There remains great advantage and success in fitting scleral lenses. However, there is also great interest in understanding both alternative uses of these lenses (such as drug delivery) and complications associated with their use. A variety of factors may impact the frequency and type of scleral lens complications that a wearer experiences, and each needs consideration. Please help us understand the more common ocular scleral-lens-related complications by participating in this month’s Quick Poll.
Jason J. Nichols, OD, MPH, PhD
Padmaja Sankaridurg Named Head of Global Myopia Centre
Leading international myopia researcher, Professor Padmaja Sankaridurg has been appointed head of the Global Myopia Centre by the Brien Holden Vision Institute. The platform hosts several online tools for myopia management, information and resources such as global prevalence data, and the Myopia Education Program.
Currently, she is head of the Myopia Program at Brien Holden Vision Institute. She was previously leader of the Vision CRC Myopia Program, a 12-year global collaboration to develop optical products to manage myopia, involving several international partners.
PEN Offers Four Coding and Compliance Seminars in January
Primary Eyecare Network (PEN), a division of ABB Optical Group, is offering four coding and compliance seminars throughout California in January.
The half-day seminars, led by industry expert John McGreal, OD, will discuss 2018 billing changes and updates, including what’s new with ICD-10, the basics of CPT, and the 2019 changes and updates for Centers for Medicare and Medicaid Services (CMS) and electronic health systems. Attendees will also have the opportunity to participate in one hour of clinical training covering dry eyes.
The seminars will take place on Jan. 12 in Glendale, CA; Jan. 13 in Irvine, CA; Jan. 26 in Sacramento, CA; and Jan. 27 in San Ramon, CA. The cost for each seminar is $235 for PEN members and $275 for non-members. The seminars offer four hours of Council on Optometric Practitioner Education (COPE) continuing education credits pending approval. Breakfast is included. To register or for more information, visit PrimaryEye.net or e-mail firstname.lastname@example.org.
Permanent J Code Issued for Avedro’s Photrexa Drug Formulations
Avedro, Inc., announced that the Centers for Medicare and Medicaid Services (CMS) issued a product-specific J code, J2787, for Photrexa Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa (riboflavin 5’-phosphate ophthalmic solution). These Photrexa formulations are the only drugs approved by the U.S. Food and Drug Administration (FDA) for use in corneal collagen cross-linking for the treatment of progressive keratoconus and corneal ectasia following refractive surgery. J2787 will become effective on Jan. 1, 2019, under the Healthcare Common Procedure Coding System (HCPCS) and is expected to stabilize payment policies and facilitate the billing process for physician practices and their patients.
VTI Appoints Dr. Peg Achenbach as Vice President, Professional Services and Clinical Science
Visioneering Technologies Inc. (VTI) has named Peg Achenbach, OD, as vice president, Professional Services and Clinical Science. In her new position, Dr. Achenbach will be responsible for increasing awareness of VTI’s portfolio of products and developing programs that help VTI better support independent eyecare professionals (ECPs) to help them improve their businesses and clinical practices.
Her professional career includes 16 years of private practice specializing in contact lenses and low vision. Additionally, she has been involved in research and drug development in oncology, HIV, dermatology, and nutritional supplements as a co-founder of a biotech company. She is a member of the Association for Research in Vision and Ophthalmology, the British Contact Lens Association, International Association of Contact Lens Educators, the American Optometric Association, and is a Fellow of the American Academy of Optometry.
Myopia Meeting to be Held in February
To address the topic of myopia, The Myopia Meeting will be held on Feb. 3 at the Gaylord National Resort & Convention Center in National Harbor, MD. Speakers during the five-hour CE program include Earl L. Smith III, OD, PhD; Patrick Caroline; Thomas Aller, OD; Erin D. Stahl, MD; and Gary Gerber, OD.
Attendees will hear the latest research, clinical information, and practice management strategies to manage myopia. COPE approval is pending for all courses. Sponsors include Essilor of America Inc., Euclid Systems Corp., Oculus, Treehouse Eyes, and Visioneering Technologies, Inc. Early bird registration of $149 ends on Dec. 31. For details or to register, visit http://regonline.com/THEmyopiameeting.
Which of the following scleral lens ocular complications occurs most frequently in your practice?
As corneal grafts age, they can become quite elevated, as you can see in this case. This required a special scleral lens made from a corneal mold. Scleral lenses can maintain useful vision for many years, thus delaying the need for more surgery.
We thank Dr. Arnold 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
Can We Improve Contact Lens Comfort with Therapeutic Intervention Using a Topical Pharmacological Dry Eye Agent?
With greater and greater attention being paid to the importance of a healthy ocular surface prior to contact lens implementation, many eyecare practitioners (ECPs) are becoming highly experienced in the diagnosis and medical treatment of ocular surface disease (OSD) and dry eye. Patients who have frank OSD and dry eye are prime candidates for topical pharmacological therapy aimed at controlling the inflammatory component of these diseases. Further, we all know that one of the most frequent (if not the most frequent) reasons for contact lens dropout is issues with contact lens comfort and associated contact lens-induced dryness. This begs the question: Can the use of a topical pharmacological agent used for dry eye therapy be effective in improving contact lens comfort?
