The results of the August Quick Poll are in, and they are rather interesting but perhaps not surprising. I am not sure that I have seen data relating to the impact of rebates on prescribing patterns, but about two-thirds of you noted that rebates have a modest-to-significant impact on which contact lenses you prescribe. I think an interesting follow-up question is, for those instances in which a rebate makes no difference, why is that the case? We hope you will take part in this follow-up Quick Poll in September.
Jason J. Nichols, OD, MPH, PhD
Joseph Gordon Named U.S. President of Bausch + Lomb
Bausch + Lomb announced that Joseph Gordon has been named U.S. president, Bausch + Lomb. In this role, he will oversee the fully integrated U.S. eyecare business, inclusive of all four business units—Vision Care, Consumer Health, Surgical, and Pharmaceuticals—reporting directly to chairman and CEO of Bausch Health, Joseph C. Papa. Most recently, Mr. Gordon was president of Bausch + Lomb’s Consumer Health and Vision Care businesses.
In unrelated news, Vyzulta (latanoprostene bunod ophthalmic solution), 0.024%, is now available in a 2.5mL bottle size in addition to the already-available 5mL size. According to the company, this bottle size will allow practitioners to provide a new one-month supply option to help patients reduce their intraocular pressure (IOP).
SpecialEyes Introduces OptiSync Technology for Multifocal Lenses
SpecialEyes, LLC has introduced OptiSync Technology, which makes it possible to correct a misalignment between the multifocal optics and a patient’s visual axis. According to the company, this type of misalignment can cause poor visual acuity, induced aberrations, and subjective complaints of glare, shadows, 3D effects, and halos.
OptiSync Technology is a customization feature that offsets (shifts) the multifocal optics from the center of the lens to better align with a patient’s visual axis. This technology is currently available in SpecialEyes 54 Multifocal and Bifocal lenses. For more information, visit https://specialeyesqc.com/optisync-technology.php.
Blanchard Contact Lenses Partners with Optometric Schools for Onefit Excellence Award Student Program
Blanchard Contact Lenses has launched the Onefit Scleral Lens Excellence Award student program in partnership with optometric educational institutions across the United States. This new program will provide students with a variety of vital learning opportunities to develop and enhance their experience with scleral lenses. Third- or fourth-year optometric students who complete each element of the four-part program will be presented with the Onefit Scleral Lens Excellence Award along with a certificate redeemable for their choice of a Onefit or Onefit MED diagnostic fitting set.
Any students in their third or fourth year from any optometric school across the United States are eligible to participate. Information and an outline of the program requirements are available directly through their respective school.
LAST CHANCE: GSLS Accepting Free Paper and Poster Submissions
Free paper and poster topics should include new and innovative concepts on all aspects of contact lenses (such as materials, designs, lens care) in addition to related topics such as corneal and ocular surface disease, diagnosis and treatment approaches, and practice management.
Abstracts for free papers and posters will be accepted until Aug. 31, 2018 at 11:59 pm Eastern Standard Time (EST) and must be submitted online.
The poster competition will be judged in two categories: Clinical and Research. Learn more.
What influence does a rebate have on the selection and prescribing of a contact lens?
This image shows band keratopathy overcasting a cataract in an eye following blunt trauma.
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
Safe Continuous Wear of Contact Lenses: A Continual Aspiration and Challenge
Safe continuous wear (CW) of contact lenses has been an aspiration of the eyecare industry for many decades. If achieved, the obvious advantages would potentially have a great impact on the penetration of contact lenses as a vision correction alternative. However, due to the relative high frequency of CW-induced complications, most eyecare practitioners dissuade their patients from this modality.
A recent study was conducted to assess what effect different interventions had on adverse events (AEs) associated with CW use of contact lenses.1 Comparative analysis of AEs across studies was conducted to determine whether some interventions were more effective at reducing inflammatory AEs. Multiple logistic regression analysis was performed of AEs from 30-day CW studies, each with a different intervention including nightly replacement (NR) of lenses; morning replacement (MR) of lenses; instillation of prophylactic antibiotic drops (AB) each morning/evening; and daily lens cleaning (LC) each morning. All studies were conducted at the same site using the same lens type (lotrafilcon A) and CW schedule.
Results indicate that a comparison of the different interventions to the individual control groups showed no difference in significant corneal infiltrative event (CIE) or mechanical events. Replacing lenses nightly during a CW schedule had the highest incidence of significant CIEs (4.9% [NR] versus 2.5% [MR] versus 1.8% [AB] versus 0% [LC]); however, adjusted logistic regression analysis of the combined control data compared to the individual interventions showed no difference in significant CIEs (P = 0.086) or mechanical AEs (P = 0.140).
