This weekend is associated with the closure of the U.S. Federal Tax season—something none of us enjoy per se, but it is important to note that federally funded biomedical research would not occur without this revenue source. It goes without saying that fundamental biomedical research on diseases (of the eye and beyond) is the basis for the development of new and novel treatments that impact our patients and practices. The National Institutes of Health is seeing its first substantial increase ($2 billion) in years which is going to help support keys areas such as the Precision Medicine Initiative and help fighting antibiotic resident bacteria. Hopefully we will continue to see increases in the support of eye and vision research as well.
Jason J. Nichols, OD, MPH, PhD
J&J Vision Care Replaces Unilateral Pricing Policy and Focuses Advocacy Efforts
Johnson & Johnson Vision Care, Inc. announced its renewed and continued commitment to advocate in support of the doctor-patient relationship and against legislation that threatens to undermine patient health and deregulate the industry. To support these focused advocacy efforts, the company has discontinued its Unilateral Pricing Policy (UPP) and is replacing it with new programs to ensure broad access and support the needs of patients, doctors, and customers.
Proponents of deregulation advocate for online prescribing of contact lenses and extending contact lens prescription expiration limits. The company strongly believes that the safe and appropriate use of contact lenses must be firmly grounded in a legislative and regulatory environment that prioritizes and recognizes the vital role of eyecare providers in ensuring patients’ health and safety.
The company’s new approach includes category growth initiatives and a rewards program that allows patients to submit for savings before they leave their eyecare professional’s office. These commercial initiatives will further improve patient affordability and access. Unlike current programs used in the industry, this rewards program will be simple and convenient for patients and eyecare professionals’ staff.
The new business strategy is consistent with J&J’s overall commitment to lead on:
Innovation: Four new vision care products launched in 2015 and eight more over the next four years, with the next one in July.
Investing to Grow the Category: Amplified investment in education and marketing efforts to activate new patients.
Access & Affordability: Majority of patients paying less for their Acuvue Brand Lenses today than they were two years ago.
Advocacy: Working on the ground in states where legislation is being considered that could interrupt the doctor-patient relationship or undermine patient safeguards.
Art Optical Contact Lens, Inc. introduces new practitioner-focused, interactive learning resources for Ampleye, their recently released scleral lens.
Partnering with optometric research teams from Pacific University College of Optometry and the Vision Research Institute (VRI) at the Michigan College of Optometry, Art Optical has educational tools to help ECPs at all levels gain a better understanding of Ampleye diagnostic selection and assessment techniques, as well as the fundamentals of scleral shape and lens fitting concepts.
The Ampleye Virtual Trial Set Demonstration tool, developed in partnership with the VRI, is a web-based, self-guided interactive training program that allows the user to select a case of interest and then follow the narration to complete the Ampleye virtual fitting process for the patient. Supported by actual on-eye fluorescein images, optic section views and OCT evaluations, the ECP will quickly grasp the Ampleye fitting process, reducing chair time and improving first-fit success.
For those that prefer lecture-based training, a live Ampleye webinar is scheduled for Wednesday, April 20, at 8:30 pm EDT. Hosted by Professor Patrick Caroline, FCLSA, FAAO, the free 1-hr presentation will feature a comprehensive Ampleye overview followed by a live Q&A session. Webinar registration is available at https://www.artoptical.com/register/.
CooperVision Seeks Proposals for 4th Annual S&T Awards Program
CooperVision, Inc. announced a call for proposals for the CooperVision Science and Technology (S&T) Awards Program. Now in its fourth year, the program fosters partnerships between award recipients and CooperVision scientists to explore new areas of advancement in contact lens technology, and enable the translation of concepts into real world solutions.
The key focus areas for the 2017 S&T Awards are:
Strategies to improve contact lens comfort, with an emphasis on devices and non-pharmaceutical approaches with novel modes of action (ocular or non-ocular) to retain, manage, or enhance moisture at the ocular and/or lens surface;
Insights into the retinal response from optical defocus; and
Technologies to expand the functionality of contact lenses as a wearable device for application beyond conventional vision correction
The CooperVision S&T Awards Program is open to researchers around the world. Interested applicants must submit a letter of intent by May 30, 2016. Upon approval of the letter of intent, applicants must submit a full proposal by August 29, 2016.