A recent study evaluated the safety and efficacy of lifitegrast 5% ophthalmic solution in improving contact lens discomfort (CLD).1 The single-center, prospective, open-label study was undertaken on patients wearing low-modulus, nonionic, monthly replacement silicone hydrogel contact lenses (SHCLs). Best-corrected visual acuity (BCVA), lissamine staining (LS), and eight-item contact lens dry eye questionnaire (CLDEQ-8) scores were assessed at baseline and after eight weeks of twice-a-day lifitegrast 5% ophthalmic solution use. Pre- and post-treatment data were analyzed for statistical significance.
Twenty-one subjects (15 female and six male), with the mean age of 31.7 years (± 5.29 years), completed the study. No reduction or statistically significant change in monocular BCVA or LS scores was observed. Data showed a statistically significant (P < 0.05) reduction in total CLDEQ-8 score in questions 1A, 1B, 2A, and 2B scores and non-statistically significant reduction in questions 3A, 3B, 4, and 5 scores. Fifteen (n = 15, 71.4%) study subjects found the therapy positive for their contact lens wear.
Based on the outcomes of the study, the authors suggested that the use of topical lifitegrast 5% ophthalmic solution twice a day may be a safe and effective therapeutic intervention for managing patients who experience CLD associated with SHCL wear; however, further research is indicated.
What is especially interesting about this particular study is that, as part of the inclusion criteria, all subjects had to report a minimum history of self-assessed comfortable wear during the previous 10 months. Yet, there was still a positive effect of the treatment on overall reported contact lens comfort. It would be interesting to see whether the results would be the same or perhaps even more dramatic in a controlled clinical trial of patients who were experiencing contact lens discomfort and limited wearing time. Once again, this study points to the fact that successful contact lens wear is optimized by combining the best management using contact lens materials, care systems, and treatment of the ocular surface.
1. Gonzalez AL. Safety and efficacy of lifitegrast 5% ophthalmic solution in contact lens discomfort. Clin Ophthalmol. 2018 Oct 16;12:2079-2085.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Caffeine and Tear Quality
As a person who highly favors coffee and who is interested in the nuances of ocular surface disease, the impact of caffeine consumption on tear quality is always a topic of interest for me. However, information on the topic is sparse and contradictory.
A recent poster at the American Academy of Optometry 20181 investigated the impact of caffeine on non-invasive tear breakup time (NITBUT) at baseline compared to one and two hours after a 200mg caffeine capsule was consumed versus placebo. What the investigators found was that 200mg of caffeine consumption resulted in a small, insignificant improvement in tear film quality (NITBUT) compared to placebo.
Approximately 85% of the U.S. population consumes caffeinated beverages every day.2 Further studies are warranted to elucidate whether caffeine intake can improve tear film quality. Certainly, a patient-personalized risk/benefit analysis of increased caffeine intake is warranted in appreciation of known adverse side effects of caffeine. Keep in mind, non-regulated eyedrops manufactured outside of the United states that contain caffeine are available.
Remember to pay special attention to dry eye needs of this special group of patients in your practice.
1. Murari S, Ho A, Cooper S, Hayes J. Effect of caffeine on tear film quality among normal healthy adults. Poster presented at the American Academy of Optometry 2018 Meeting, San Antonio.
2. Mitchell DC, Knight CA, Hockenberry J, Teplansky R, Hartman TJ. Beverage caffeine intakes in the US. Food Chem Toxicol. 2014 Jan;63:136-142.
Scleral Asymmetry as a Potential Predictor for Scleral Lens Compression
The purpose of this study was to identify the position and magnitude of lens compression due to short-term mini-scleral contact lens wear as well as to evaluate the usefulness of scleral asymmetry as a predictor for scleral lens decentered compression.
Fourteen healthy subjects (mean ± S.D.: 29.2 ± 6.0 years) wore a GP spherical-haptic mini-scleral contact lens during a five-hour period. Corneoscleral height Fourier profilometry was captured using an Eye Surface Profiler (Eaglet Eye) before and immediately after lens removal. Scleral asymmetry, lens compression location, and magnitude were processed using custom-made algorithms, both globally and for scleral quadrants.
Mini-scleral contact lenses do not sit uniformly on the ocular surface, with the largest decentration seen along the horizontal meridian. The researchers found that the greatest flexural stress exerted by the lens on the ocular surface occurs at the point coinciding with the inner diameter landing point of the lens and not with its overall diameter. Scleral asymmetry was significantly correlated with compression location (R = 0.71, p = 0.002) and compression magnitude (R = 0.81, p < 0.001), showing its potential as a compression predictor.
The authors determined that larger amounts of scleral asymmetry will lead to more decentration of spherical haptic scleral lenses. Objective and accurate methods, such as the one presented here, could help practitioners prevent cases of scleral blanching or discomfort due to an excessive compression by the lens.
Consejo A, Behaegel J, Van Hoey M, Iskander DR, Rozema JJ. Scleral asymmetry as a potential predictor for scleral lens compression. Ophthalmic Physiol Opt. 2018 Nov 18. [Epub ahead of print]