Although the contact lens market has seen growth in the daily disposable modality, it is important that we not lose sight of the importance of contact lens care for the rest of our contact lens-wearing patients. In an ideal world, patients would remain compliant with the use of your prescribed care system, but we know that this is often not the case. There are probably many factors that contribute to patients using alternative care solutions. One factor that many practitioners feel is important to help build compliance is the ability to provide “starter kits” to patients. We would like to get your thoughts on this. Let us know by voting in the May Quick Poll, which is live on our website now.
Jason J. Nichols, OD, MPH, PhD
ABB Optical Data Addresses Direct-to-Patient Shipments
ABB Optical Group released market data showing that eyecare practices that ship more than 10% of their soft contact lens (SCL) sales directly to patients outpace the national average for dollar growth. Conversely, practices with little to no direct-to-patient shipping activity underperform compared to the national average. The national average for direct-to-patient dollar share was 25%, and the national average for dollar growth in 2017 was 7.2%. Practices with more than 45% direct-to-patient dollar share grew 8.6% year-over-year, while practices with less than 10% direct-to-patient dollar share grew at only 6.3%.
ABB Optical’s data also indicate that more than one-third of direct-to-patient shipments are daily disposables and that more than one-quarter of direct-to-patient shipments are torics.
The analysis is based on 2017 sales data from approximately 11,000 eyecare offices, which represents nearly 31% of total contact lens wholesale dollars in the United States.
Blanchard Announces Notching Technology for the Onefit Family of Scleral Lenses
Blanchard Contact Lenses has unveiled its latest design option for its Onefit and Onefit Med scleral lenses. Control Peripheral Recess (CPR) is a manufacturing process that creates a precise, controlled, and reproducible peripheral recess on a lens (notch) to accommodate pingueculas and any other types of growths and shunts. CPR technology is available on all Onefit lens designs (Spherical, Sym-Toric, Toric Peripheral Curve, and Quadrant Specific). An extremely user-friendly CPR Tool available at blanchardlab.com simplifies the design and ordering process and provides a visual representation of the lens design, according to the company.
ABDO Appoints New Chief Examiner for Contact Lenses
The Association of British Dispensing Opticians (ABDO) has appointed Dean Dunning to take over for Rosemary Bailey in February 2020 as chief examiner for contact lenses. He will be shadowing Ms. Bailey over the next four examination sessions to ensure a smooth transition.
Mr. Dunning is an ABDO contact lens examiner for theory and practical exams. With 22 years of experience in the profession, he is also program leader in contact lenses at Bradford College.
Glowing Contact Lens Could Prevent A Leading Cause of Blindness
California Institute of Technology (Caltech) graduate student Colin Cook, MS, along with a group of researchers from the lab of Yu-Chong Tai, Caltech’s Anna L. Rosen Professor of Electrical Engineering and Medical Engineering, has developed a potential treatment for diabetic retinopathy—a glow-in-the-dark contact lens.
The loss of vision that accompanies diabetes is the result of the damage that the disease causes to tiny blood vessels throughout the body, including those in the eye. That damage results in reduced blood flow to the nerve cells in the retina and their eventual death. Because damage to the retina begins with an insufficient supply of oxygen, it should be possible to stave off further eyesight loss by reducing the retina’s oxygen demands. The eye’s rod cells, which provide vision in low-light conditions, need and use a lot more oxygen in the dark than they do when they’re awash with light.
The contact lenses are designed to reduce the retina’s night-time oxygen demand by exposing the rod cells to a faint amount of light while the wearer sleeps. The illumination is provided by tiny vials filled with tritium, a radioactive form of hydrogen gas that emits electrons as it decays. Those electrons are converted into light by a phosphorescent coating. This system ensures a constant light output for the lifetime of the contact lens. The vials, which are only the width of a few human hairs, are implanted in the lens in a radial pattern that is just big enough to fall outside of the wearer’s view when the pupils are constricted in lighted conditions. In the dark, the pupil expands, and the faint glow from the vials can illuminate the retina.
Cook has been engaged in early testing in collaboration with Mark Humayun’s lab at the University of Southern California. In the next few months, he and his fellow researchers will start testing the lenses to see whether their ability to reduce retinal metabolism will translate into the prevention of diabetic retinopathy. Following those tests, they will seek FDA permits to begin clinical trials.
Tom Shone to Assist Eaglet-Eye
Eaglet-Eye announced that contact lens industry veteran Tom Shone will be assisting Eaglet’s sales and marketing efforts. Mr. Shone, former president of Alden Optical and prior to that president of CooperVision USA, will assist the Eaglet team with sales and marketing primarily in North America.
Brian Andrews to Succeed Albert White as CFO of The Cooper Companies
The Cooper Companies, Inc. announced that Brian Andrews has been promoted to senior vice president, CFO, and treasurer of The Cooper Companies effective May 1, 2018. Mr. Andrews will succeed Albert White as CFO, who will assume the role of president and CEO on May 1, 2018.
Mr. Andrews began his career at Cooper in 2006 as assistant treasurer and served in that role until 2013 when he was promoted to treasurer. He was promoted to vice president in 2015 and added the role of vice president, Global Logistics and Service for CooperSurgical in 2017. Prior to joining Cooper, he held various corporate and investment banking positions at KeyBanc Capital Markets and at ING Barings.
