In last week’s edition of CL Today, we recognized that 2016 is quickly winding down and that we should be planning ahead to make 2017 even that much more prosperous. I have been thinking along those lines, and believe that 2017 might be a pivotal year for multifocal contact lenses. Although multifocal contact lenses maintain a respectable market share, I think there is tremendous potential for substantial increases in this important segment of our market. We have seen significant advances in both materials and lens designs in multifocal contact lenses that improve our success with this modality. Likewise, there are tremendous efforts being put forth in research and development of these technologies, both directly and through efforts in the surgical correction of presbyopia that lend themselves to insights into the advanced optics of multifocal contact lenses. This points towards an exciting future ahead for this very important contact lens modality.
Jason J. Nichols, OD, MPH, PhD
ASCO Case Studies in Cultural Competency Available Online
The Association of Schools and Colleges of Optometry’s (ASCO) Diversity and Cultural Competency Committee (DCCC) announced that their Case Studies in Cultural Competency are available online.
For those wanting to incorporate cultural competency into their teaching or clinical efforts, this must-have tool is a downloadable compendium and contains the seven winning and best case studies from two years of entries to the ASCO Cultural Case Study Competition for Students and Residents.
Each case study describes patient-based encounters in detail and how cultural competency played a role. The studies offer details regarding patient-centered attitude, knowledge and skills as well as the dilemma or circumstance pertaining to cultural awareness/competency and how the situation was handled, and what was learned from it. A “case discussion questions” section is also included in the document.
This valuable resource was made possible by funding from Walmart.
Live Scleral Lens Manufacturing Demonstration at the GSLS!
The 2017 Global Specialty Lens Symposium will be held January 26-29, 2017 at the Rio Hotel in Las Vegas, Nevada. This year the GSLS is co-locating with the Contact Lens Manufacturers Association (CLMA) annual meeting!
With the co-location of these two meetings, attendees will have several opportunities in the GSLS exhibit hall to watch the live fabrication of scleral, corneal, multifocal, and toric GP lenses from start to finish. For any practitioner who has not been able to see this process with their respective CLMA labs, this is a great chance to see how your specialty GP lenses are manufactured.
The GSLS is a must-attend meeting, brought to you by Contact Lens Spectrum, focusing on the successful management of ocular conditions using today's specialty contact lenses. The meeting includes insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.
CooperVision Employee Efforts Propel Donation to OGS
Propelled by the tireless and creative efforts of CooperVision, Inc. employees worldwide, the company has made a $164,000 donation to Optometry Giving Sight in support of the 2016 World Sight Day Challenge. This is the fifth consecutive year that employees organized a wide variety of fundraisers over multiple weeks, with matching funds pledged by The Cooper Companies.
The $164,000 donation is the largest-ever World Sight Day Challenge contribution made by the company. CooperVision is an Optometry Giving Sight Global Gold Sponsor.
More than thirty CooperVision teams and locations generated funds through activities including food festivals in Puerto Rico, a mountain climbing challenge in the U.K., guide dog seminars and a 5K walk/run in the U.S., an auction in China, customized cupcake sales in Spain, and bracelet sales in Mexico and elsewhere.
CooperVision’s cumulative support for Optometry Giving Sight over the last several years is expected to exceed USD$2 million by the close of 2016. In addition to its World Sight Day Challenge donation, the company contributes funding through a patient rebate donation program in the United States, LensFerry S donations for completed patient annual subscriptions and Europe’s One Bright Vision cause-related marketing program, which benefits communities in Africa and India. The company also supports several specific programs, providing funding as well as sending experts on site for professional guidance and observation.
VTI Names Lee as Executive Director of Manufacturing and Engineering
Visioneering Technologies, Inc. (VTI) has named Rosa Lee to the position of Executive Director of Manufacturing and Engineering. Lee will direct the manufacturing and product optimization efforts for the company.
Lee received her B.S. and M.S. from the University of Rochester in Optics and Biomedical Engineering and is Six Sigma certified. She brings over 16 years of product development and optimization experience with companies such as Bausch + Lomb, SynergEyes and Corning where she helped develop innovative technologies and improvements in design.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD
PGA and MGD
It is generally accepted that long-term topical ocular hypotensive therapy can be deleterious to the ocular surface. What about the about the meibomian glands?
Recently published in the Journal of Glaucoma is a study aimed to evaluate the association of long-term prostaglandin analog (PGA) use with meibomian gland dysfunction (MGD) in medically treated glaucoma patients.1 This was a prospective cross-sectional study conducted at a single academic setting. In total, 70 eyes of 70 patients with a medical diagnosis of glaucoma who were on long-term (>12 mo.) topical hypotensive medication(s) were included. Patients were classified based on whether they were on PGA or non-PGA class of medication(s). MGD was defined based on meibomian gland terminal duct obstruction and graded between 1 and 5 based on severity. For all subjects, the Ocular Surface Disease Index (OSDI), break-up time, lissamine green staining, and Schirmer test (under topical anesthesia) was administered. Study results show that MGD frequency was higher in patients treated with PGA monotherapy (92.0%) compared with those who received non-PGA therapy (58.3%). Obstructive type of MGD was detected in the majority of patients treated with PGAs (95.7%). Grade 2 and 3 MGD was noted in 80.5% of patients on PGA. Patients on PGA had worse OSDI and ocular surface test results compared with those of control subjects. The authors conclude that long-term administration of PGA is associated with obstructive type of MGD. More data is necessary to support this finding, however PGA analog use should be considered in evaluation of our OSD patients.
