Education Highlights from the 2015 GSLS

Specialty contact lens education reigned supreme at this year’s record-breaking conference.


Education Highlights from the 2015 GSLS

Specialty contact lens education reigned supreme at this year’s record-breaking conference.

By Jason J. Nichols, OD, MPH, PhD, FAAO; Edward S. Bennett, OD, MSEd, FAAO, FSLS; and Lisa Starcher

The 2015 Global Specialty Lens Symposium (GSLS), which took place Jan. 22 to 25 in Las Vegas, not only resulted in record-breaking attendance, but also a record number of educational opportunities. Attendees had almost 75 hours of learning to choose from when considering all of the general sessions, continuing education courses, breakout sessions pertaining to specific manufacturer designs and related topics, and breakfast and lunch seminars.

The conference’s education program emphasized applied clinical presentations focusing on areas of high practitioner interest, most notably scleral lenses, myopia control, and multifocal contact lenses. However, between the continuing education program, the scientific papers and posters featuring cutting-edge research, and the manufacturer seminars, almost every conceivable specialty contact lens topic of interest was presented.

In addition, the preconference program featured four tracks of four one-hour sessions pertaining to “Building the Myopia Control Practice” (hosted by the Orthokeratology Academy of America), “Building the Specialty Contact Lens Practice with Proper Billing and Coding,” “Building the Dry Eye Practice,” and “Building the Scleral Lens Practice” (hosted by the Scleral Lens Education Society).

As in previous years, the education program was developed by the GSLS Education Planning Committee members Craig W. Norman, FCLSA; Jason J. Nichols, OD, MPH, PhD; Edward S. Bennett, OD, MSEd; Eef van der Worp, BOptom, PhD; and Patrick Caroline, FAAO, FCLSA.

Contact Lens Industry Update

The main conference of the 2015 GSLS kicked off with a customary “State of the Industry” presentation by Contact Lens Spectrum Editor-in-Chief Dr. Jason Nichols. This session presented trends in the contact lens field as reported by Contact Lens Spectrum in the “Contact Lenses 2014” annual report published in the January 2015 issue.

Dr. Nichols reported a few trends worth noting. First, the soft contact lens market was somewhat flat in terms of its global value, showing a similar worth of $7.6 billion (same as 2013). There were more than 39 million contact lens wearers in the United States in 2014. Some trends included continued expansion of the daily disposable segment (up again by at least 20% in the United States) and continued expansion of the specialty lens category.

Dr. Nichols highlighted the multifocal segment of the market, showing how this market is underutilized relative to the need for presbyopia-correcting contact lenses. For example, rates of soft lens multifocal use are approximately 9% to 12% of all soft lens fits; in contrast, at least 15% of all contact lens wearers are of presbyopic age, and only 29% of these wearers are fitted in multifocals. Indeed, we can do better in this specific category.

During the second portion of the opening session, a panel of representatives from industry addressed various themes, trends, and issues associated with the contact lens marketplace. This panel included Carla Mack, OD, FAAO (Alcon), Mark McKenna (Bausch + Lomb), Jan Svochak (Contact Lens Manufacturers Association), Bob Ferrigno (CooperVision), and Louis Dias (Johnson and Johnson Vision Care, Inc.).

The panel first addressed insights into potential growth (or lack thereof) within the contact lens market. It was acknowledged that some traditional markets (the United States and Australia) have been somewhat flat, whereas other global markets (Asia, and Latin and South America) are showing tremendous growth in contact lenses. The panel seemed to uniformly suggest that solving the discomfort issue and increasing innovation and technology were primary ways to drive growth in all segments of the global market. The panel discussed issues about lens modality, materials, and design and suggested that there is never one particular lens attribute that would be right for everyone. Every patient has different needs, and this requires careful attention when working with them. The session ended with enthusiastic discussion about myopia control with contact lenses.

Scleral Lenses—New Opportunities, New Challenges

These sessions were, once again, a highlight of the conference. As in previous years, Session Chair Pat Caroline addressed several key clinical areas for optimizing success with scleral lenses. He showed slides pertaining to each clinical area and then obtained input from a very qualified panel including Jennifer McMahon, BOptom, MCOptom; Josh Lotoczky, OD; Lynette Johns, OD; Langis Michaud, OD; and Chad Rosen, OD. The following topics were among those presented and discussed.