CSP Report for the Oculus Pentacam
With the new CSP Report, the Pentacam now measures sagittal height, a parameter used in scleral lens fitting. In the measuring process, 250 Scheimpflug images covering a diameter of up to 18mm are taken. All images of a Cornea Scleral Profile (CSP) scan are taken from the same visual axis without the need for eye movement, according to the company. Oculus says that the usual Pentacam data are recorded as well and populated into the displays already familiar to Pentacam users.
The CSP scan is a tear film-independent measurement with automatic release. Oculus says that this means that the values from the new CSP Report are as reproducible as all other data measured with the Pentacam. A link to external fitting software for scleral lenses is available. This software module is available for the Pentacam only and is subject to a charge.
Topcon’s DRI OCT Triton Series Receives 510(k) Clearance
Topcon Medical Systems (TMS) announced that its DRI OCT Triton Series has received 510(k) clearance from the U.S. Food and Drug Administration (FDA). Topcon says that the DRI OCT Triton features easy image capture and a 1 micron, 1050nm light source with a scanning speed of 100,000 A-scans/second. In addition to anterior segment scanning, the DRI OCT Triton can visualize deeper pathology, rapidly penetrating ocular tissues such as the choroid and even the sclera, without being obscured by media opacities or hemorrhage, according to the company. Topcon says that the DRI OCT Triton can visualize from vitreous through to sclera at the press of a single button with high sensitivity and speed. The instantaneous capture of a high-density data cube, comprised of 512 B-scans, reduces interpolation between slices and allows the most revealing imagery, according to the company.
The instrument also features widefield OCT scanning (12mm x 9mm) with reference database, which the company says is useful in annual exams, allowing fully automated mapping and illustration of both the macula and optic disc in one single scan and potentially halving the number of scans the patient requires. It displays high-resolution fundus images with clear retinal vessel and macular mapping to allow Pin-Point Registration of the deepest pathology, according to Topcon.
CareCredit Introduces Promotion to Help Increase Optical Sales
CareCredit will be offering a new promotion from May 1 through July 31, 2018; optical patients can earn a $30 Prepaid Mastercard when they open a new CareCredit healthcare credit card, use it to make a purchase of just $200 or more of vision care and products, and then register online by Aug. 15, 2018.
Patients can use CareCredit to pay for a wide range of vision care and optical products from routine eye exams to quality frames, premium lenses, sunwear, or an annual supply of contact lenses. During this promotion, practices accepting CareCredit will receive a Promotional Materials Kit that will include all of the patient education and team resources necessary to let patients know about the benefits of CareCredit and how new cardholders can earn the $30 Prepaid Mastercard.
Last Chance to Participate in Contact Lens Spectrum’s Dry Eye Survey
We need your insights for our biennial Dry Eye Diagnosis and Treatment Study. What percentage of your patients exhibit dry eye symptoms? What is your preferred method of diagnosing dry eye? What is your preferred method of treatment? Your responses, merged with your peers’ and trended with previous years’ results, will be featured in an upcoming issue of Contact Lens Spectrum. To participate, go to https://www.surveymonkey.com/r/SRF9TFT.
Have you observed increases in any of the following categories of infectious keratitis in your contact lens-wearing patients?
This 48-year-old male mechanic was complaining about progressive vision loss in both eyes for three years. Past medical history included no surgery, no systemic symptoms, and no use of drugs or medications. Visual acuity (without correction) was OD 20/80, OS counting fingers 1m. His refraction was OD +0.25 (20/80), OS impossible due to cornea opacity. Biomicroscopy in both eyes showed conjunctival hyperemia 3+/4+, cornea opacity with new vessels, inferior deposits, transparent lens, and blepharitis. Tonometry in both eyes was 12 mmHg. Additionally, fundoscopy showed an attached retina, physiological cupping of the optical nerve, and preserved macula in the right eye, while the left eye wasn’t able to be examined due to cornea opacity. We performed a conjunctival biopsy. The result was a lichenoid reaction (i.e., a non-keratinized stratified squamous epithelium, with a band-like lymphocytic infiltrate, that is associated with spongiosis and without acantholysis).
We concluded that only cutaneous lupus erythematosus and lichen planus could be possible. However, he did not show characteristic features of lichen planus, such as the skin lesions and oral ulcers, which are generally developed in the presence of amalgam fillings in the teeth.
We prescribed prednisone 80mg per day for two weeks. After two weeks, he returned with visual acuity of OD 20/30, OS 20/400.
We thank Dr. Sobrinho 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.
CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
The Good, Bad, and Ugly Red Eye
Contact lenses (CLs) are generally considered safe vision correcting devices, though the complexities and the long-term use of CLs make it challenging for patients to fully comply with manufacturer and provider care and compliance recommendations.1 With that said, CL sinners and saints often have the same health outcome: no or very minimal complications.2 Nevertheless, there are an unfortunate few who do sometimes develop serious ocular complications related to poor CL compliance.2
The literature is rich with CL-related factors that are associated with developing eye disease, though until recent work from the Contact Lens Assessment in Youth (CLAY) Study group on children and young adults, there has been limited guidance as to what factors are associated with “serious and significant” (SS) events such as microbial keratitis and “non-serious and significant” (NSS) ocular events such as a subconjunctival hemorrhage.3 In comparison with patients who have NSS events, patients who have SS events are more likely to wear CLs overnight, to purchase CLs via the internet, to have their CLs purchased by their parents compared to self-purchasing, and to wear two-week replacement CLs compared to daily disposable CLs.3 Likewise, in comparison with healthy patients, patients who have SS events were more likely to not discard old CL case solution, to purchase CLs via the internet, to wear CLs overnight, to not share a bathroom with someone else (unclear underlying cause), and to replace their CLs only after a problem.3 In short, these habits, some of them seemingly benign, appear to be associated with higher instances of the most severe complications.3
Interestingly, there are some commonalities but also differences in the risk factors associated with SS and NSS ocular events.3 Practitioners need to be vigilant with all of their patients and educate them when we notice that a patient is not complying with a specific task or when we detect even a minor complication. Practitioners can use the above information to help select specific tasks to focus on during patient education to maximize our effectiveness and to help better protect patients.
1. Robertson DM, Cavanagh HD. Non-compliance with contact lens wear and care practices: a comparative analysis. Optom Vis Sci. 2011 Dec;88:1402-1408.
2. Stapleton F, Keay L, Edwards K, Holden B. The epidemiology of microbial keratitis with silicone hydrogel contact lenses. Eye Contact Lens. 2013 Jan;39:79-85.
3. Sorbara L, Zimmerman AB, Mitchell GL, et al. Multicenter Testing of a Risk Assessment Survey for Soft Contact Lens Wearers With Adverse Events: A Contact Lens Assessment in Youth Study. Eye Contact Lens. 2018 Jan;44:21-28.
MATERIALS & DESIGNS
David L. Kading, OD
Prism in Contact Lenses
Cindy is an 18-year-old young lady who has historically been very involved in sports. She was referred to the clinic from an outside binocular vision specialist. Cindy has been a very competitive softball player and was struck in the head by a line drive while pitching. She did nine months of intensive vision therapy training but has a residual vertical diplopia that seems to be affecting her performance on the mound. She is functional with glasses during the day. Cindy has attempted various sporting glasses but does not get the precision of vision due to her face mask while wearing her helmet to hit.
We took the hyper measurements from the referring physician and designed a lens that eliminated 1.0 prism diopters of vertical diplopia. She is back on the mound pitching strikes and reported back that she was just offered scholarships to three different schools to pitch for them.
Although Cindy’s case is a rare instance, contact lenses can be used to correct vertical postings through the use of prism, both with soft toric as well as with scleral lenses. A discussion with the laboratory is indicated. For patients who have bilateral astigmatism for which toric lenses will be prescribed, make sure that prism is put only in one of the lenses and that stability is achieved through another design for the contralateral eye. For patients who have small amounts of vertical imbalance, don’t forget that we have lenses for that, too.
Visual Acuity and Over-refraction in Myopic Children Fitted with Soft Multifocal Contact Lenses
The purpose of this study was to determine the spherical over-refraction (SOR) necessary to obtain best-corrected visual acuity (BCVA) when fitting myopic children with a center-distance soft multifocal contact lens (MFCL).
Children (n = 294) aged 7 to 11 years who had myopia (spherical component) of –0.75D to –5.00D (inclusive) and 1.00D cylinder or less (corneal plane) were fitted bilaterally with +2.50D add Biofinity “D” MFCLs (CooperVision). The initial MFCL power was the spherical equivalent of a standardized subjective refraction, rounded to the nearest 0.25D step (corneal plane). An SOR was performed monocularly (each eye) to achieve BCVA. Binocular, high-contrast logMAR acuity was measured with manifest spectacle correction and MFCLs with over-refraction. Photopic pupil size was measured with a pupilometer.
The mean (±SD) age was 10.3 ± 1.2 years, and the mean (±SD) SOR needed to achieve BCVA was OD –0.61D ± 0.24D / OS –0.58D ± 0.27D. There was no difference in binocular high-contrast visual acuity (logMAR) between spectacles (–0.01 ± 0.06) and best-corrected MFCLs (–0.01 ± 0.07) (P = 0.59). The mean (±SD) photopic pupil size (5.4mm ± 0.7mm) was not correlated with best MFCL correction or with the over-refraction magnitude (both P ≥ 0.09).
The researchers concluded that children achieved BCVA with +2.50D add MFCLs that was not different than with spectacles. Children typically required an over-refraction of –0.50D to -0.75D to achieve BCVA. With a careful over-refraction, these +2.50D add MFCLs provide good distance acuity, making them viable candidates for myopia control.
Schulle KL, Berntsen DA, Sinnott LT, et al; Bifocal Lenses in Nearsighted Kids (BLINK) Study Group. Visual Acuity and Over-refraction in Myopic Children Fitted with Soft Multifocal Contact Lenses. Optom Vis Sci. 2018 Apr;95:292-298.