While stepped therapy programs are not new, it feels as though we in the eyecare business may be feeling their impact on the care of patients more and more frequently. This may be true in particular for those practitioners actively treating ocular surface disease, as new treatments have expanded our options for these patients. The idea in stepped therapy programs is that insurers require healthcare providers to prescribe older treatments first due to their lower costs compared to newer therapies. While there are many issues on both sides of these programs, opponents seem to be gaining traction in several states with legislative efforts. The National Psoriasis Foundation has an interesting website that summarizes these efforts on a state-by-state basis for the nation (http://www.steptherapy.com/step-therapy-legislation-by-state/).
Jason J. Nichols, OD, MPH, PhD
CooperVision Expands Myopia Management Team
Responding to surging global interest in myopia management and its MiSight 1 day contact lenses, CooperVision’s Specialty EyeCare Division has named two eyecare industry veterans to newly established professional services roles.
Elizabeth Lumb, BSc(Hons), MCOptom, has been appointed as head of Professional Services, MiSight 1 day, EMEA (Europe, Middle East and Africa) and global brand manager for the lens. She joined the organization in 2013, serving as Professional Services training manager for Europe. Earlier in her career, she worked at Eurolens Research and also was also a senior optometrist with Boots Opticians.
Chi Shing Fan, PD Optom, PhD, has been appointed as Professional Service and Commercial lead, MiSight & Specialty Business, Asia Pacific. He joined CooperVision in 2009, serving as Professional Services director, Asia Pacific and as the region’s Frequent Replacement Category lead. Previously, he held regional professional services roles with Bausch + Lomb and Ciba Vision.
The company has also recently appointed MiSight Professional Services leads for the United Kingdom, France, and Iberia. It intends to staff similar roles in Germany-Austria-Switzerland, Hong Kong, and Singapore, aiding the establishment of myopia management best practices in those markets.
Alcon Acquires Tear Film Innovations
Alcon, a division of Novartis, announced that it has acquired Tear Film Innovations, Inc. (Tear Film), a privately held company and manufacturer of the iLux handheld device used to treat meibomian gland dysfunction. The iLux Device is an in-office treatment that warms the eyelids via disposable silicone pads through the application of light-based heating. While using the iLux Device, practitioners can view the eyelid margin and apply manually-controlled compression to express blockages. The iLux Device received 510(k) clearance from the U.S. Food and Drug Administration in December 2017 and was officially launched by Tear Film in May 2018.
Optometric Organizations Establish New COPE Governing Committee
The American Academy of Optometry (AAO), the Association of Schools and Colleges of Optometry (ASCO), and the Association of Regulatory Boards of Optometry (ARBO) announced that a joint agreement has been reached to restructure the governance of the Council on Optometric Practitioner Education (COPE). The newly established COPE Governing Committee will be comprised of representatives from ARBO, ASCO, and the AAO to assure collaboration and the ongoing advancement of the quality of optometric continuing education.
Initial nominations to the COPE Governing Committee are now underway, with the anticipation of completion in Jan. 2019. Duties of the governing committee will include setting standards, policies, and procedures for the COPE accreditation program, making accreditation determinations based on compliance with COPE accreditation criteria and policies, and preparing and presenting an annual report to the ARBO House of Delegates and the boards of directors of the participating organizations.
Which of the following scleral lens ocular complications occurs most frequently in your practice?
A well-centered multifocal intraocular lens can provide crisp vision at all distances. Refinements in lens design and surgical techniques have made the use of these lenses more common. This happy patient was 20/20 at both distance and near.
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.
SPECIALTY LENS SPACE
Karen DeLoss, OD
Toric Peripheral Curves
A toric scleral lens is commonly defined as having the toricity in the landing zone on the sclera; this can be confusing. It may be helpful to be more specific with terminology such as toric peripheral curves. Studies have shown that the sclera is asymmetric in shape and that the asymmetry increases as you move away from the limbus.1,2 Studies have also shown that toric peripheral curves can improve comfort.3,4 Indications that a switch is needed from a spherical periphery to a toric periphery include observed edge lift along one meridian, compression or blood vessel blanching along one meridian, or both.
Edge lift can cause lens awareness; patients will note discomfort, which can lead to intolerance. Edge lift can also lead to bubble intrusion. In this case, it is helpful to switch to a toric peripheral curve to bring down the edge to better match the profile of the sclera. Blanching or vessel impingement can be symptomatic or asymptomatic.
Often, patients will complain of a dull ache with the lens in place or after removal. In this case, switching to a toric peripheral curve can minimize symptoms and improve long-term success.
