While this was an important step, key issues still need to be addressed. It is fair to say that many of the questions and issues remain today and have perhaps even expanded with growing concern and angst given the continued lack of response or oversight from regulatory agencies.
As I reflect on these issues and on our current state of affairs as it relates to contact lens prescribing and distribution, I am reminded of a commonly used quote that was modified by comedian George Carlin: "If you can't beat them, arrange to have them beaten."
It is important that we all get in front of this ever-emerging trend, if for nothing else than for the best interests and safety of our patients.
Jason J. Nichols, OD, MPH, PhD
Alcon Completes Spinoff from Novartis
On April 9, 2019, Alcon completed its separation from Novartis. Under the terms of the separation, each Novartis shareholder or ADR (American Depositary Receipt) holder will receive one Alcon share for every five Novartis shares or ADRs that they held as of the close of business on April 1, 2019, the record date for the distribution.
Alcon is headquartered in Geneva. In addition, its facilities in Fort Worth, Texas, will remain a major operational center and innovation hub with a large base of employees.
Asepticys LLC announced the submission of its 510k application to the U.S. Food and Drug Administration (FDA) for a contact lens care solution containing TriFlect technology, a patent-protected biocidal compound.
2019 ARVO Student Travel Fellowship Recipients Announced
The American Academy of Optometry announced the recipients of its 2019 Student Travel Fellowship Awards. The travel fellowships, supported by Johnson and Johnson Vision Care Inc., will allow five students to present their research at the Association for Research in Vision and Ophthalmology (ARVO) 2019 annual meeting. The 2019 recipients and their respective schools are Suman Adhikari, BOptom, University of Houston; Moonjung Choi, MS, Indiana University; Justin Courson, University of Houston; Nicole Karson, University of Houston; and Natalie Stepien-Bernabe, University of California, Berkeley.
The American Academy of Optometry administers travel fellowships to encourage optometry students, optometric residents, and students in eye- and vision-related graduate programs to attend key national meetings and exchange scientific ideas on research. Fellowships are awarded primarily for accomplishment and potential in optometric research and education and are evaluated by the American Academy of Optometry’s Research Committee.
Applications for student travel fellowships for Academy 2019 Orlando and the 3rd World Congress of Optometry will be available in July 2019. For more information, visit http://www.aaopt.org/students/stf.
ABB Optical Group Announces New Senior Vice President of Operations
ABB Optical Group appointed Tom Calhoun as senior vice president of operations. According to the company, Mr. Calhoun will be responsible for streamlining ABB Optical Group’s business operations for enhanced efficiency and productivity, along with aligning all aspects of the company's operations to deliver best-in-class service to its customers. He comes to ABB Optical Group with nearly 30 years of experience in the healthcare industry.
AOA Announces 2019 National Optometry Hall of Fame Inductees
The American Optometric Association (AOA) and Optometry Cares—The AOA Foundation announced this year’s inductees into the National Optometry Hall of Fame. This year’s honorees are Murray Fingeret, OD; Donald Jarnagin, OD; Michael Mittelman, OD; and Glen Steele, OD.
Euclid Systems will be hosting a webinar titled "Proactively Managing Myopia with Orthokeratology: Taking Your Practice from Good to Great" on April 23, 2019 at 8:00 p.m. (Eastern). This is the first program in a four-part series.
During the webinar, David L. Kading, OD, will discusses why implementing a proactive myopia management program into your practice is important, co-morbidities associated with the disease, and simplified methods to get started with a myopia management program today.
Clearside Biomedical Appoints Dr. George Lasezkay as Interim CEO
Clearside Biomedical, Inc. has appointed George Lasezkay, PharmD, JD, to the position of interim CEO, effective immediately. Dr. Lasezkay, a current member of the Clearside board of directors, succeeds Daniel H. White, who resigned as president and CEO and as a member of the board of directors to pursue other opportunities. The board is initiating a search to identify a permanent CEO.
Previously, Dr. Lasezkay served as executive vice president and general counsel at Acucela Inc. Before that, he held the positions of president of Horizon Pharma Group and corporate vice president for corporate development at Allergan, Inc.
Call for CE Courses
The Global Specialty Lens Symposium (GSLS) Program Committee invites you to submit one-hour continuing education courses for consideration for the GSLS 2020, which will take place in Las Vegas from January 22-25, 2020. Course submissions can cover all aspects of contact lenses (such as materials, designs, lens care) in addition to related topics such as corneal and ocular surface disease, diagnosis and treatment approaches, and practice management. Submissions must be received by 5:00pm ET on May 10, 2019.
Tom Arnold, OD, Sugar Land, TX
Radial keratotomy was a popular surgical procedure in the 1970s and 1980s. However, sometimes significant scarring resulted. If the scarring entered the visual axis as shown in this optical coherence tomography (OCT) image, best visual acuity would be reduced.
We thank Dr. Arnold for this image and welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit http://www.cltoday.com/upload/upload.aspx to upload your image. Please include a detailed explanation of the photo and your full name, degree or title, and city/state/country.
S. Barry Eiden, OD
Taking Things to the Next Level: Correction of Higher-Order Aberrations with Sclerals in Keratoconus
Visual acuity is only one measure of the impact that keratoconus has on visual function. We are all now familiar with the degradation of vision induced by higher-order aberrations (HOAs) in keratoconus. These aberrations are induced primarily by the irregularity of the anterior corneal surface; however, there is surely a clinically significant influence from the irregular posterior corneal surface as well.
When a scleral or other type of rigid contact lens is placed on the eye, the vast majority of anterior corneal irregularity is "masked," and associated HOAs are minimized. The posterior cornea unfortunately continues to influence total HOAs and subsequent vision quality. Attempts have been made to quantify these residual HOAs and then to hopefully design contact lenses that can neutralize them via placement of HOA correction on the anterior surface of the contact lens.
