One of the hottest topics in the contact lens field today remains myopia and its control with optical devices and other agents. That said, there are many clinical questions that remain unanswered—one of which is found this month’s Quick Poll. As noted, most respondents believe that standard, spherical soft contact lenses labeled to correct myopic refractive error do not contribute to the progression of myopic refractive error. We plan to cover this issue in depth in both the pages of Contact Lens Spectrum as well as at the Global Specialty Lens Symposium being held Jan. 22 to 25, 2020. Stay tuned for more information.
Jason J. Nichols, OD, MPH, PhD
Online Vision Test Recalled
Visibly, formerly known as Opternative, has ceased making available its Visibility Online Refractive Vision Test, which is part of the Visibly Vision Test Solution. Partners and their customers were given access to this software application, which is used to measure vision refraction. This action is a result of a recent U.S. Food & Drug Administration (FDA) recall notice that cites the company’s lack of 510(k) clearance and the nonexistence of a marketing application for the product.
In April 2016, the American Optometric Association (AOA) had filed a complaint against Visibly (Opternative). That complaint raised concerns over potential serious health risks of the product and noted its lack of premarket approval. Then, in 2017, the FDA issued a warning letter to Opternative indicating the company was in violation of the Food, Drug and Cosmetic Act (FDCA) and requested the company “immediately cease activities that result in the misbranding or adulteration of the On-Line Opternative Eye Examination Mobile Medical App device, such as the commercial distribution of the device through your online website.” The FDA will be monitoring the company’s actions in light of the recall.
MyopiaCare Welcomes New Team Members
MyopiaCare, an online educational platform for myopia specialists and parents, announced the following new team members.
Ross Grant, BSc (Hons), MSc, FCOptom, PDipM, has joined as chief business development officer. He will connect MyopiaCare with associations, industry, and KOLs worldwide. He has more than 40 years’ experience in clinical practice, academia, research, marketing, and general management.
Thomas Aller, OD, has joined as a clinical advisor. For the past 27 years, Dr. Aller has been researching the use of bifocal contacts for the control of myopia. He is currently conducting clinical trials on myopia management with an extended depth of focus (EDOF) multifocal contact lens, as well as an anti-hyperopia multifocal lens design.
Oliver Woo, OD, joins MyopiaCare as a clinical consultant. Dr. Woo’s special interests are pediatric optometry, myopia prevention and control contact lens fitting with orthokeratology and specialty contact lenses. In 2007, Dr. Woo became the first Australian fellow of International Academy of Orthokeratology and Myopic Control (FIAOMC) and opened an orthokeratology and myopia control clinic in 2010.
Giancarlo Montani, Dip Optom, completes the team of clinical advisors. He is professor of Clinical Contact Lens Application at the University of Salento, Italy. He was department head of the Contact Lens Division at the Santa Chiara University Medical Centre in Pisa, Italy until 2004. In 2007, Professor Montani co-founded the Centre for Contact Lens Research of the University of Salento.
Alcon to Launch Precision1 Daily Disposable Contact Lenses
Alcon announced plans to launch the Precision1 daily disposable, silicone hydrogel contact lenses in the United States. According to the company, Precision1 lenses come with Alcon’s proprietary SmartSurface technology, a permanent, micro-thin, high-performance layer of moisture at the lens surface that helps support a stable tear film to deliver lasting visual performance from morning to night. The lenses are made in the verofilcon A material and have Class 1 ultraviolet-blocking capabilities, according to Alcon.
Initial patient availability is scheduled for September 2019, with wide availability across the United States scheduled for early 2020. In March 2019, Alcon launched Precision1 contact lenses in Australia and New Zealand, and expects to launch these lenses in additional markets around the globe throughout 2020 and 2021.
CLI Supports CDC Healthy Contact Lenses Program
The Contact Lens Institute (CLI) provided a gift to the Centers for Disease Control and Prevention (CDC) to support the CDC Healthy Contact Lenses Program, which was held Aug. 19 to 23. The theme of this year’s Health Week campaign was “Contact Lens Health Starts with You.”
Better Vision Solutions Develops New Contact Lens Disinfection System
Better Vision Solutions has developed and patented a one-step contact lens disinfection system providing a solution for multiuse contact lenses. According to the company, the patented system incorporates a unique catalyst that supercharges hydrogen peroxide; it works with all of the hydrogen peroxide solutions on the market with similar effectiveness—making them 1,000 times more effective than the hydrogen peroxide solution alone. The company also reports that the one-step disinfection system kills acanthamoeba and acanthamoeba cysts, which can lead to the prevention of acanthamoeba keratitis and subsequent blindness.
