD, Allergan Senior Director, Consumer Eye Care Research and Development. While most artificial tears typically provide moisture to the tear film, Optive Lubricant Eye Drops is optimally formulated to provide both lubrication to the tear film and penetration below the surface of the eye for osmoprotection against hypertonic stress.