Lastly, the fluid reservoir can become cloudy due to debris. While not always successful, toric peripheral curves can minimize debris entrapment and increase patient satisfaction.
1. Consejo A, Llorens-Quintana C, Bartuzel MM, Iskander DR, Rozema JJ. Rotation asymmetry of the human sclera. Acta Ophthalmol. 2018 Aug 26. [Epub ahead of print]
2. van der Worp E, Graf T, Caroline P. Exploring beyond the corneal borders. Contact Lens Spectrum. 2010 Jun;25:26-32
3. Visser ES, Visser R, Van Lier HJ. Advantages of toric scleral lenses. Optom Vis Sci. 2006 Apr;83:233-236.
4. Visser ES, Van der Linden BJ, Otten H, Van der Lelij A, Visser R. Medical applications and outcomes of bitangential scleral lenses. Optom Vis Sci. 2013 Oct;90:1078-1085.
MATERIALS & DESIGNS
David L. Kading, OD
Contact Lenses for the Holidays
This year, give yourself a Christmas present. Yeah, we know that you get things for yourself anyway while shopping for your family and friends, but let’s get one more thing: A new way of fitting contact lenses.
Every year, at about this time, I like to reflect back on accomplishments and think forward on strategies for the next year to make my patients’ experience in the office better. Two things that you can give your contact lens self are innovation and health.
Everyone is looking for a healthier way in life. Just look at what is about to happen in January with gym memberships. Patients want to be healthier, and practitioners (should) want to make them healthier as well. A shift in mindset was our Christmas present in past years, and it has yielded the healthiest contact lens-wearing patient base imaginable.
Into which lenses are you fitting >50% of your patient? Look at those lenses and see whether there is a better and healthier option for them. If your patient is experiencing a problem with a hydrogel lens, perhaps switching to a monthly SiHy lens is the way to go. If you feel that daily disposable lenses are the healthiest option, then move your patients into daily disposable lenses. As Yoda might say, “Do, there is no try.”
Innovation can be an expensive gift, but it doesn’t have to be. It might be time for you to be innovative and to give scleral lenses a try. Perhaps you need to start prescribing custom multifocal lenses, or maybe you need to start fitting patients who have < 1.0D of cylinder into toric lenses. Regardless of where you are, you can always innovate. There are always things (lenses) that you have not tried yet.
Every year, I like to think of some contact lens innovations that I need to make in the coming year. Perhaps you have a large budget to spend at year’s end…then invest in more technology. I have never purchased any equipment that didn’t provide valuable information about my patients. Certainly, some information is more valuable than others, so it is a good idea to do some quick research on how it is going to help you innovate.
Until we reach 100% of our patients with contact lenses, there will always be more gifts that we can give ourselves for the improvement of our patients’ lives.
Patients’ and Prescribers’ Perception of Contact Lenses as a Potential Ocular Drug Delivery System
Contact lenses (CLs) designed to deliver medication gradually to the eye are being developed and investigated for use in ocular drug delivery. The aim of this research is to determine patients’ acceptance of the use of lenses for ocular drug delivery. In addition, the study aimed to seek the views and perceptions of healthcare professionals (HCPs) on CLs as a method of ocular drug delivery and whether it will be prescribed to treat ocular conditions.
This cross-sectional survey targeted patients and HCPs. Two separate questionnaires were created with open-ended, closed-ended, and multiple-response questions, gauging the perceptions and acceptance of CLs as drug delivery tools. The patients’ survey was distributed in John Radcliffe (JR), Oxford, and Moorfields Eye Hospital (MEH) in London. The HCPs’ questionnaires were manually distributed and were also created on Survey Monkey and sent by email to ophthalmologists, optometrists, opticians, general practitioners, and hospital and community pharmacists. The data were analyzed using SPSS statistical software and Excel.
More than 60% (92/151) of patients indicated that they would accept the use of CLs for their ocular treatment, with the highest acceptance being reported by patients in the age group of 30 to 49 years old. The most frequently used conventional treatment formulation was eye drops, as indicated by 87% (131/151) of the responses. More than half of eye drop users (57%, 75/131) indicated that they would accept using CLs and that by doing so, they would expect to reduce the frequency of application of the medicine and that it would be less time consuming. Interestingly, half of HCPs were not aware of CLs as an ocular drug delivery method; nevertheless, a total of 65 HCPs out of the 112 surveyed stated that they would prescribe/dispense CLs to treat ocular disease.
Ghazal H, Ahmadouk J, Dhanji S, El-Bushra A, Kayyali R, ElShaer A. Patients’ and prescribers’ perception of contact lenses as a potential ocular drug delivery system. Cont Lens Anterior Eye. 2018 Nov 13. [Epub ahead of print]