Blanchard Contact Lenses announced its recent hire of Monica E. Shea, LO. Ms. Shea’s responsibilities include building and nurturing professional relationships with, and providing fitting consultation to, eyecare providers in the Northeast for Blanchard’s scleral and GP lens portfolio. She has 21 years of experience with contact lens services, having spent the last 15 years of her career as a senior contact lens specialist at Consulting Ophthalmologists, P.C. in Farmington, CT.
FDA Approves New Paragon Contact Lens Manufacturing Facility in Phoenix
The U.S. Food and Drug Administration (FDA) has approved Paragon Vision Science’s newly-constructed contact lens manufacturing site in suburban Phoenix. Paragon is part of CooperVision Specialty Eye Care. The Gilbert, AZ facility will produce advanced orthokeratology products such as Paragon CRT for use in the United States. The new site is more than double the size of the company’s current plant in nearby Mesa, AZ. The Mesa location will continue to fabricate lenses for global markets after U.S. production is transferred to Gilbert over the next several months.
In keeping with CooperVision’s commitment to sustainable practices, the site incorporates an environmentally responsible cooling system, as well as other features such as energy-conserving LED lighting and a drinking water filtration system that will encourage refillable water bottle use.
The Myopia Meeting to Be Held in Newport Beach, CA
The next The Myopia Meeting will be held on Oct. 6 at the Balboa Bay Resort in Newport Beach, CA. Speakers and topics featured at the six-hour CE program include: Thomas Aller, OD, Multifocal Contact Lens Treatments; Mark Bullimore, OD, PhD, Risks and Benefits of Myopia Management Options; Jeffrey Cooper, OD, Atropine Use in Myopia Management; Gary Gerber, OD, The Myopia Opportunity; Michael Lipson, OD, Rigid Lens Options for Myopia Control; Matt Oerding, MBA, Getting Mom to Say Yes: Implementing in Practice; and Earl L. Smith III, OD, PhD, Observations Relevant to Treatment Strategies for Myopia.
Luneau Technology Welcomes New National Director of Sales
Luneau Technology announced the appointment of Lon Dowell to the role of national director of Sales. Mr. Dowell joins the Luneau Technology USA leadership team with more than 20 years of experience in the ophthalmic industry, leading sales, marketing, and project teams.
Do you believe that standard soft contact lenses used to correct myopia are associated with actual increases in myopic refractive error?
Fitting a scleral lens over intracorneal ring segments can be a challenge. It is important to have adequate clearance in order to not create pressure on the ring itself. A very thin optic section with the brightest setting will help in the evaluation.
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SPECIALTY LENS SPACE
Karen DeLoss, OD
The Next “Wave”
Current buzzwords popular in the specialty lens world are “wavefront-guided” or “aberration-control” contact lenses. These lenses mainly serve to improve quality of vision beyond spectacle problems and are commonly indicated for corneal ectasia.1 In this patient population, the presence of rapid steepening of the cornea creates a high magnitude of higher-order aberrations that degrades retinal image quality.2 Previously, wavefront-guided lenses and their performance on the eye were mainly limited to soft custom lenses.3-5 Recently, some scleral lenses offer wavefront-guided optics and this area will likely continue to expand.
In 2013, Sabesan and coauthors first reported improvement in visual acuity reducing higher-order aberrations using wavefront-guided optics incorporated into a scleral lens for keratoconus patients.2 Similarly, in 2019, Hastings et al reported similar outcomes of ability of wavefront-guided lenses to improve vision and reduce higher-order aberrations and improve visual image quality over an eight-week period.6 Finally, Gumas and colleagues reported on the benefit of wavefront-guided lenses on patients who have a wide variety of corneal conditions beyond ectasia.7 While wavefront-guided scleral lenses are only available from a limited number of manufacturers, the future appears to be clearer for many patients.
1. Marsack JD, Parker KE, Pesudovs K, Donnelly WJ 3rd, Applegate RA. Uncorrected wavefront error and visual performance during RGP wear in keratoconus. Optom Vis Sci. 2007 Jun;84:463-470.
2. Sabesan R, Johns L, Tomashevskaya O, Jacobs DS, Rosenthal P, Yoon G. Wavefront-Guided Scleral Lens Prosthetic Device for Keratoconus. Optom Vis Sci. 2013 Apr;90:314-323.
