With a new prescription pharmaceutical having been recently approved for the treatment of signs and symptoms of dry eye disease, this brings optimism and hope for potential advances in the treatment of contact lens dry eye in the future. As you know, contact lens dry eye is the primary reason why our patients discontinue contact lens wear so we are eager to have better management strategies to keep our patients comfortably in contact lenses for longer periods of time.
Jason J. Nichols, OD, MPH, PhD
Advanced Vision Technologies Receives FDA Clearance for EyePrintPRO
Advanced Vision Technologies, Inc. has received FDA clearance for the EyePrintPRO prosthetic scleral device utilizing the proprietary EyePrint Impression Process. The EyePrint Impression Process creates an exact 3-D model of the ocular surface, which in combination with the EyePrint Designer (EPD) software develops a unique and precise scleral device for protection and optical correction of the eye.
According to the company, the patent pending EPD software utilizes proprietary Elevation Specific Technology enabling 360° of perfect alignment of the EyePrintPRO haptic landing zone, achieving unparalleled comfort, vision and ocular health for the most highly irregular and diseased corneal conditions. The EyePrintPRO is exclusively manufactured by Advanced Vision Technologies and is featured in the Optimum Extra 100Dk Contamac GP material.
Advanced Vision Technologies also manufactures the AVT Scleral, Naturalens; GP corneal contact lenses for normal and irregular corneas; the Naturalens Progressive; Distance Center multi-zoned aspheric presbyopic design; the FDA cleared NaturaSOFT; and High-Dk silicone hydrogel family of custom soft lens products.
On August 1, Alcon launched Alcon Dailies Choice for new patients. The program is designed to help eyecare professionals provide more of their patients with access to a healthy and convenient choice through a significant savings on all Alcon daily disposable contact lenses, including the new Dailies Total1 Multifocal contact lenses. The program offers a high-value rebate of up to $200 off a patient’s first annual supply purchase.
Patients may redeem the rebate offer by visiting DailiesChoice.com through December 31, 2016. The rebate can also be downloaded online, and to help reduce the hassle of having to mail in proof of purchase, patients can upload it from their mobile devices.
Papers and Posters GSLS 2017 Submission Deadline Is August 31
The Educational Program Committee of the Global Specialty Lens Symposium invites the submission of abstracts for the Free Paper Section and the Scientific Poster Competition. Papers and posters related to presbyopia, keratoconus, corneal topography, post penetrating keratoplasty or related irregular corneal surface, myopia control, orthokeratology and lens care topics are welcome.
The GSLS will be held January 19-22, 2017 at The Rio Hotel in Las Vegas, Nevada. Visit www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2016.
Opternative has partnered with contact lens provider 1-800-Contacts to launch InstaRx, an online service that allows existing patients to update their prescriptions without seeing an eye doctor in-person. According to the companies, the service is only intended for those who have existing prescriptions and are in need of a renewal, not first-time visitors who haven’t been to an in-person eye doctor before.
The service is available to all patients between the ages of 18 and 50 wherever telehealth services are legally permitted to operate. Information on the service can be found at www.1800contacts.com/InstaRx.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
My favorite topic in eye health, beyond the lids and ocular surface, is pseudoexfoliation syndrome (PXF). When I was in optometry school (a long time ago, mind you) PXF was mentioned in passing on a singular slide in a secondary glaucoma lecture. At that time, all that was required of me to remember about PXF was that it was an identifiable risk for glaucoma. It was not until I embarked upon my professional career in a practice whose demographics included an extraordinarily high patient population with PXF that I learned the overarching ocular clinical impact of PXF. PXF is a fascinating topic.
It is not a surprise to me that PXF and dry eye are intertwined. Patients with PXF appear to have higher predisposition of tear function disorders. One study demonstrated that there was a statistically significant difference in tear film break-up time, Schirmer II test and lid parallel conjunctival folds in PXF patients as compared to controls.1 There is up-regulation of the non-specific inflammatory marker MMP-9 in tear film in PXF-syndrome.2 Tear osmolarity is higher in both eyes of patients when compared with normal subjects.3 Pseudoexfoliation is suggested to alter basic features of goblet cell morphology, thus affecting tear film stability.4 I can go on. It may be prudent to add PXF as a risk factor for dry eye, especially in those patients who have converted to PXF glaucoma and are on topical hypotensive therapy.
