It has been about 40 years since the last total solar eclipse. We are now about to experience another during which the moon will cover at least part of the sun for a period of two to three hours tomorrow. About halfway through, some locations will experience a total eclipse during which the moon will completely block the sun for about 2.5 minutes. During this time, the sun’s outer atmosphere (called the corona) will be visible. Although this is a magnificent spectacle, it is critical that we advise our patients about how to safely view the eclipse, which includes the use of ISO 12312-2 approved viewers. A link to more information from NASA about how to safely view the eclipse can be found at https://www.nasa.gov/content/eye-safety-during-a-total-solar-eclipse. Safe viewing!
Jason J. Nichols, OD, MPH, PhD
Visionary Optics Announces FDA Clearance for Entire Scleral Lens Product Line
Visionary Optics has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its complete line of scleral contact lenses (Jupiter, Europa, and Elara lenses).
Visionary Optics’ scleral lenses for daily wear are indicated for the management of multiple ocular conditions, such as degenerations that lead to an irregular corneal shape (keratoconus, keratoglobus, pellucid marginal degeneration, Salzmann’s nodular degeneration), dystrophies (Cogan’s dystrophy, granular corneal dystrophy, lattice corneal dystrophy), post-surgery (corneal transplant, laser-assisted in situ keratomileusis [LASIK], radial keratotomy), and corneal scarring from infection or trauma. They are also indicated for therapeutic management of ocular surface disease including dry eye (ocular manifestations of graft-versus-host disease, Sjögren’s syndrome, dry eye syndrome), limbal stem cell deficiency (Stevens-Johnson syndrome, chemical and thermal burns, radiation, filamentary keratitis), epidermal ocular disorders, disorders of the skin (atopy, ectodermal dysplasia), neurotrophic keratitis (herpes simplex, herpes zoster, familial dysautonomia), and corneal exposure (anatomic, paralytic) that might benefit from the presence of an expanded tear reservoir and protection against an adverse environment.
Shire Announces Submission of Lifitegrast MAA in Europe
Shire plc announced that the Marketing Authorization Application (MAA) for lifitegrast, submitted on Aug. 7, 2017, has been validated by the United Kingdom as the Reference Member State involved in the Decentralized Procedure (DCP). The lifitegrast MAA was submitted via the DCP to Denmark, Norway, Sweden, Finland, the United Kingdom, Germany, the Netherlands, France, Italy, Portugal, Spain, and Greece.
Shire’s MAA for lifitegrast is supported by five clinical trials with more than 2,500 patients. In these studies, the signs of dry eye disease were measured using corneal staining, and the symptoms were measured by using patient reported eye dryness score (EDS).
The U.S. Food and Drug Administration approved lifitegrast under the brand name Xiidra (lifitegrast ophthalmic solution) 5% for the treatment of signs and symptoms of dry eye disease in July 2016.
Valley Contax to Offer Tangible Hydra-PEG Option
Valley Contax announced that beginning in September 2017, it will be offering the Tangible Hydra-PEG coating as an option to all of the company’s lenses manufactured in Contamac Optimum materials. Tangible Hydra-PEG is a hydrophilic coating that is permanently bonded to the surface of the lens and lasts the life of the lens. It has been FDA cleared for use on the Contamac Extra and Extreme materials.
SpecialEyes Debuts New Website with Mobile Optimization and Added Features
SpecialEyes, LLC launched a new and improved website (www.specialeyesqc.com) that is designed to provide a better user experience for eyecare practitioners. Among the enhancements are simplified navigation, mobile optimization, and expanded functionality, making it easier to research and order custom soft contact lenses, according to the company.
A new tools and resources page compiles fitting guides, calculators, case studies, webinars, and other useful content in one place. In addition to ensuring that all web pages are mobile-responsive, SpecialEyes has optimized its online Arc Length Calculator and Over-Refraction Calculator for mobile devices. Eyecare practitioners can now attach topography results and other files when placing an initial order via the Arc Length Calculator by using the upload feature on the order-review page. SpecialEyes also upgraded its chat functionality, enabling users to upload documents and images in the chat window, obtain a transcript of each chat session, and rate the chat services.
Contact Lens Health Week Promotes Healthy Contact Lens Wear and Care
The American Academy of Ophthalmology and the American Academy of Optometry have joined the Centers for Disease Control and Prevention (CDC) and its other partners to promote Contact Lens Health Week during the week of Aug. 21 through Aug. 25. This year’s campaign theme is “Healthy Habits Mean Healthy Eyes.” These organizations are encouraging youth to start healthy habits early to help ensure a lifetime of healthy vision.
This is a 47-year-old female who has retinitis pigmentosa. She has 20/20 OD and 20/15 OS best-corrected visual acuity. The optical coherence tomography shows a very nice, albeit dramatic, image of peripheral thinning.