1) Cloudy Vision/Post-Lens Tear Debris A relatively common, but preventable, problem with scleral lenses manifests as an opaque-appearing tear film that can be observed with both biomicroscopy and optical coherence tomography (OCT) (Figure 1). Research performed at the Pacific University College of Optometry has found that this opaque film consists of a high concentration of lipids (Walker et al, 2014). It was proposed that this problem may result from limbal clearance.

Figure 1. Post-lens tear “fogging” shown via biomicroscopy (left) and via OCT at baseline and after four hours of lens wear (right).

Preventing this debris from traveling from the lens periphery to the lens center and possibly contaminating the solution between lens and eye should reduce/eliminate the problem. A more viscous solution, such as a preservative-free artificial tear, can help by serving as a greater obstacle for the contaminants to move through. Smaller lenses (i.e., corneo-sclerals) are more likely to exhibit limbal alignment, which blocks the path for potential debris entrapment. For larger lenses, toric peripheries may reduce this problem by providing more optimal alignment. The panel felt that reducing limbal vault does not impact stem cell health.

Post-lens debris (Figure 2) is more common during the first 30 days of lens wear and then often lessens; therefore, advise patients that improvement should result over time. Patients who continue to experience this problem—often those who have ocular surface disease—can use an eye-cup (i.e., a device for applying eyewash to the eye, consisting of a cup or glass with a rim shaped to fit snugly around the orbit of the eye) and the same solution as that used for filling the lens to dislodge and rinse away much of the debris that accumulates overnight prior to lens application.

Figure 2. Post-lens debris.

2) Surface Filming/Non-Wetting Plasma-treated lenses with wet shipment can help optimize initial wettability. Hydrogen peroxide is beneficial for both cleaning and disinfecting; however, a compatible GP lens cleaner is still recommended once the lens has been removed from the hydrogen peroxide solution.

If surface deposits are a problem over time, some wetting solution can be placed on a plunger (such as those used for lens application) to scrub the front lens surface while it is on the eye, similar to a squeegee effect on a window. This restores surface wettability and may eliminate the inconvenience of removing the lens in the middle of the day for cleaning purposes. Also, an extra-strength cleaner can be used every three weeks initially; the use can be increased to every two weeks and ultimately to weekly if surface filming is still impacting vision.

3) Application Bubbles/Optimizing Initial Experience Bubbles upon application are often peripheral in location and result from either insufficient filling of the lens well or losing some solution due to a faulty application technique. It is important for patients to have their face perfectly parallel to the ground and also to overfill the lens with the filling solution to create a positive meniscus. Beginning with a more viscous solution (i.e., preservative-free artificial tears) will help patients gain confidence with application due to less potential for spillage.

Likewise, initially storing the filling solution in the refrigerator will provide a cool sensation when it touches the eye so patients know to push the lens closer toward the eye before releasing.

4) Epithelial “Bogging” This term, coined by Patrick Caroline, refers to how the epithelium may look following the initiation of scleral lens wear. It can appear waterlogged or boggy, with a corrugated appearance (Figure 3). He stated that this is believed to result from exposure to saline solution for 12 to 16 hours a day, as saline does not contain any of the nutrients found in the tear film. Fortunately, this tends to go away over time. However, it will be important to develop filling solutions with the appropriate nutrients for compatibility with the eye to help eliminate this problem.

Figure 3. Epithelial “bogging” one week post-fitting (a) and two months post-fitting (b).

5) Oxygen Transmission How much oxygen transmission is enough with scleral lenses? The panel quoted the recent publications of Michaud et al (2012) and Jaynes et al (2015) in which the combination of a thick lens and excessive apical clearance can result in corneal hypoxia. These studies all indicate that the highest-oxygen-permeable materials should be used in combination with a central thickness that is not too great (i.e., 250µm) and fitted with a clearance that does not exceed 200µm.