Mocan MC, Uzunosmanoglu E, Kocabeyoglu S, Karakaya J, Irkec M. The Association of Chronic Topical Prostaglandin Analog Use With Meibomian Gland Dysfunction. J Glaucoma. 2016 Sep;25(9):770-4.
Let's Not Forget That Most of Us Use Two Eyes Together…Binocular Vision Implications of Corneal Reshaping Treatment
Most efforts regarding vision analysis in contact lens wear emphasizes monocular visual performance. Although most contact lens practitioners will at least take binocular visual acuity measurements, often we fail to take into consideration other binocular vision components to visual performance. Patients often can complain of asthenopia, frank diplopia, and even what one might confuse with dry eye symptoms, when in fact a binocular vision deficit is present with contact lens wear.
A study was performed that looked at binocular vision performance in a group of patients that underwent overnight corneal reshaping (orthokeratology or Ortho-K).1 The intent of the study was to analyze the binocular function changes produced on subjects undergoing overnight orthokeratology (OK) treatment over short-term (3 months) and long-term (3 years) wear. A prospective, longitudinal study on young adult subjects with low to moderate myopia was performed. Binocular function was assessed by the following sequence of tests: Distance and near horizontal phoria (Von Graefe technique), distance and near horizontal vergence ranges (Risley rotary prisms), accommodative convergence/accommodation (AC/A) ratio (gradient method) and the near point of convergence (standard push-up technique). The short-term sample consisted of: 21 subjects in the control group, 26 in a corneal refractive therapy (CRT - Paragon) treatment lenses group and 25 in a Seefree treatment lenses group (an alternative corneal reshaping lens type). Those subjects were evaluated at baseline and at a 3-month follow-up visit. Twenty one subjects were old CRT wearers that attended a 3-year follow-up visit (long-term group). Outcomes found a statistically significant difference over the 3-month treatment for divergence at distance: the break point decreased 1.4 Δ (p = 0.0006) in the CRT group and the recovery point increased 1.2 Δ (p = 0.001) in the Seefree group. Also, the Seefree group had an exophoric trend of 2.3 Δ at near (p = 0.02) and a base-out break decrease of 2.3 Δ (p = 0.03). For the long-term group, only the base-out break point at distant vision showed a statistically significant difference of 4.9 Δ (p = 0.02). The authors concluded that OK induces only minimal changes in the binocular function for either short-term or long-term periods, apart from a near exophoric trend over the short-term period.
The point of reviewing this study was not to show any unexpected influence on binocular vision induced by corneal reshaping or any other contact lens treatment modality. The key point is that we as contact lens practitioners should always evaluate binocular vision function and keep in mind the importance of these findings on the visual function of our patients. A comprehensive approach to vision management that includes sensitivity and attention to binocular vision function will result in a greater degree of success for our patients.
1. Felipe-Marquez G, Nombela-Palomo M, Palomo-Álvarez C, Cacho , Nieto-Bona A. Binocular function changes produced in response to overnight orthokeratology. Graefes Arch Clin Exp Ophthalmol. 2016 Nov 21. (Epub ahead of print).
Reversibility of Gland Dropout and Significance of Eyelid Hygiene Treatment in Meibomian Gland Dysfunction
The purpose of the study was to observe reversibility of meibomian gland (MG) dropout and analyze correlated factors and to compare the treatment efficiency with and without eyelid hygiene in patients with meibomian gland dysfunction (MGD).
Consecutive 78 eyes of 78 MGD (stage 2-3) patients who finished follow-up examination after 1-month of treatment were recruited in this retrospective study. All patients were treated with artificial lubricant and eyelid hygiene. Related ocular surface evaluation and meibomian gland assessment were examined.
There were 26 (33%) patients (included in group 1) who ignored doctors' order for eyelid hygiene, and 52 (67%) patients (included in group 2) were compliant. There was no statistical difference between group 1 (age, 44.4 ± 12.2) and group 2 (age, 38.9 ± 16.6) in characteristics and pretreatment clinical indexes. However, after 1-month of treatment, only the ocular surface disease index of group 1 improved (P = 0.048), whereas all clinical indexes of group 2, except the Schirmer test result, improved (including expressibility, all P < 0.05). A 5% decrease in MG dropout of both upper (5.4%) and lower (4.6%) eyelids in group 2 was observed. Improvement in upper-eyelid dropout and expressibility were the predictors of lower-eyelid dropout improvement. The reversibility had no correlation with age, sex, pretreatment MGD stage, disease duration, and use of topical anti-inflammation medication.
The researchers concluded that, with expressibility-improving treatment, MG dropout was reversible to some extent. Eyelid hygiene is an efficient treatment of MGD; however, there is a need for ophthalmologists to instruct patients on conduct and supervise patients' compliance.
Yin Y, Gong L. Reversibility of Gland Dropout and Significance of Eyelid Hygiene Treatment in Meibomian Gland Dysfunction. Cornea. 2016 Oct 14. [Epub ahead of print]