Many have considered the option of overnight orthokeratology (OOK) for those lens wearers who suffer from the annoying and burdensome symptoms associated with contact lens dry eye. I have heard several anecdotal reports that OOK can alleviate these issues, but the abstract this week highlights important clinical information.
In particular, with the teenagers in this study, nearly all had increased subjective scores on the Ocular Surface Disease Index (OSDI) over the first six months of wear; but then, these regressed toward baseline between 12 and 24 months of wear. This may, in part, relate to an adaption period that is important for practitioners to consider when fitting OOK.
Visionary Optics introduced the Latitude scleral lens, which the company says is the first such lens that is completely custom made to exactly fit the corneal and scleral surfaces based upon scleral topography (sMap3D) measurements. The Latitude lens exactly conforms to the scleral shape at the landing zone and is designed to even out the central, midperipheral, and limbal clearances regardless of the degree of corneal irregularity, including asymmetric ectasias in which uneven clearances are especially obvious, according to the company. Visionary Optics says that this uniformity of lens-to-ocular surface clearance is critical to ocular surface health because it ensures that oxygenation to the cornea and limbus is optimized. Data required to fit the lens is based upon a no-ocular-touch, three-to-five minute corneal-scleral topography examination.
Medicine-Releasing Contact Lens in Development
Researchers at the Fraunhofer Institute for Applied Polymer Research (IAP) are working with Israeli and German partners to develop long-wearing contact lenses that can release medicine. The Israeli partner company EyeYon Medical has already developed drug-administering contact lenses that the company says ensure longer residence times of the active substances.
The goal of the German-Israeli research team is to coat the inside of the contact lens with liposomes that carry a drug and release it over time. The liposomes are produced at the Weizmann Institute of Science by a research group led by Prof. Jacob Klein and Dr. Ronit Goldberg. However, the use of liposomes is not the only strategy for optimizing contact lenses. Sugars are also added to make the contact lens particularly comfortable to wear, according to the company. The glycopolymer coating on the contact lens is being developed by the German company Surflay Nanotec.
The five partners and two subcontractors (DendroPharm GmbH and Nextar Chempharma Solutions) are working closely with one another in obtaining an approved medical device. The three-year project will run until July 2021. The researchers must also ensure that all of the components are biocompatible. Biocompatibility tests are being carried out at the Rostock University Medical Center. The two subcontractors are also checking whether all system components have been manufactured in accordance with good manufacturing practice guidelines.
The project is receiving around 1 million euros in funding from the German Federal Ministry of Education and Research.
Bausch + Lomb Announces New Divisional Leadership in the United States
Bausch + Lomb announced the appointment of new leadership in its Pharmaceuticals and Consumer Health Care divisions in the United States.
Yolande Barnard, formerly the vice president, marketing and sales, U.S. Neurology, Bausch Health, will now serve as vice president and general manager, U.S. Pharmaceuticals, Bausch + Lomb. Chris Marschall, most recently vice president, marketing for Bausch + Lomb’s U.S. Consumer Health Care business, has been promoted to vice president and general manager, U.S. Consumer Health Care. Ms. Barnard and Mr. Marschall assume responsibility for the day-to-day management of their respective businesses, ensuring all marketing and sales goals and objectives are met while increasing operating performance.
Ms. Barnard and Mr. Marschall will join John Ferris, vice president and general manager, U.S. Vision Care, and Chuck Hess, vice president and general manager, U.S. Surgical, to round out Bausch + Lomb’s fully integrated eye health leadership team in the United States. Ms. Barnard and Mr. Marschall are based at the company’s headquarters in Bridgewater, NJ.
Akorn Receives FDA Approval for Generic Loteprednol Etabonate
Akorn announced that it received a new abbreviated new drug application approval from the U.S. Food and Drug Administration (FDA) for loteprednol etabonate ophthalmic suspension, 0.5%.
Loteprednol etabonate 0.5% is indicated for the treatment of postoperative inflammation following ocular surgery and for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitis, and when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation.
Safilens Launches Fusion 1day Vista and Weekly Fusion Segment
Safilens launched its Fusion 1day Vista and the weekly Fusion segment in the U.K. market.