As an addendum to the panel comments, Grant Watters, MScOptom, presented a paper titled “Comparison of five commonly used semi-scleral contact lenses: average thickness, transmissibility (Dk/t), lens profile and settling characteristics.” His research team ordered five scleral lenses, all in a 100-Dk material with the same base curve radius, power, and diameter. The results showed great variance in oxygen transmission of the total system (i.e., post-lens tear film thickness and average lens thickness Dk/t ranged from 12.3 to 35.1) due to variations in center thickness and fitting relationship. It was concluded that if using a 100-Dk lens material, the average contact lens and tear film combined thickness needs to be 350µm or less to satisfy both the Holden-Mertz (1984) and Harvitt-Bonanno (1999) criteria. For example, if the lens had a thickness of 250µm and the tear film was 100µm, it would meet this criteria.

6) Lens Settling Optimum initial clearance is in the 250µm to 300µm range, as data from Pacific University has found that scleral lenses will settle anywhere from 70µm to 250µm over an eight-hour period, with an average of 127µm (Caroline, 2013). This data is similar to the study by Kauffman et al (2014). Settling can vary due to the specific lens design and also due to individual variations in the conjunctiva.

Custom Soft Lenses

Marco van Beusekom, BOptom, moderated the general session “Customizing Soft Lenses: a New Era for Soft Lens Fitting,” which also included presentations by Matt Lampa, OD, and Lee Hall, BSc, PhD. He noted that despite all of the advancements in soft contact lens materials, designs, oxygen transmissibility, and surface properties, the dropout rate remains the same as it did 25 years ago. Why is this? He noted that with soft contact lenses, it’s all about comfort—and that it may be time for a revision in the way soft lenses are fit.

He proposed a simple method for evaluating the movement of any contact lens: set the slit lamp beam to 1mm, turn it 90º, and align the bottom part of the slit beam with the lowest lag of the lens. Movement is thought to be needed for tear exchange—but how much movement is really needed for soft lenses? The more movement we see, the more discomfort we get. Newer research suggests that 0.1mm to 0.4mm of movement is best for comfort with soft lenses (Troung et al, 2014).

Dr. Lampa discussed the anatomical features that influence the shape of the eye. He focused primarily on corneal diameter, which he said is the parameter that most dictates the depth of the eye. Specifically, as the corneal diameter gets bigger, the overall depth of the eye increases. The implication when fitting soft contact lenses is that patients who have closer to an average corneal diameter will do well in the available standard soft lenses that have fixed diameter and base curve offerings, whereas patients whose corneal diameters fall outside of the average range may not do as well in these lenses from a fitting standpoint, and likely from a comfort standpoint as well. He stated that he would prefer to have a single fixed base curve available in a range of diameters, which is the opposite of what is typically offered in off-the-shelf, standard soft contact lenses.

Dr. Hall explained that the factors that govern soft contact lens fit are not well understood. He discussed the shape of the eye at the corneal/scleral junction and how this impacts the sagittal depth of the eye. In research that he performed with a team led by Graeme Young, MPhil, PhD, FCOptom, they found that while corneal diameter is a large driving factor in sagittal height, the corneal/scleral junction adds significantly to soft lens fit. Dr. Hall also discussed new technologies in contact lens metrology.

The panel concluded that much more work needs to be done in understanding soft lens fitting characteristics, but poor centration, poor vision, and poor physiology are factors that indicate it would be time to consider switching from a standard soft lens to a custom soft lens.

Myopia Control

A large number of courses and breakout sessions focused on this topic as it pertained to both corneal reshaping (orthokeratology) GP designs and new specialty soft lenses. The latter was the focus of a cutting edge session titled: “The future of myopia management with contact lenses” moderated by Brien Holden, PhD, DSc, OAM. Earl Smith, OD, PhD; Monica Jong, PhD, BOptom; and Thomas Aller, OD, also presented on this topic.

1) Impact of Myopia Dr. Jong performed a PubMed search and found that in North America, about one-third of individuals were myopic in 2000; this will increase to 50% by 2030 and to 60% by 2050. Furthermore, the incidence of high myopia will increase from 9 million to 23 million people from 2000 to 2050. The incidence of glaucoma is much higher with highly myopic individuals, and the risk of retinal pathology is eight times higher if an individual has a refractive error ≥ 8.00D. In addition, myopic macular degeneration is a leading cause of blindness worldwide, but it is not being recognized and addressed.

