This is no doubt a busy time of year for all of us, but as the kids take to their holiday break and vacation schedules set in, what an opportune time to bring them in for eye examinations. Perhaps those contact lenses a teenager wants so much could be part of a holiday gift? Be creative and use the time wisely as we help preserve and restore the precious sense of sight.
Jason J. Nichols, OD, MPH, PhD
Merchea Joins Alcon to Lead Medical Affairs for U.S. and Canada Vision Care
Alcon has appointed Mohinder (Mo) Merchea, OD, PhD, MBA as Head of Medical Affairs for Vision Care in the U.S. and Canada.
In his new role for Alcon, Dr. Merchea will develop strategic scientific plans for brands in the Vision Care franchise, with a focus on the needs of patients, the medical and scientific communities and regulatory authorities. Merchea will lead regional strategy for Phase IIIb and Phase IV trials in the U.S. and Canada. In addition to contributing to medical communication, publication and key conference plans, he will oversee independent medical education programs for Alcon’s clinician partners.
Dr. Merchea brings more than 18 years of experience in eye health, clinical research and medical device development. His clinical expertise includes refractive surgery, keratoconus, topography, wavefront aberrations, ocular surface and contact lenses, and lens care solutions. Merchea concluded a 12-year career at Bausch + Lomb, a division of Valeant Pharmaceuticals Inc., as the head of medical affairs, Vision Care; and most recently with Lensar Inc. where he served as the Vice President of Clinical & Regulatory Affairs.
Merchea earned his Doctor of Optometry degree from The Ohio State University College of Optometry, where he also completed a combined Advanced Practice Fellowship in cornea and contact lenses, a Master of Science degree in physiological optics and a Doctorate in vision science. He later went on to earn a Master of Business Administration from the Fisher College of Business at The Ohio State University.
Alden Optical Receives ISO 13485 Certification
Alden Optical has received full ISO 13485 certification by successfully demonstrating that the company operates under a comprehensive quality management system for the design and manufacture of medical devices. This industry standard certification further demonstrates Alden Optical’s ongoing commitment to provide practitioners and patients with the highest quality contact lens designs and diagnostic products.
Alden Optical (www.aldenoptical.com) was established in 1969 by Charles "Pat" Creighton, OD. The company manufactures premium specialty and custom made-to-order soft and gas permeable contact lenses while offering unparalleled customer service. Over the last few years, Alden Optical has developed an extensive portfolio of custom + specialty lenses including HP Toric, Astera Multifocal Toric, NovaKone and now Zenlens.
Don’t Miss the 10th Global Specialty Lens Symposium
The 10th Global Specialty Lens Symposium will be held January 21 – 24, 2016 at Caesars Palace Las Vegas, Nevada. 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. This meeting will include insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.
The 2015 event was attended by almost 600 registrants from 36 countries, 42 states, Puerto Rico and Guam. It continues to be the largest conference of its kind in the U.S.
Join your peers in 2016 for the 10th anniversary in Las Vegas! Visit www.GSLSymposium.com for more information and to register.
International Keratoconus Academy of Eye Care Professionals Established
The International Keratoconus Academy of Eye Care Professionals (IKA) was recently established to promote ongoing professional education and scientific development in the area of keratoconus and other forms of corneal ectasia. Its mission is to promote and develop the knowledge base and awareness of the state-of-the-art pertaining to the diagnosis and management of keratoconus and other forms of corneal ectasia, and further to promote the awareness and understanding of the most appropriate and effective treatment strategies for the management of these diseases.
IKA. will accomplish its mission by providing an array of educational initiatives which will include live events, web-based education, social media activities and publications in the professional literature. It will also be dedicated to supporting ongoing clinical research. IKA will function as a complementary entity to other organizations that support patients with these diseases such as the National Keratoconus Foundation (NKCF). These organizations will work cooperatively to establish a comprehensive effort to advance knowledge, awareness and quality of care.
The founding executive board of IKA is comprised of highly regarded experts in the field including: S. Barry Eiden, OD, FAAO; Andrew Morgenstern, OD, FAAO; Timothy McMahon, OD, FAAO; Joseph Barr, OD, FAAO; William Tullo, OD, FAAO; Clark Chang, OD, FAAO; Eric Donnenfeld, MD; and Yaron Rabinowitz, MD. An international physician’s advisory board comprised of expert optometrists and ophthalmologists is being formed.