Fusion 1day Vista features a D-Stress design. According to Safilens, this new geometry offers greater depth of field and is custom-designed to reduce eye strain commonly associated with daily activities that exacerbate proximal vision, such as the prolonged use of digital devices. Furthermore, the controlled release of natural substitutes for the tear film from the lens to the eye surface ensures long-lasting comfort in dry environments or when reduced frequency or incomplete blinking occurs, according to the company. Fusion 1day Vista expands the daily contact lens family of lenses that incorporate the fusiontechnology system, which includes the synergistic action of hyaluronic acid and tamarind seed polysaccharide (TSP) that normalizes and maintains stability of the physiological relationship between the lacrimal film and the ocular surface, according to the company.
The Fusion weekly segment is available for myopia and hyperopia (Fusion 7days), presbyopia (Fusion 7days Presbyo, with Safilen’s patented Afocal lens design), and astigmatism (Fusion 7days Astigma, with Sleekform design).
Prevent Blindness to Host Eighth Annual Focus on Eye Health National Summit
Prevent Blindness will hold its eighth annual Focus on Eye Health National Summit on July 17, 2019 at the National Press Club in Washington, D.C. The Summit will include a variety of presentations related to this year’s theme, “A Lifetime of Vision.” Those unable to attend in person will have an opportunity to watch a live video stream of event presentations as well as to follow the event on Twitter at #eyesummit.
The keynote speaker is Bill Barkley, a visually impaired adventurer, advocate, and author. He will share tales of his accomplishments including being the first deaf-blind individual to climb Mount Kilimanjaro in Africa in 2008, leading expeditions for deaf teenagers to the Amazon jungle and the Grand Canyon, and being the first deaf-blind person to complete the Boston Marathon.
Silver sponsors include the Alliance for Eye and Vision Research (AEVR), American Academy of Ophthalmology, American Optometric Association, Association for Research in Vision & Ophthalmology, Bausch Foundation, BrightFocus Foundation, CooperVision, Foundation Fighting Blindness, Lions Clubs International, Mallinckrodt Pharmaceuticals, OneSight, Research to Prevent Blindness, Vision 2020 USA, Vision Impact Institute, and VisionServe Alliance.
This image shows Avellino corneal dystrophy (aka granular corneal dystrophy type II). This patient has similar corneal findings in both eyes and is asymptomatic. No treatment was needed, and the patient is monitored yearly for any changes in symptoms.
We thank Dr. Deligio 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
Bandage CLs, Steroids, and Epi-Off Cross-Linking…Is It a Risky Cocktail?
Today, the standard of care for addressing progressive keratoconus is to perform corneal cross-linking (CXL). The efficacy of CXL—in terms of its ability to halt progression of the disease—is quite impressive. So, the question is no longer “if”—now it turns to “how.”
A recent study was published that investigated the role of bandage contact lenses (BCLs) and topical steroids as risk factors for the development of microbial keratitis after epithelium-off CXL.1 Patients who underwent CXL between February 2011 and July 2017 were included in the researcher’s investigation. Patients were divided into two groups: those who were treated postoperatively with a BCL, topical antimicrobial, and steroids (group 1) and those who received only a topical antimicrobial until healing of the epithelial defect before introduction of topical steroids (group 2). In the study, 1,273 eyes of 964 patients were included. Group 1 comprised 316 eyes, and group 2 comprised 957 eyes.
There were no significant differences in the presence of persisting corneal haze or scarring between the two groups (p = 0.57). Microbial keratitis occurred in nine eyes (0.71% of eyes) of eight patients (0.83%) (one case was bilateral) out of 1,273 eyes. Staphylococcus aureus was cultured from corneal scrapes in seven out of nine cases (77.8%) and from contiguous sites in the two cases. All cases occurred in group 1 (incidence = 2.85%) and none in group 2 (p < 0.0001). A greater proportion of patients who developed microbial keratitis were atopic (75%, p = 0.4).
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.
The authors concluded that the use of BCLs and topical steroids prior to healing of the epithelium is a significant risk factor for microbial keratitis. S. aureus is the most common microorganism and is likely to originate from an endogenous site. Not using a BCL and delaying the introduction of topical steroids until epithelial healing significantly reduce the risk of developing microbial keratitis without increasing the risk of persistent corneal haze.
Without question, CXL is critically important in the management of patients who have progressive keratoconus and for patients at high risk of progression. That being said, the application of CXL is a developing area. Great efforts are being made in developing safer and more comfortable techniques with faster visual recovery and stability, all while maintaining or improving upon efficacy. Again, it is not a matter of “if” we should perform CXL for appropriate patients, but rather “how” we are going to perform it. The future is very exciting!