A recent study was published that compared, in a crossover design, optical and visual performance of eyes that have corneal ectasias wearing dispensed best conventional scleral lens corrections and dispensed individualized wavefront-guided (WFG) scleral lens corrections.1 Ten subjects (20 eyes) participated in a randomized crossover study in which best conventional scleral lenses and WFG scleral lenses (customized through the fifth radial order) were worn for eight weeks each.
These corrections, as well as each subject's habitual correction and normative data for normal eyes, were compared using residual higher-order aberrations (HORMS), visual acuity (VA), letter contrast sensitivity (CS), and visual image quality (logarithm of the visual Strehl ratio, or logVSX). Correlations were performed between Pentacam (Oculus) biometric measures and gains provided by WFG lenses.
Results indicated that mean HORMS was reduced by 48% from habitual to conventional and by 43% from conventional to WFG. Mean logMAR VA improved from habitual (+0.12) to conventional (–0.03) and further with WFG (–0.09); six eyes gained greater than one line with WFG over conventional. The percentage of the eyes achieving normal levels were as follows: HORMS, 40% for conventional and 85% for WFG; VA, 50% for conventional and 85% for WFG; and CS, 60% for conventional and 90% for WFG. logVSX improved by 16% from habitual to conventional and 25% further with WFG. Reduction in aberrations with WFG lenses best correlated with posterior cornea radius of curvature. The researchers concluded that with WFG lenses, HORMS and logVSX significantly improved, allowing more eyes to reach normal levels of optical and visual performance compared with conventional lenses.
Various studies have been conducted over the years that attempted to provide HOA correction with contact lenses of various designs. Our practice has been involved in a number of these studies. The greatest challenge continues to be the establishment of a stable environment to apply HOA corrections to the lenses. Any lenses that have significant movement or rotational instability are very challenging in this regard. Corneal GPs simply have too much movement; soft lenses also have movement and also suffer from surface shape instability and dehydration effects. Scleral lenses seem to be the best contact lens option so far available to apply HOA compensation on the anterior contact lens surface.
This study supports the value of application of HOA corrections to scleral lenses to provide superior visual performance. An interesting side note was the correlation of effect on HOA reduction with posterior corneal findings found with Scheimpflug corneal tomography (Pentacam). This suggests (as indicated earlier) that the source of residual HOAs in keratoconus patients found after rigid contact lenses are applied is from the posterior corneal irregularity. Continued work in the development of HOA-correcting contact lenses will help our patients who have keratoconus and other causes of corneal irregularity to achieve greater levels of visual function with contact lenses.
1. Hastings GD, Applegate RA, Nguyen LC, Kauffman MJ, Hemmati RT, Marsack JD. Comparison of Wavefront-guided and Best Conventional Scleral Lenses after Habituation in Eyes with Corneal Ectasia. Optom Vis Sci. 2019 Apr;96:238-247.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
You Just Mite See Them
Way back in 2013, I described a method to identify Demodex organisms in the eyelash follicle without epilating eyelashes or rushing a freshly-pulled lash to a microscope to search for Demodex organisms.1 I was excited about this technique, as I knew that extracted lashes generally were stripped of their associated mite. From experience, I was often left with a clean eyelash in my forceps and many mites left at the follicle orifice. I was also pleased to know that all practitioners who have a slit lamp would be able to evaluate for Demodex overpopulation without the addition of special technology to their offices.
Just this month, another group demonstrated that this technique, which involves lash rotation and traction, delivers larger quantities of D. folliculorum than epilation of the eyelash does. The authors conclude, adding evidence to the 2013 proposal, that in a clinical setting, eyelash epilation is not necessary to accurately detect Demodex blepharitis requiring treatment.
Give it a whirl to see what you see!
1. Mastrota KM. Method to identify Demodex in the eyelash follicle without epilation. Optom Vis Sci. 2013 Jun;90:172-174.
2. Murphy O, O’Dwyer V, Lloyd-McKernan A. The Clinical Use of Eyelash Manipulation in the Diagnosis of Demodex folliculorum Blepharitis. Eye Contact Lens. 2019 Apr 2. [Epub ahead of print]
An Update of Eye Shape and Myopia
Myopia is one of the most prevalent eye diseases, and its advanced form, high myopia, is a leading cause of subsequent pathologic myopia, which in turn results in an increased risk of retinal diseases. The prevalence of myopia and high myopia is 28.3% and 4.0% of the global population, respectively, and these numbers are estimated to increase to 49.8% for myopia and 9.8% for high myopia by 2050, thus making myopia a severe global socioeconomic problem. Eye shape has been receiving increasing attention as a possible biomarker for myopia.
Among several modalities, magnetic resonance imaging (MRI) is currently considered to be the best to measure the 3-D eye shape, and one study using MRI revealed that myopic eyes became much larger in all three dimensions, but more so in length (0.35mm/D) than in height (0.19mm/D) or in width (0.10mm/D), which fitted in global and axial elongation models.
Another recent study reported that emmetropic retinas were oblate but oblateness decreased with myopia progression. And, according to a different study that evaluated eye shapes in high myopia, although all emmetropic eyes had a blunt shape, almost half of the high-myopic eyes had a pointed shape. Multiple lines of evidence suggest that abnormal eye shape changes can cause not only simple myopia but also various ocular complications through biomechanical stretching.
In this review, the authors highlight recent findings on eye shape changes in myopic eyes and abnormal eye shapes in pathologic myopia.
Matsumura S, Kuo AN, Saw SM. An Update of Eye Shape and Myopia. Eye Contact Lens. 2018 Dec 19. [Epub ahead of print]