We thank Sergina M. Flaherty 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
Contact Lens Replacement Reminders
A 27-year-old male who wears two-week daily wear soft contact lenses reports to your clinic for his annual eye exam. Upon examination, the patient admits that he only discards his contact lenses every six to eight weeks. He complains of end-of-day discomfort, and you note advancing corneal vascularization. While this is a relatively common scenario, it is a difficult case to address because patients frequently fail to understand the importance of replacing their contact lenses on time. Additionally, after wearing contact lenses for a while, it is easy for patients to forget to replace their contact lenses on schedule.1,2
While there are a number of methods to improve contact lens replacement compliance–such as patient education and changing the wear schedule or material3-5–practicing in the information age has its advantages. Contact lens manufacturers provide web-based systems that can send patient reminders. Patients can download a reminder app for their smartphone. In fact, when I went to the app store on my smartphone and typed in “contact lens reminder and tracker,” I found seven different apps (three that were free) that were indicated for helping with contact lens replacement. After selecting an app, I then downloaded it, entered an example replacement schedule, and I had a reminder to replace my theoretical contact lenses every two weeks. I had to invest only about one minute of my time.
Therefore, the next time you have patients who are noncompliant with their contact lens wear schedule, you may want to help them download and setup a reminder app on their smartphone during your education session.
1. Collins MJ, Carney LG. Patient compliance and its influence on contact lens wearing problems. Am J Optom Physiol Opt. 1986 Dec;63:952-956.
2. Davidson SI, Akingbehin T. Compliance in ophthalmology. Trans Ophthalmol Soc U K. 1980 Jul;100:286-290.
3. Cardona G, Llovet I. Compliance amongst contact lens wearers: comprehension skills and reinforcement with written instructions. Contact Lens Anterior Eye. 2004 Jun;27:75-81.
4. McMonnies CW. Improving patient education and attitudes toward compliance with instructions for contact lens use. Contact Lens Anterior Eye. 2011 Oct;34:241-248.
5. Bui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: perceptions, awareness, and behavior. Eye Contact Lens. 2010 Nov;36:334-339.
MATERIALS & DESIGNS
David L. Kading, OD
The Digital Dilemma
I remember 10 years ago when we talked about taking a case history, and we thought it was novel to ask our patients whether they used a computer. We could never have imagined how silly this question would sound to our modern-day selves. We don’t have to ask this question anymore. The reality is that fewer patients don’t use a computer today than did use one 10 years ago. Digital device use is a standard. It’s everywhere. We have observed that when we are working on a computer or digital device, we blink far less often. As such, we tend to develop bad blinking habits. These habits may lead to incomplete blink, corneal staining, and possibly lagophthalmos at night.
Managing the patients of today is very different than it was a decade ago. We not only need to provide them with the best vision, but now we need to monitor and treat their blinking. This was frequent 10 years ago, but not nearly to the degree that it is today.
Even more important today is the need for materials that have surfaces that are as extremely slippery as possible. Several materials have come onto the market with unique treatments or surfaces specifically aimed at helping with this. I would encourage all of us to keep those materials in mind for patients who have blink problems. The more progressive and the more preventative we become, the longer we can keep our patients happy.
The Temporal Dynamics of Miniscleral Contact Lenses: Central Corneal Clearance and Centration
The purpose of this study was to examine the time course of the reduction in central corneal clearance and horizontal and vertical lens translation (decentration) during mini-scleral contact lens wear and the theoretical influence upon the optics of the post-lens tear layer.
Repeated high-resolution optical coherence tomography (OCT) images were captured over an eight-hour period of mini-scleral contact lens wear (using a rotationally symmetric 16.5mm diameter lens) in 15 young, healthy participants who had normal corneas. Central corneal clearance and lens decentration were derived from OCT images using semi-automated image processing techniques.
The study reported that central corneal clearance decreased exponentially over time, reducing by 76μm ± 8μm over eight hours. Fifty percent of this reduction occurred within 45 minutes of lens wear and 75% within two hours, with thinning of the post-lens tear layer plateauing four hours after lens application. Lens translation exhibited a similar pattern of change (0.18mm ± 0.04mm temporal and 0.20mm ± 0.09mm inferior decentration), stabilizing 1.5 to two hours after application. The change in the lens fit over time resulted in a small reduction in the power of the post-lens tear layer (–0.12D ± 0.01D) and induced a prismatic effect of 0.01 ± 0.16 Δ base out and 0.50 ± 0.19 Δ base down relative to the pupil center.
The authors concluded that for the mini-scleral contact lens studied, horizontal and vertical lens decentration followed an exponential decay over eight hours that plateaued approximately two hours after lens application, while central post-lens tear layer thinning plateaued after four hours of lens wear.
Vincent SJ, Alonso-Caneiro D, Collins MJ. The temporal dynamics of miniscleral contact lenses: Central corneal clearance and centration. Cont Lens Anterior Eye. 2017 Jul 14. [Epub ahead of print].