Through the S&T Awards program, there are two types of awards available. The CooperVision Seedling Award is intended to incentivize collaboration with CooperVision in a new research area for a one-year period. The award enables investigators to generate preliminary data that could be used toward a future CooperVision Translational Research Award. The maximum total cash amount for a CooperVision Seedling Award is $100,000, including indirect costs.
The CooperVision Translational Research Award is a multi-year award for a substantive translational research project. Research under this award is milestone-driven in order to remain focused on a well-defined goal. It provides funding for up to two years, totaling up to $400,000, including indirect costs. A maximum of $250,000 can be requested for any one year. A CooperVision Translational Research Award may be considered for renewal at the end of the initial research period.
American Optometric Association and American Academy of Ophthalmology Support Contact Lens Prescription Verification and Patient Safety Bill
The American Optometric Association (AOA) announced its support for the Contact Lens Consumer Health Protection Act of 2016 (S. 2777), a bill introduced by Sen. Bill Cassidy, M.D., (R-La.), to ensure more effective Federal enforcement of contact lens patient health and prescription verification safeguards by targeting an array of schemes being used by unscrupulous Internet sellers. The bill seeks to hold sellers accountable for deceptive, abusive and illegal sales tactics, especially those that cause patient harm and result in added health care costs.
As a patient health safeguard, the FCLCA requires online sellers to verify the validity of contact lens prescriptions with the patient’s doctor before fulfilling an order. Eye doctors and patients have been reporting that some Internet sellers are not following these health, safety and commonsense requirements in the law and are placing patients needlessly at risk.
In their release, the American Academy of Ophthalmology also announced their support of the Contact Lens Consumer Health Act, stating that this legislation would protect contact lens consumers and eyecare providers from harmful business tactics. It would facilitate a prescriber's ability to verify and correct patient prescriptions. Additionally, it would put an end to contact lens vendors falsely advertising their ability to sell contact lenses without a prescription.
Click here for information on the bill and to follow S. 2777 through its process.
Our Children’s Vision Campaign To Screen 50 Million Children By 2020
Optometry Giving Sight co-hosted the official launch of the Our Children’s Vision Campaign at the Australian Consulate in New York on April 12. This new global campaign has been initiated by the Brien Holden Vision Institute and the Vision for Life fund, created by Essilor. It seeks to bring together governments, development agencies, the private sector, eye health practitioners and communities with the goal of screening 50 million children worldwide for vision impairments by 2020.
Optometry Giving Sight is a global partner in the campaign and will seek to mobilize support from the global optometric community.
Optometry Giving Sight has been pleased to work with CooperVision, VSP, Marchon, Essilor, Alcon and our optometric network partners Vision Source, FYidoctors and Eye Recommend to support child and school eye health projects in India, Tanzania, Cambodia, China, El Salvador, South Africa, Mexico, Haiti and Australia. They hope more companies and individuals will add their financial and in kind support to the campaign.
Other funding partners include leading sunglasses brand Revo, through the ‘Buy Vision Give Sight’ initiative. The campaign is endorsed by the World Council of Optometry and the International Council of Ophthalmology. To date, 34 international and national organizations have joined Our Children’s Vision.
Members of the optometric community who are interested in learning more about the campaign and how to get involved are invited to contact Optometry Giving Sight – firstname.lastname@example.org.
Looking at Lid Wiper and Inflammation in Contact Lens Induced Dry Eye
A recently published study looked at indicators of inflammatory cell response on the lid wiper portion of the eyelid margins of patients who had contact lens induced dry eye (CLAID) and those wearers without CLAID in comparison to a group of non- contact lens wearing and asymptomatic controls.1 The goal of the study was to determine if the Langerhans cells in the lid wiper are upregulated in CLIDE.