1. Škegro I, Suić SP, Kordić R, Jandroković S, Petriček I, Kuzman T, Kalauz M, Perić S, Masnec S. Ocular surface disease in pseudoexfoliation syndrome. Coll Antropol. 2015 Mar;39(1):43-5.
2. Zimmermann N, Erb C. Immunoassay for matrix metalloproteinase-9 in the tear film of patients with pseudoexfoliation syndrome - a pilot study. Klin Monbl Augenheilkd. 2013 Aug;230(8):804-7. doi: 10.1055/s-0032-1328410. Epub 2013 May 13.
3. Öncel BA, Pinarci E, Akova YA. Tear osmolarity in unilateral pseudoexfoliation syndrome. Clin Exp Optom. 2012 Sep;95(5):506-9. doi: 10.1111/j.1444-0938.2011.00683.x. Epub 2012 Jan 11.
4. Kozobolis VP, Christodoulakis EV, Naoumidi II, Siganos CS, Detorakis ET, Pallikaris LG. Study of conjunctival goblet cell morphology and tear film stability in pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 2004 Jun;242(6):478-83. Epub 2004 May 11.
A clinical case study report was recently published that suggested a potential relationship between migraine attacks and contact lens wear.1 Clinical trials and electrophysiologic studies have demonstrated increased perceptual sensitivity in patients suffering from migraines. At least, one triggering factor is described in 85% of migraine patients. The authors described two patients who were diagnosed with migraine and reported that the frequency of migraine attacks increased after they switched to using contact lenses with different base curves (BCs). These two patients, who began using CL with different BCs experienced discomfort and dryness of the eye. The ocular complaints were followed by migraine attacks. CL intolerance was also developed during migraine attack in one of the cases. The frequency of migraine attacks decreased and allodynia (defined as pain due to a stimulus that does not usually provoke pain) relieved significantly when flatter BCs were selected. The authors summarized that the relationship between CLs and migraine attacks may easily be overlooked because uncomfortable CL-related disorders are usually temporary and fitting of CLs is not usually evaluated by neurologists. They suggested that every migraine patient who uses CLs should be questioned for CL comfort before a treatment plan is made considering the high prevalence of migraines, headaches, and CL use. Furthermore, it is possible that a CL-related stimulus could have triggered the migraine attack and allodynia since they observed that the frequency of migraine attacks decreased and ocular allodynia relieved significantly when proper, well-fit CLs were selected.
It should be clearly stated that this article is simply a series of case reports and not a controlled clinical trial. Making conclusions from anecdotal case reports is not an evidence based decision. However such case reports and observations often spark thought and interest and hopefully lead to well-designed scientific study. So let’s just keep this potential association in mind and look out for good science in the evaluation of the relationship between contact lens wear and migraine.
1. Timucin OB, Karadag MF, Mehmet B. Contact lenses, migraine, and allodynia. Oman J Ophthalmol. 2016 May-Aug;9(2):101-3.
Neutrophil-to-Lymphocyte Ratio Increases in Patients with Dry Eye.
The purpose of this study was to assess the neutrophil-to-lymphocyte ratio (NLR) as an indicator of inflammation in patients with non-Sjögren dry eye disease.
Serum NLR and C-reactive protein values were determined in 33 patients with dry eye and in 32 controls. The NLR was calculated by dividing the neutrophil count by the lymphocyte count.
Characteristics of the dry eye and control groups were similar. The mean NLR value was 2.8 ± 1.4 (range: 1.1-6.1) in the dry eye group and 1.6 ± 0.7 (range: 0.8-2.8) in the control group (P = 0.002, t test). The mean C-reactive protein value was 0.6 ± 0.7 mg/dL (range: 0-2.3 mg/dL) in the dry eye group and 0.5 ± 0.6 mg/dL (range: 0-1.9 mg/dL) in the control group (P = 0.307, t test).
The authors concluded that the NLR values were found to be higher in patients with non-Sjögren dry eye than in controls. This result suggests that non-Sjögren dry eye disease may be associated with systemic inflammation or the NLR values may increase in local inflammatory ocular diseases.
Sekeryapan B, Uzun F, Buyuktarakci S, Bulut A, Oner V. Neutrophil-to-Lymphocyte Ratio Increases in Patients with Dry Eye. Cornea. 2016 Jul;35(7):983-6. doi: 10.1097/ICO.0000000000000872.