As noted by this month’s poll results (see below), contact lens discomfort is a major factor associated with contact lens discontinuation and dropout. Although there are other contributing factors such a poor vision, cost, and lack of motivation, we need to proactively do more to manage and prevent contact lens discomfort. From actively expressing your patients’ meibomian glands to choosing the optimal contact lens material or design for their specific ocular surface, make sure you cover all of the bases to best eliminate discomfort in all of your contact lens wearers.
Jason J. Nichols, OD, MPH, PhD
Valley Contax Custom Stable Receives 510(k) Clearance
Valley Contax received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its Custom Stable line of scleral contact lenses indicated for the therapeutic management of several ocular conditions.
The lens is indicated for the management of conditions such as degenerations that lead to an irregular corneal shape (e.g., keratoconus, keratoglobus, pellucid marginal degeneration, Salzmann’s nodular degeneration), dystrophies (e.g., Cogan’s dystrophy, granular corneal dystrophy, lattice corneal dystrophy), and corneal scarring. Indications also include post-surgery (e.g., corneal transplant, LASIK, radial keratotomy) use. The lens may also be prescribed for the management of ocular surface diseases (e.g., dry eye syndrome, graft-versus-host disease, Sjögren’s syndrome, filamentary keratitis, limbal stem cell deficiency, epidermal ocular disorders, neurotrophic keratitis, and corneal exposure/lagophthalmos). When prescribed for therapeutic use, the Custom Stable GP scleral lens is also indicated for correction of refractive error in persons who have myopia, hyperopia, or presbyopia.
The clearance designated that eyecare practitioners may prescribe the lenses for frequent/planned replacement wear, assuming regular cleaning, disinfection, and scheduled replacement.
Contamac Ltd Announces Strategic Alliance with Haohai
Contamac Ltd has formed a strategic alliance with Haohai Biological Technology Co., Ltd, of Shanghai, in the People’s Republic of China (PRC). As a result, Haohai will acquire a majority sharehold in Contamac Ltd (subject to PRC approval). Haohai is a high-tech enterprise, principally engaged in the research and manufacture of absorbable biomedical materials for use in a wide variety of surgical applications including orthopedics, ophthalmology, and medical aesthetics.
According to Contamac, the new partnership is a logical and symbiotic progression of its work as a leading innovator in the development of specialist polymers and biocompatible materials for medical applications.
Prevent Blindness Declares May as UV Awareness Month
Prevent Blindness has declared May as UV (ultraviolet) Awareness Month, with the goal to help educate the public on the dangers of UV and steps to take to protect vision today and in the future.
UV damage to the eyes can be both immediate, including a condition called “ultraviolet keratitis,” and cumulative, leading to cataract or macular degeneration later in life. People who work or play in the sun for long periods of time are at the greatest risk. Information on the dangers of UV exposure and how to choose the best UV protection are available through the Prevent Blindness dedicated web page at www.preventblindness.org/protect-your-eyes-sun or by calling (800) 331-2020.
POLL: What percentage of your contact lens dropouts do so because of contact lens discomfort?
Tom Arnold, OD, Sugar Land, TX
This image shows a 15.6mm scleral lens over keratoconus with Intacs. In these patients, it is important to adequately clear the cornea and not impinge on the rings. Good centration is critical to sharp vision. This patient was correctable to a crisp 20/20.
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.
CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
World Hand Hygiene Day
Good hand hygiene may seem like a simple or even a trivial task, yet it is actually a critical act. In fact, the Centers for Disease Control and Prevention (CDC) indicates that proper hand hygiene can stop the spread of disease and prevent antibiotic resistance, which subsequently saves lives.1 The importance of hand hygiene is further emphasized by the World Health Organization’s (WHO) sponsorship of its annual World Hand Hygiene Day on May 5.2
There are two primary methods for maintaining good hand hygine.1 The traditional method involves cleaning your hands with soap and water; you should wet your hands with soap and water, lather and scrub hands together for ~20 seconds, rinse, and dry hands with air or a clean towel.1 Soap and water removes dirt and microbes via physical removal, though this method has no direct antimicrobial properties when standard soap is employed.1 The other method is to sanitize your hands with an alcohol-based sanitizer; you should cover your hands with sanitizer and allow them to air dry.1 Alcohol-based sanitizers directly kill microbes by broadly denaturing microbial proteins.1
In a clinical setting, alcohol based-hand sanitizers should be chosen as the primary method for maintaining good hand hygiene because they are easier and faster to employ and because they have a direct antimicrobial action.1 With that said, soap and water should be the first choice for cleaning visibly dirty hands.1 Additional information about hand washing and education materials (e.g., posters, fact sheets, podcasts) can be found on the CDC’s (www.cdc.gov/features/handhygiene/) and WHO’s (www.who.int/gpsc/5may/en/) websites.1,2
When we hear the word orthokeratology, most of us think about myopia control. As an industry, we have done a great job of sharing how great orthokeratology is for myopia control—of course, there is certainly more work to be done. However, there is another large group of patients who can also benefit from using these lenses: adults. Orthokeratology has major benefits for patients of any age who wear them. They provide freedom from glasses and have the added advantage of reducing or eliminating the need to wear any type of correction during the daytime. Just like for kids, using these overnight lenses can be a huge advantage for adults. This is especially true considering the amount of time we spend using computers, not to mention the indoor environmental issues with being in forced air throughout the day.
Wearing orthkeratology lenses as an alternative to daytime contact lenses is a major win for patients who have dryness that develops during their day. Additionally, it is a great option for patients who travel frequently—not just for the dry airplane cabin, but also because if frees patients from having to deal with their lenses for the majority of their trip. Some patients are able to go two to four days without wearing their lenses if the treatment lasts (obviously, results vary).
I have one adult patient who is presbyopic and wears his lenses on the weekends and once during the week. Although he has glasses for driving, he opts to have a slightly weaker prescription during the week that provides him with an effective add. While this is certainly not ideal for patients desiring pristine vision, my patient would never think to forfeit his glasses-free vision most of the time for contact lenses or glasses all the time.
In my opinion, I do my adult patients a disservice by not offering them orthokeratology lenses as often as I should. Just remember, big people are important too.
Change in Vault During Scleral Lens Trials Assessed with Anterior Segment Optical Coherence Tomography
The purpose of this study was to assess the change in vault during scleral lens fitting with anterior segment optical coherence tomography (AS-OCT). This study was comprised of patients who had AS-OCT performed after one and four hours of scleral lens wear (PROSE, prosthetic replacement of the ocular surface ecosystem, Boston Foundation for Sight). Vault was measured on AS-OCT as the distance between the front surface of the cornea in the center and the back surface of the scleral lens.
Fifty eyes of 41 patients were analyzed. The main indications for a scleral lens trial were ectasia (e.g., keratoconus, post surgery) (n = 20 eyes) and ocular surface disease (e.g., Stevens-Johnson syndrome, dry eyes, and limbal stem cell deficiency) (n = 30 eyes). The mean age of the patients was 31.4 years, and 20 of them were male. The diameter of the scleral lens ranged from 16mm to 18.5mm.
The study found that vault measurements decreased in 45 out of 50 eyes (90%), remained the same (n = 2), or increased (n = 3). The overall mean vault decreased from 680μm ± 421μm at one hour to 589μm ± 355μm (p ≤ 0.001) at four hours of lens wear. The mean vault in the ectasia group was 759μm ± 574μm and 634μm ± 455μm (p = 0.02) at one and four hours of lens wear, respectively. In the OSD group, the mean vault was 626μm ± 276μm and 558μm ± 273μm (p < 0.01) at one and four hours of lens wear, respectively. In addition, the average reduction in the vault was 125μm in the ectasia group and 68μm in the OSD group.
The authors concluded that vault decreased significantly after four hours of lens wear during scleral lens trials, which indicates that the final assessment of the scleral lens may be done after four hours of lens wear.
Rathi VM, Mandathara PS, Dumpati S, Sangwan VS. Change in vault during scleral lens trials assessed with anterior segment optical coherence tomography. Cont Lens Anterior Eye. 2017 Mar 30. [Epub ahead of print]