The lid wiper of one eye of 17 participants with CLIDE (assessed using the CLDEQ-8) and 29 without CLIDE (NO-CLIDE) was examined using a Heidelberg laser scanning confocal microscope after 6 months wear of daily disposable hydrogel contact lenses. Twenty non-contact-lens-wearing controls were also examined. Langerhans cell density (LCD) in each participant was taken as the mean cell count calculated manually from six clear, randomly selected images of known dimensions. Results of the data analysis found that there were significant overall differences in LCD in the lid wiper among the three groups (p < 0.001). LCD was significantly greater in the lid wiper in CLIDE (17 ± 10 cells/mm) compared to controls (8 ± 4 cells/mm) (p < 0.001); however, there was no difference in LCD between NO-CLIDE (10 ± 5 cells/mm) and controls (p = 0.489). LCD was significantly greater in CLIDE than NO-CLIDE (p = 0.002). Based upon these results the authors concluded that Langerhans cells in the lid wiper are upregulated in CLIDE, suggesting an inflammatory component in the etiology of this condition.
Langerhans cells are dendritic cells (antigen-presenting immune cells) that are responsible for recognition, processing, and presentation of antigens as part of the immune response of the eye and other parts of the body. The results of this study support the concept that inflammation plays a significant role in ocular surface disease. Specifically, as demonstrated here, even cases of contact lens induced dry eye also have a significant inflammatory component. Paying attention to specific findings discovered in the dry eye/ ocular surface work up such as the status of the lid wiper, tear osmolarity, and detection of inflammatory markers among many others will help in the differential diagnosis and in guiding management which should be aimed at reduction of ocular surface inflammation.
1. Alzahrani Y, Colorado L, Pritchard N, Efron N. Inflammatory Cell Upregulation of the Lid Wiper in Contact Lens Dry Eye. Optom Vis Sci. 2016 Apr 6. Epub ahead of print.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
This week as you examine your dry eye patients I imagine that you may note your patient chart via the van Bijsterveld. System. Are you thinking what is van Bijesterveld system?
Van Bijsterveld described an ocular surface vital dye staining scoring system that divides the ocular surface into three zones: nasal bulbar conjunctiva, temporal bulbar conjunctiva, and cornea. Each zone is evaluated on a scale of 0 to 3, with 0 indicating no staining and 3 indicating confluent staining; the maximum possible score with this system is 9.1
Subsequent, more precise systems defined to quantify ocular surface staining include the NEI/Industry Workshop guidelines, the Oxford Scheme, the area-density combination index, and the Sjögren's International Collaborative Clinical Alliance ocular staining score. More recent objective digital image analysis technique to evaluate corneal staining may be useful for objective assessment of corneal staining.2
At present, there are no published studies demonstrating that one grading system is innately better than another. Remember that when considering/comparing clinical studies that involve surface staining, that differences in grading scales and study designs make it difficult to compare results across clinical studies.
1. van Bijsterveld OP. Diagnostic tests in the sicca syndrome. Arch Ophthalmol. 1969 Jul;82(1):10-4.
2. Chun YS, Yoon WB, Kim KG, Park IK. Objective Assessment of Corneal Staining Using Digital Image Analysis. Invest Ophthalmol Vis Sci. 2014 Nov 18;55(12):7896-903.
Inflammatory Cell Upregulation of the Lid Wiper in Contact Lens Dry Eye
The purpose of this study was to determine if Langerhans cells in the lid wiper are upregulated in contact lens-induced dry eye (CLIDE).
The lid wiper of one eye of 17 participants with CLIDE (assessed using the CLDEQ-8) and 29 without CLIDE (NO-CLIDE) was examined using a Heidelberg laser scanning confocal microscope after 6 months wear of daily disposable hydrogel contact lenses (Biomedics 1 day Extra). Twenty non-contact-lens-wearing controls were also examined. Langerhans cell density (LCD) in each participant was taken as the mean cell count calculated manually from six clear, randomly selected images of known dimensions.
There were significant overall differences in LCD in the lid wiper among the three groups (p < 0.001). LCD was significantly greater in the lid wiper in CLIDE (17 ± 10 cells/mm) compared to controls (8 ± 4 cells/mm) (p < 0.001); however, there was no difference in LCD between NO-CLIDE (10 ± 5 cells/mm) and controls (p = 0.489). LCD was significantly greater in CLIDE than NO-CLIDE (p = 0.002).
The authors concluded that Langerhans cells in the lid wiper are upregulated in CLIDE, suggesting an inflammatory component in the etiology of this condition.
Alzahrani Y, Colorado L, Pritchard N, Efron N. Inflammatory Cell Upregulation of the Lid Wiper in Contact Lens Dry Eye. Optom Vis Sci. 2016 Apr 6. [Epub ahead of print]