2) Peripheral Plus Power Soft Lenses and Myopia Control The work of Dr. Smith has shown that the peripheral retina has enormous impact on eye growth. Peripheral hyperopic refractive error, which is stimulated by most conventional spectacles and contact lenses, is essentially a “Go” sign for eye growth. If the optics of a contact lens can be designed such that a myopic peripheral refractive error can be achieved, myopia progression can be significantly reduced. This has been noted in recent years with corneal reshaping designs and is exhibiting great promise with peripheral plus power soft lenses.

Professor Holden discussed a series of studies to evaluate several different lens designs at the Brien Holden Vision Institute (BHVI). In a three-year study, they found a 47% reduction in myopia with a peripheral plus power design. These designs have extended depth of focus, which in theory allow for good vision at all distances. When rating vision on a 10-point scale, the average scores were 8.2 (distance), 9.1 (intermediate), and 7.8 (near), in which a score of 8 out of 10 would be better than current center-near multifocal lenses in common use today. Holden also described a study in which they recently fitted lenses with the extended depth of focus on 100 children in two different designs, and once again positive visual results from distance to near were demonstrated, with an overall vision rating greater than 9 out of 10. In addition, after six months of data, they found approximately 50% reduction in myopia plus 58% reduction in axial length growth compared to non-peripheral plus power subjects. This research demonstrates great potential for the field of myopia control. For example, a 1.00D myopic 7-year-old child will progress to approximately 6.00D by age 16. A 50% myopia control lens could reduce this to approximately 3.00D at age 16, which is highly significant from an ocular health standpoint.

3) Distance-Center or Near-Center Design? Dr. Aller made the interesting observation that while many believe that only distance-center lens designs work for myopia control, there currently isn’t any data available to support this claim. He presented a case series of patients in his practice in which he fitted them primarily in a near-center daily disposable design and found no evidence in this case series of patients that near-center lenses don’t work. He believes that this design is at least worth a look and that practitioners shouldn’t be afraid to use near-center for myopia control; he stated that the eye responds to the plus wherever it is, so any multifocal lens will work. He further stated that it’s time to start thinking of standard contact lenses as no longer the standard of care.

4) The Bottom Line Professor Holden made it clear that everyone needs to recognize how significant a problem myopia is worldwide. Global awareness among industry, practitioners, and caregivers of young myopic patients is imperative. As a result, the BHVI has engaged the assistance and cooperation of the World Health Organization (WHO). A joint WHO-BHVI meeting on myopia and vision impairment took place March 16 to 20, 2015. In addition, the BHVI is launching a myopia institute for the purpose of education, providing evidence-based knowledge and state-of-the-art information through science, education, and communication.

Contact Lens Correction of Presbyopia

As always, this was a popular topic among the education sessions as well as among the scientific papers and posters. Who constituted successful multifocal wearers today, new and successful multifocal lens designs, and the future of multifocal contact lenses was the focus of a general session titled “Can we solve the presbyopia dilemma?” with Drs. Ed Bennett, Amy Dinardo, and Stephanie Woo. Following are some of the points discussed.

1) The Successful Multifocal Contact Lens Wearer in 2015 Dr. Dinardo discussed the attributes of successful wearers based on research that she and colleagues have conducted at the Michigan College of Optometry (Dinardo, 2014; Dinardo and Fosso, 2014). Successful wearers scored a distance rating of 4.3 (out of 5), 4.31 at intermediate, and 3.89 at near. They did not necessarily have to wear their lenses all day to be successful, as soft lenses wearers averaged 10.1 hours per day. Likewise, it was not a red flag to wear over-readers with their multifocal contact lenses, as 25% of successful wearers did use ancillary spectacles. When patients were not successful, the primary factors included poor vision (i.e., 92% reported reduced near vision, 50% reported reduced distance vision, and 33% reported poor intermediate vision) and discomfort. She provided evidence to dispel the following myths about multifocal contact lenses: 1) They do not work; 2) They are not worth the chair time; 3) Monovision works better, and 4) They do not meet patient expectations.

2) New and Successful Multifocal Lens Designs Dr. Woo reviewed patient selection, fitting, and troubleshooting of two presbyopic contact lens modalities that are currently gaining popularity: scleral multifocals and hybrid multifocals. Both modalities offer the benefits of good vision and initial comfort comparable to a soft lens. Scleral multifocal lenses, in particular, have applications for both dry eye patients and for post-refractive surgery patients.