1. Tzamalis A, Romano V, Cheeseman R, et al. Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL. BMJ Open Ophthalmol. 2019 Feb 16;4:e000231.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Fabry Disease Manifestations
We spend many hours examining the anterior segment of our dry eye/ocular surface disease patients. Dry eye has been associated with Fabry disease.1
Fabry disease is a progressive disorder, and symptoms that affect the kidneys, heart, gastrointestinal (GI) system, or brain and most often occurs when patients are age 30 to 45 years.2 Fabry disease is the result of a mutation of the gene responsible for making alpha-galactosidase enzyme, which is located on the X chromosome. Fabry disease affects mostly males, though females may rarely inherit the disease.
Ophthalmological manifestations are common in Fabry disease and result from the progressive deposition of glycosphingolipids in various ocular structures. The most specific ocular manifestations of Fabry disease are conjunctival vascular abnormalities, corneal opacities (cornea verticillata), lens opacities, and retinal vascular abnormalities.
Cornea verticillata consist of bilateral whorl-like opacities located in the superficial corneal layers, most commonly in the inferior corneal area. These opacities are typically cream colored, ranging from whitish to golden-brown. They are termed cornea verticillata because the deposits are distributed in a vortex pattern. In the early stages, the opacities may form fine horizontal lines, but they later develop into curving lines, radiating from a point below the center. The cause of the vortex pattern of the corneal deposits is unknown. Various hypotheses cite the influence of ocular hydrodynamics, periodic blinking, or ocular magnetic fields. Another possible cause is the centripetal movement of the renewing epithelial cells from the periphery toward the center of the cornea, forming small whorls before becoming almost straight at the periphery.
Keep this distinct pathology in mind when you examine patients who have the unique corneal/other ophthalmic findings of this genetic disease.
1. Klein P. Ocular manifestations of Fabry’s disease. J Am Optom Assoc. 1986 Sep;57:672-674.
2. Sodi A. Ioannidis A, Pitz S. Chapter 26 Ophthalmological manifestations of Fabry disease In Fabry Disease: Perspectives from 5 Years of FOS., Mehta A, Beck M, Sunder-Plassmann G, eds. Oxford PharmaGenesis, Oxford, 2006.
The Influence of Overnight Orthokeratology on Ocular Surface and Meibomian Gland Dysfunction in Teenagers with Myopia
The aim of this study was to investigate the effect of overnight orthokeratology (OOK) on ocular surface and meibomian gland dysfunction in teenagers who have myopia.
A total of 59 subjects were recruited in this prospective study. Tests—including the Ocular Surface Disease Index (OSDI) questionnaire, slit lamp examination, and Keratograph 5M (Oculus Inc.)—were performed before and after one, three, six, 12, and 24 months of OOK lens wear.
No infectious keratitis occurred during the study. OSDI scores increased gradually and reached the maximum at six months of OOK wear (P < 0.001). The meniscus height was significantly increased at one and three months after the initiation of OOK (P = 0.006, P = 0.04). The corneal fluorescein staining at one, three, six, 12, and 24 months after wearing OOK were all increased compared to the pre-wearing level, with significant difference (P = 0.01, P = 0.04, P < 0.001, P < 0.001, and P = 0.008, respectively). The first and the average tear film Non-Invasive Keratograph Break-Up Time (NIKBUT) were all higher compared to the pre-wearing level, but there was no significant difference between each follow-up time point (P > 0.05). The lid margin abnormalities were significantly increased (P = 0.003, P = 0.04, and P = 0.02) at six, 12, and 24 months after the initiation of OOK. There was no significant difference in the meibomian gland orifice scores at each follow-up time point compared to the pre-wearing level (P > 0.05). The meibomian gland lipid secretion scores after wearing OOK were higher than were those of the pre-wearing level, however, without statistically significant difference (P > 0.05). No significant differences in the degree of difficulty of lipid excretions were detected after the initiation of OOK (P > 0.05). There was no significant difference in meibomian gland dropout scores between all follow-up time points and the pre-wearing level (P = 1.00).
The researchers determined that OOK increased the symptoms of dry eye and decreased the function of the tear film by affecting the meniscus height and BUT. OOK did not affect the function of meibomian glands.
Wang X, Li J, Zhang R, Li N, Pang Y, Zhang Y, Wei R. The Influence of Overnight Orthokeratology on Ocular Surface and Meibomian Gland Dysfunction in Teenagers with Myopia. J Ophthalmol. 2019 Jan 21;2019:5142628.