Professionals interested in membership in IKA may visit the website at www.keratoconusacademy.com and subscribe using the coupon for complimentary membership dues. Also you can visit the IKA Facebook page at International Keratoconus Academy.
AEA Investors to Acquire a Majority Interest of 1-800 Contacts
AEA Investors, LP announced that it has entered into a definitive agreement to acquire a majority interest of 1-800 Contacts, Inc. from Thomas H. Lee Partners, L.P., who will remain a significant shareholder in the Company. Credit Suisse and Barclays, as well as an affiliate of the Merchant Banking Division of Goldman Sachs, are providing debt financing to support the purchase. Terms of the transaction were not disclosed.
Founded by the Rockefeller, Mellon and Harriman family interests and S.G. Warburg & Co. in 1968, AEA Investors is a pioneer in the private equity industry with a global network of investors, business leaders and sector-focused industry professionals. AEA's individual investors include more than 75 of the world's leading industrial families, business executives and former government leaders. AEA Investors currently manages funds that have approximately $9.0 billion of invested and committed capital including the leveraged buyouts of middle market companies and small business companies and mezzanine and senior debt investing. Information on the AEA can be found at www.aeainvestors.com.
See Your Interesting Case Photo Here in the Next Issue
Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in Contact Lenses Today in the coming weeks!
We welcome photo submissions from our 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.
Contact Lens Options for Myopia Progression Management – The Evidence Continues to Mount!
We are all familiar with the dramatic increases in myopia worldwide and the implications of myopia in terms of ocular health, financial impact and quality of life issues. We need to be aware of these factors and do what we can to thwart the ever increasing rates of progressive myopia if at all clinically possible. Over the past decade more and more clinical evidence supporting the efficacy of a number of treatment approaches for progressive myopia has been presented in the literature and at the podiums at eye research meetings all over the world.
Recently another clinical study was published that looked at the efficacy of both multifocal soft daytime wear contact lenses and corneal reshaping treatment on controlling myopic progression in a group of young myopes. The objective of the study was to evaluate the degree of axial elongation with soft radial refractive gradient (SRRG) contact lenses, orthokeratology (OK), and single vision (SV) spectacle lenses (control) during a period of 1 year before treatment and 2 years after treatment. This was a prospective, longitudinal, nonrandomized study. The study groups consisted of 30, 29, and 41 children, respectively. The axial length (AL) was measured during 2 years after recruitment and lens fitting. The results of the study found after 2 years, the mean myopia progression values for the SRRG, OK, and SV groups were -0.56 ± 0.51, -0.32 ± 0.53, and -0.98 ± 0.58 diopter, respectively. The results represent reductions in myopic progression of 43% and 67% for the SRRG and OK groups, respectively, compared to the SV group. The AL increased 27% and 38% less in the SRRG and OK groups, respectively compared with the SV group at the 2-year visit (P < 0.05). Axial elongation was not significantly different between SRRG and OK (P = 0.430). The researchers concluded that The SRRG lens significantly decreased AL elongation compared to the SV control group and that the SRRG lens was similarly effective to OK in preventing myopia progression in myopic children.
Though still off-label use, I believe that the evidence is now approaching overwhelming in supporting our ability to influence myopia progression with a variety of treatment modalities that include corneal reshaping (orthokeratology), peripheral myopic defocus inducing daytime wear multifocal contact lenses and pharmaceutical intervention such as atropine therapy. We as eye care professionals need to become far more proactive in our approach to myopia management. At our practice we have established a myopia management sub-specialty service over the past years that is as well developed, organized and evidence based as our other sub-specialty eye care services. I urge you to consider doing the same or to appropriately refer your progressive myopes to someone who does.