3) The Future in Multifocal Contact Lenses Dr. Bennett reviewed innovations in this category over the past five years and what we should expect in the next five years and beyond. Just in the last few years, we have seen the introduction of newer and improved hybrid multifocals, GP multifocals for post-refractive surgery patients, improved high-add aspheric multifocals, and scleral multifocals. Despite this and the fact that practitioner preference for multifocals over other contact lens options has increased from 59% (Nichols, 2008) to 70% (Nichols, 2015) in recent years, it is evident that practitioners are still under-prescribing multifocal contact lenses (Morgan et al, 2011). Presbyopes today have a more active lifestyle compared to in the past, with greater variance in vision demands—notably hand-held devices—and they often would prefer to not use supplemental spectacles.

The next few years should bring more improvements in multifocal lens design. Upcoming simultaneous vision designs may take into consideration factors that impact vision such as decentration/line of sight, pupil diameter, and aberrations (wavefront correction).

Parameters will continue to expand, including in daily disposable silicone hydrogel multifocals. We will see higher add powers through lenses that have specifically designed optics for each eye; more options in disposable/planned replacement soft toric multifocal lens designs; single-use lenses customized for daytime and nighttime; and greater expansion of hybrid multifocal lens parameters.

Scleral multifocal lenses should also become more mainstream. Scleral multifocals are being developed to align the optical center with the pupil center to compensate for decentration. In addition, scleral multifocals will serve as a good option for irregular cornea patients desiring a multifocal correction.

Corneal reshaping, usually noteworthy for its ability to slow myopia progression, is also demonstrating much potential for presbyopic application.

Looking further into the future, accommodating multifocal lenses will likely appear within the next five to 10 years. These so-called “Smart Lenses” (Google/Novartis) will restore the eye’s ability to autofocus by changing the refractive error based upon the task.

Contact Lens Care and Compliance

Michael Ward, MMSc, FAAO, FCLSA, moderated an enlightening session on regulatory and epidemiology issues with contact lens care that included presentations by Lyndon Jones, PhD, FCOptom, and Jennifer Cope, MD, MPH, medical epidemiologist for the Centers for Disease Control and Prevention (CDC).

Mr. Ward initiated the session by asking the audience whether it was acceptable to rinse GP lenses with tap water, and whether or not this puts patients at risk for microbial keratitis (MK). As we all know, this is a long-standing practice with many GP wearers, and many GP-specific care systems have labeling instructions to rinse with tap water. He commented, though, that MK is a severe complication, and we need to do all we can to protect against this in our lens-wearing patients. He also pointed out that for infection to occur, the cornea not only needs a significant inoculum of microbes, but also some compromise (e.g., contact lens wear).

Prof. Jones then presented on two topics—the frequency of MK and the risk factors for MK in contact lens wearers. He showed the tremendous research efforts as published in PubMed, with exponential increases in the volume of papers published on this topic—predicting 300 such publications within the current decade alone. Prof. Jones showed data from the CDC indicating that there are 1 million clinical visits for MK and/or contact lens complications each year, with estimated costs of about $175 million. Contact lens wear continues to be the primary risk factor for MK, with Pseudomonas (~70% of lens wearers) still leading as the primary infective organism. However, he noted a few new pathogens that are starting to emerge: Achromobacter, Delftia, and Stenotrophomonas.

Prof. Jones presented data indicating that the incidence of MK has not changed over the years, even with new technologies that would theoretically reduce these rates. Incidence studies indicate that the lowest rates of MK with lens wear are with daily wear GPs, and the highest rates are in hydrogel extended wear (this has not changed over time, but silicone hydrogel extended wear may show less severity).

Lastly, Dr. Cope presented on the CDC’s initiatives specifically targeted at Acanthamoeba keratitis (AK). She noted that the first case of AK was described in the early 1970s—a Texas rancher who experienced AK as a result of ocular trauma. Since that time, she noted two periods of increased frequency of AK—one in the mid-1980s, and the other in the mid 2000s. The CDC’s investigations in both of these periods show a similar trend in terms of risk factors—homemade saline, wearing contact lenses while swimming, and improper disinfection.