The researchers concluded that replacing lenses each night seemed to be inferior compared to the other interventions of replacing lenses each morning, daily lens cleaning, and daily antibiotic drop instillation during CW. The results of the collective studies and additional analysis suggest that overnight wear of contact lenses seems to create an adverse environment that remains despite the various interventions intended to improve this adverse environment.
So, once again, practitioners have to continue to aspire to finding the key to safe and effective continuous wearing of contact lenses. Some people feel that this goal can never be achieved; however, I remain the eternal optimist. I know that safe and effective continuous wearing of contact lenses will ultimately be achieved and that this will have a dramatic positive effect on the contact lens industry. Practitioners need to keep plugging away.
1. Ozkan J, Lazon de la Jara P, Willcox M. Comparative Analysis of Adverse Events From a Series of Proof-of-Principle Extended Wear Studies. Eye Contact Lens. 2018 Aug 3. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
An Alternative Approach to Dry Eye
Alternative and complementary medicine, including its use in dry eye, is of interest to patients. A recent study explored the addition of acupuncture or oral herbal supplements to artificial tears versus artificial-tears-alone responses in dry eye.1 Results of this randomized, 150-patient cohort study showed that participants treated with acupuncture were more likely to respond symptomatically compared to those on artificial tears alone (Standardized Patient Evaluation of Eye Dryness [SPEED] Questionnaire score). Interestingly, participants in the acupuncture-plus-tears group had reduced conjunctival redness (grading with an Oculus Keratograph) and reduced tear T-helper cell (Th1)-cytokine tumor necrosis factor α and Th2-cytokine interleukin 4 concentrations compared with the artificial-tear-alone group. Acupuncture was not significantly superior to artificial tears in other outcomes such as tear osmolarity, tear evaporation rates, corneal staining, and tear breakup times. The authors concluded that acupuncture provides additional benefit in mild-to-moderate dry eye (up to one month), compared to artificial tears alone. Traditional Chinese medicine acupuncture treatment in this study was associated with demonstrable molecular evidence of reduced inflammation.
Certainly, continued exploration in this area is warranted, and acupuncture should not be discounted as practitioners delve deeper into our understanding of ocular surface disease.
1. Tong L, Htoon HM, Hou A, et al. Acupuncture and herbal formulation compared with artificial tears alone: evaluation of dry eye symptoms and associated tests in randomised clinical trial. BMJ Open Ophthalmol. 2018 June 18;3:e000150.
Central Corneal Edema with Scleral-Lens Wear
The purpose of this study was to evaluate the safety of scleral lens designs. The researchers modeled and clinically assessed central corneal edema induced by scleral lens wear for healthy subjects.
Central corneal swelling during scleral lens wear was measured using optical coherence tomography (OCT). Transport resistances were modeled for oxygen diffusion through the scleral lens and post-lens tear film (PoLTF) and into the cornea. Oxygen deficiency in the cornea activates anaerobic metabolic reactions that induce corneal edema. Oxygen permeability, carbon-dioxide permeability, settled-lens PoLTF thickness, and scleral lens thickness were varied in the calculations to mimic different lens fits.
Transport modeling predicted that, for open eyes, increasing PoLTF thickness from 50µm to 400µm increases central corneal swelling by approximately 1% to 1.5% when oxygen transmissibility (Dk/L) is greater than 10 hBarrer/cm (i.e., hectoBarrer/cm). Although swelling is larger for oxygen Dk/L < 10 hBarrer/cm, PoLTF thickness has minimal impact in this range. For open-eye wear, oxygen transmissibility of the lens plays a significant role in corneal edema but is negligible when oxygen Dk/L is > 40 hBarrer/cm. For closed-eye wear, central corneal swelling is greater than 5% for an oxygen Dk/L range of 0 to 100 hBarrer/cm with typical lens-fitting parameters. For carbon dioxide transmissibilities increasing from 50 to 250 hBarrer/cm and with a fixed oxygen Dk/L of 25 hBarrer/cm, calculated swelling diminishes by an additional 0.5%. Comparison of model calculations to clinical-swelling data is within the error range of the clinical measurements.
Oxygen/metabolite transport calculations for open-eye scleral lens wear show that typical PoLTF thicknesses fitted by clinicians (i.e., PoLTF thicknesses < 400 µm) with modern scleral lenses (i.e., oxygen Dk/L > 25 hBarrer/cm) produce corneal swelling of less than 2% in agreement with the experiment. Therefore, the researchers determined that scleral lenses prescribed today evoke less than physiological hypoxic swelling (i.e., less than 4%) for healthy corneas during open-eye wear. Closed-eye wear, however, appears clinically unsafe.
Kim YH, Tan B, Lin MC, Radke CJ. Central Corneal Edema with Scleral-Lens Wear. Curr Eye Res. 2018 Jul 17:1-11. [Epub ahead of print]