3. López-Gil N, Chateau N, Castejón-Mochón JF, Artal P, Benito A. Correcting ocular aberrations by soft contact lenses. S Afr Optom. 2003;62:173-177.
4. Sabesan R, Jeong TM, Carvalho L, Cox IG, Williams DR, Yoon G. Vision improvement by correcting higher-order aberrations with customized soft contact lenses in keratoconic eyes. Opt Lett. 2007 Apr;32:1000-1002.
5. Marsack JD, Parker KE, Applegate RA. Performance of wavefront-guided soft lenses in three keratoconus subjects. Optom Vis Sci. 2008 Dec;85:1172-1178.
6. Hastings GD, Applegate RA, Nguyen LC, Kauffman MJ, Hemmati RT, Marsack JD. Comparison of Wavefront-guided and best conventional scleral lenses after habituation in eyes with corneal ectasia. Optom Vis Sci. 2019 Apr;96:238-247.
7. Gumus K, Gire A, Pflugfelder SC. The impact of the Boston ocular surface prosthesis on wavefront higher-order aberrations. Am J Ophthalmol. 2011 Apr;151:682-690.
MATERIALS & DESIGNS
David L. Kading, OD
Orthokeratology Myopia Management for Toric Patients
Myopia management is a new normal. It is becoming more and more a part of all practices. If you have not yet decided to stop this progressive disease, it’s time to join the movement. Astigmatism is one area that often hinders myopia managers who do orthokeratology. Most of the designs that are advocated are spherical in nature and tend to not manage cylinder. However, while it is true that we have some amazing solutions for spherical patients, we also have great solutions for patients who have astigmatism.
When it comes to orthokeratology, much of the cylinder that patients have can be treated along with the myopia. It is important to differentiate between limbal cylinder and central cylinder. Understand that it is not dependent on the amount of cylinder, it is the way that the cylinder extends beyond the central 4mm to 5mm of the cornea that makes the difference.
If a patient has central cylinder, most standard orthokeratology lenses will treat this. However, if a patient has limbal astigmatism, the lens may not get the seal that it needs to properly treat the cylinder. As such, these patients need a lens that has altered peripheral curves that more closely contour to the shape of the cornea. Consultants can help to design these lenses with the use of topography; there are also some designs that have specific fitting sets.
In our office, we are seeing more and more of the patients that we historically fit with standard designs benefitting from these “toric” designs. Review the challenging cases that you are managing, you may benefit from a design change.
Healthy Contact Lens Behaviors Communicated by Eye Care Providers and Recalled by Patients - United States, 2018
The purpose of this article was to examine the common practices of patients regarding lens wear and care, including possible complications and risks, in relationship to what they had or had not been instructed by their eyecare practitioners. The authors found that data on communication between eyecare providers and contact lens wearers on contact lens wear and care recommendations are limited.
Two surveys were conducted to better understand and assess contact lens education about nine recommendations: the first survey assessed contact lens wearer experiences regarding recommendations received from eyecare providers during their most recent appointment and the second survey evaluated provider-reported practices for communicating contact lens wear and care recommendations to their patients.
Results indicated that one-third (32.9%) of contact lens wearers aged ≥ 18 years recalled never hearing any lens wear and care recommendations. Fewer than half (47.9%) recalled hearing their provider recommend not sleeping in lenses at their last visit, and 19.8% recalled being told to avoid topping off their contact lens solution. A majority of providers reported sharing recommendations always or most of the time at initial visits, regular checkups, and complication-related visits. Providers reported sharing nearly all recommendations more frequently at initial and complication-related visits than at regular checkups. Of the nine recommendations for safe contact lens wear and care, eyecare providers at regular checkups most often recommend complying with the recommended lens replacement schedules (85% of regular visits), not sleeping in lenses (79.0% of regular visits), and not topping off solutions (64.4% of regular visits).
The authors determined that eyecare providers play an important role in the health of their contact lens-wearing patients and can share health communication messages with their patients to help educate them about healthy wear and care habits. These findings can assist in the creation of health communication messages to help encourage eyecare providers to communicate more effectively with their patients.
Konne NM, Collier SA, Spangler J, Cope JR. Healthy Contact Lens Behaviors Communicated by Eye Care Providers and Recalled by Patients - United States, 2018. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):693-697.