In the more recent outbreak, a commercial care product was associated with the increased incidence. However, as she pointed out, a voluntary recall and removal of this product from the market did not lead to a decrease in AK events in subsequent years. Because of this, the CDC continued with ongoing surveillance of AK in the United States. Dr. Cope discussed a recent study involving the CDC (Yoder et al, 2012). Their findings noted that 68% of AK patients had topped off their solutions, as opposed to 33% of controls; 37% of AK patients were younger than 26 years old (versus 25% of controls), and 26% were older than 55 years of age (versus 14% of controls). In addition, 25% of AK patients stored their lenses in water (versus only 3% of controls). In a review of 54 rigid lens wearers (37 AK, 17 control), they found that 18 of the 37 AK patients usually or always used tap water to store lenses versus one of 17 controls. In addition, 12 of 37 AK cases slept in their lenses (including four corneal reshaping patients), versus only one control.

Dr. Cope noted the CDC’s continued efforts in studying this important problem. Her bottom line recommendations included encouraging proper hygiene practices among contact lens wearers. This includes regular cleaning of lenses, avoiding lens contamination with water, and effective use of disinfecting solutions including no topping off. We should educate contact lens wearers and providers about risks of MK. Also, we need to establish standards for contact lens disinfection against Acanthamoeba, as the U. S. Food and Drug Administration (FDA) does not currently require products to demonstrate efficacy against Acanthamoeba to be FDA approved.

Breakout Session Highlights

One of the breakout sessions featured Prof. Jones discussing “What’s New and Sexy in Contact Lenses?” He noted that outside of the fact that eyecare practitioners are generally terrible at getting patients into contact lenses, there are two real problems that need to be solved to grow the contact lens market: 1) end-of-day dryness/discomfort and 2) vision. Focusing mostly on more mainstream products, he discussed recent advancements in daily disposables; silicone hydrogel lenses, including soon-to-come new lathable options; new designs and expanded parameters in lenses that correct presbyopia; new options in the cosmetic category (which he thinks will be big business); and the latest lens care solutions. He also discussed what’s coming in the future for the industry, including the revolutionary impact that myopia control will have once commercially available products emerge. Additionally, he mentioned current and future technologies in biosensing contact lenses used as diagnostic devices for conditions such as glaucoma and diabetes. Prof. Jones encouraged attendees to try new lens materials and care solutions even on satisfied patients and to talk with their company representatives to make sure they are staying on top of new products.

Drs. Lynette Johns and Jennifer McMahon discussed “Soft Lenses for Irregular Corneal Conditions.” They noted that using soft lenses for irregular corneas is not actually a new concept; they were first reported by McTigue and Townsend in 1971 with relatively good outcomes. Indications include ectatic disorders, forme fruste keratoconus, post-refractive surgery, post-penetrating keratoplasty, post-corneal cross-linking, and corneal GP intolerance. They noted that soft lenses offer comfort, ease of handling, centered optics, and they can be less intimidating for some practitioners. Soft lens designs for irregular corneas can be a good first choice or an only choice for some patients, they can be fit on more advanced cases, and they can be a good choice for uniocular fits, they indicated.

Buddy Russell, COMT, FCLSA, FSLS, and Michael Ward discussed “Contact Lens Management of Infants and Kids.” Mr. Russell discussed fitting medically necessary contact lenses—the “have to” fits rather than the “want to” fits. He mentioned the importance of “fitting the caregiver” first. Practitioners need to tell parents that they won’t hurt the child, but the child will still cry. He said you need to find out from the parents what a child likes and what the child responds to so you know what buttons to push to engage the child in the process. It’s best to try to expose a child to only one trauma at a time—for example, hold off on patching to allow a child time to acclimate to contact lenses. He noted that you need to be frank with parents about what they need to do and about what you need to do, for which you need to get the parents’ permission.

Honoring Excellence

The Global Specialty Lens Symposium Award of Excellence One of the very special traditions of the GSLS is honoring legendary pioneers in contact lenses. With the increasing interest in scleral contact lenses, it was very appropriate to award the Global Specialty Lens Symposium Award of Excellence to the following individuals who are most responsible for scleral lens developments: Don Ezekiel, AM, Dip Opt (Australia); Ken Pullum, FCOptom, DipCLP (United Kingdom); Perry Rosenthal, MD (United States); and Rients Visser (The Netherlands) (Figure 4).