Pauné J, Morales H, Armengol J, Quevedo L, Faria-Ribeiro M, González-Méijome JM. Myopia Control with a Novel Peripheral Gradient Soft Lens and Orthokeratology: A 2-Year Clinical Trial. Biomed Res Int. 2015;2015:507572. Epub 2015 Oct 28.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Prepping for Intraocular/Intravitreal Injections
At Omni, intraocular/intravitreal injections are a daily event. Each day many patients are prepped for the in-office procedure. After informed consent, the patient’s identified eye’s pupil is dilated and the eye is anesthetized. Knowing that the most common bacteria isolated from post-injection infections are common to the lid margin flora, the lids and ocular surface are treated with povidone iodine solution; effective, but toxic to the ocular surface. A lid speculum is then inserted, and the injection is administered. This procedure is accepted by most practices and the rate of post-injection infection is low. Generally most patients’ corneas come through the procedure without sequelae. But, for those patients with fragile corneas or those sensitive to povidone iodine, deleterious effects ranging from significant infection to corneal edema or corneal abrasion can occur. Of course the cornea may be impacted by desiccation or contact from the speculum. Nevertheless, it is important for us as primary care providers to ensure the ocular surface is as robust as possible to support ocular surgery.
Corneal Nerve Regeneration after Collagen Cross-Linking Treatment of Keratoconus: A 5-Year Longitudinal Study
It is unknown whether a neurotrophic deficit or pathologic nerve morphology persists in keratoconus in the long term after corneal collagen cross-linking (CXL) treatment. Nerve pathology could impact long-term corneal status in patients with keratoconus.
The researchers’ objective was to determine whether CXL treatment of keratoconus results in normalization of subbasal nerve density and architecture up to 5 years after treatment.
This was an observational study of 19 patients with early-stage keratoconus indicated for a first CXL treatment with longitudinal follow-up to 5 years postoperatively (examinations were performed from 2009 to 2015; analysis was performed from February to May 2015) and 19 age-matched healthy volunteers at a primary care center and a university hospital ophthalmology department.
The patients with keratoconus underwent standard epithelial-off UV-A/riboflavin CXL treatment with 30-minute UV-A exposure at 3 mW/cm2 irradiance.
Central corneal subbasal nerve density and subbasal nerve architecture by use of laser-scanning in vivo confocal microscopy; subbasal nerve analysis by two masked observers and by use of a fully automated method; wide-field mosaics of subbasal nerve architecture by use of an automated method; and ocular surface touch sensitivity by use of contact esthesiometry.
Mean (SD) age of the 19 patients with keratoconus was 27.5 (7.1) years (range, 19-44 years), and minimal corneal thickness was 428 (36) μm (range, 372-497 μm). Compared with the mean (SD) preoperative subbasal nerve density of 21.0 (4.2) mm/mm2 in healthy corneas, the mean (SD) preoperative subbasal nerve density of 10.3 (5.6) mm/mm2 in the corneas of patients with stage 1 or 2 keratoconus was reduced 51% (mean difference, 10.7 mm/mm2 [95% CI, 6.8-14.6 mm/mm2]; P < .001). After CXL, nerves continued to regenerate for up to 5 years, but nerve density remained reduced relative to healthy corneas at final follow-up (mean reduction, 8.5 mm/mm2 [95% CI, 4.7-12.4 mm/mm2]; P < .001) despite recovery of touch sensitivity to normal levels by 6 months. Preoperatively, more frequent nerve loops, crossings, and greater crossing angles were observed in the corneas of patients with keratoconus compared with healthy corneas. Postoperatively, the frequency of nerve looping increased, crossings were more frequent, and nerve tortuosity increased. Wide-field mosaics indicated persistent disrupted orientation of the regenerating subbasal nerves 5 years after CXL.
The authors concluded that keratoconus is characterized by a neurotrophic deficit and altered nerve morphology that CXL treatment does not address, despite providing a positive biomechanical effect in the stroma. Given the widespread use of CXL in the management of patients with keratoconus, the progression of abnormal innervation after CXL should be recognized.
Parissi M, Randjelovic S2, Poletti E, Guimarães P, Ruggeri A, Fragkiskou S, Wihlmark TB, Utheim TP, Lagali N. Corneal Nerve Regeneration After Collagen Cross-Linking Treatment of Keratoconus: A 5-Year Longitudinal Study. JAMA Ophthalmol. 2015 Nov 12:1-9. doi: 10.1001/jamaophthalmol.2015.4518. [Epub ahead of print]