Figure 4. The GSLS Award of Excellence Winners: Ron Beerten, BOptom (accepting for Rients Visser); Lynette Johns, OD (accepting for Perry Rosenthal, MD), Ken Pullum, FCOptom, DipCLP; Marco van Beusekom, BOptom (accepting for Rients Visser); and Don Ezekiel AM, Dip Opt, with Ed Bennett, OD, MSEd.

In his introductory comments before presenting the awards, Dr. Bennett expressed the significant impact that the award winners have had on patients’ lives: “Imagine waking up in the morning and your eyes feel very dry and uncomfortable, and there seems to be nothing you can do about it. Or your life is one big blur. People ostracize you because you can’t see what they see. You go to the drivers’ license bureau to renew your license, and you then lose your driving privileges because you fail the vision examination. You lose your job because you just can’t perform the visual tasks as well as those who work with you...You live your life in total fear of what tomorrow may bring. Then, one day, your eyecare practitioner fits you into scleral lenses, and you...cry, because the miracle you have prayed for every night for years has occurred. The four people we are honoring today are the reason we are dramatically changing the quality of thousands of people’s lives every day.”

Poster Awards and Photo Competition This year’s GSLS presented 70 clinical and scientific posters. PDFs of most of these posters are available at The photo competition this year featured nearly 20 entries in two different categories: Cornea/Conjunctiva/Lids and Contact Lens. Table 1 lists the winners (Figures 5 and 6).

TABLE 1 Poster and Photo Competition Award Winners
First Place: Amy Dinardo, OD, MBA, FAAO, & Evan Andrews, “A Comparison of the Neutralization Process Amongst Various Hydrogen Peroxide-Based Contact Lens Solutions”
Second Place: Adeline Bauer, OD, & Josh T. Lotoczky, OD, FAAO, “Let’s Settle This Once and For All: A Comparison of Scleral Lens Settling”
First Place: Heidi Miller, OD, & Timothy B. Edrington, OD, MS, FAAO, “Corneo-Scleral Lens Management of a Bilateral Corneal Transplant Patient Suffering from Severe Ocular Surface Disease”
Second Place: Brooke Messer, OD, “Utilizing Micro-Vaults to Improve Comfort and Cosmesis in Scleral Lens Wearers with Pingueculae”
PHOTOGRAPHY CONTEST (Winning photos appear on this month’s cover)
First Place: Masao Matsubara, MD, DMSc, “Dementors in a Cornea”
Second Place: Stephanie L. Woo, OD, FAAO, “Explosive Iris Bomb”

Figure 5. Clinical Poster award winners Evan Andrews and Amy Dinardo, OD, MBA, with Ed Bennett, OD, MSEd.

Figure 6. Scientific Poster award winner Heidi Miller, OD, with Ed Bennett, OD, MSEd.

Come Check It Out

The Global Specialty Lens Symposium continues to set the standard for specialty contact lens education, with the goal of being the “Go To” meeting for eyecare practitioners desiring to build their practice with scleral, multifocal, corneal reshaping, myopia control, and other specialty contact lenses. If you want to build your practice and patient base in these areas, plan to attend the next GSLS scheduled for Jan. 21 to 24, 2016 at Caesar’s Palace in Las Vegas.

Acknowledgements: Josh Adams; Arthur Back, OD; Melissa Barnett, OD; Doug Benoit, OD; Mile Brujic, OD; Robert Davis, OD; Tim Edrington, OD, MS; Barry Eiden, OD; Jason Jedlicka, OD; Michael Lipson, OD; Ken Maller, OD; Robert Maynard, OD; Langis Michaud, OD; Bruce Morgan, OD; Clarke Newman, OD; Renee Reeder, OD; Muriel Schornack, OD; Jeff Sonsino, OD; Jan Svochak; Harvard Sylvan, OD; Eef van der Worp, BOptom, PhD; Stephanie Woo, OD.

To obtain references for this article, please visit and click on document #233.

Dr. Nichols is an assistant vice president for industry research development and professor at the University of Alabama-Birmingham as well as editor-in-chief of Contact Lens Spectrum and editor of the weekly email newsletter Contact Lenses Today. He has received research funding or honoraria from Vistakon, Alcon, and Allergan.

Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. You can reach him at

Ms. Starcher is the managing editor of Contact Lens Spectrum.