We continue to see more and more data suggesting the efficacy for potential management strategies for myopia. This week’s abstract provides further evidence for the off-label use of atropine for slowing myopia progression. As we evaluate results such as these, it is important to keep patients and their lifestyle in mind as you implement management strategies in your clinic.
Jason J. Nichols, OD, MPH, PhD
CooperCompanies Appoints Mark Drury as Vice President, General Counsel, and Corporate Secretary
CooperCompanies announced that Mark Drury has been appointed vice president, general counsel, and corporate secretary effective Feb. 15, 2020, reporting to Albert G. White, president and CEO. Mr. Drury joined CooperCompanies in January 2011 and is currently the company’s deputy general counsel with responsibility for CooperVision’s global legal function along with certain corporate matters. Prior to joining CooperCompanies, Mr. Drury was an attorney with Latham & Watkins.
Mr. Drury succeeds Randal L. Golden, who announced his plans to retire. As part of a smooth transition, Mr. Golden will continue to serve in a legal advisory role until Feb. 1, 2021.
Ovitz Introduces Ovitz Xwave
Ovitz Incorporated introduced its new Ovitz Xwave system. The Ovitz Xwave works by utilizing a patented aberrometer device powered by proprietary machine learning and an AI software platform. According to Ovitz, eyecare professionals can use the system to create a wavefront-guided contact lens, neutralizing higher-order aberrations of the entire visual system.
Which of the following scleral lens designs do you generally prefer fitting?
These intracorneal ring implants are 18 years old. Until now, this eye was not functionable. So, we fit a scleral lens on this eye.
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SPECIALTY LENS SPACE
Karen DeLoss, OD
A Better Fit
While scleral lenses have greatly improved comfort for patients who have not been able to successfully wear GP lenses or for those who require scleral lenses for medically necessary conditions or for better optical quality, achieving a perfect fit can still pose a challenge.
Schornack and Pate noted that keratometry readings from corneal topography were not a predictive value in base curve selection for scleral lenses.1 However, the shape and sagittal height of the sclera can help achieve a better fit by indicating when toric haptics would provide better alignment on the sclera, which has been shown to improve comfort.2-5
Technology for mapping the scleral profile is readily available to those who fit scleral lenses, and several options are available. There are several benefits of this technology. First, practitioners can obtain sagittal height, which can help guide them in both the fitting relationship and lens vault over the cornea. Second, these devices can help map out the level of toricity within the sclera. Finally, many of these instruments link to software that can help generate or suggest an initial lens that is customized for a patient. While not all technology is needed, it can be helpful and hopefully will expedite the fitting process.
1. Schornack MM, Pate. SV. Relationship between corneal topographic indices and scleral lens base curve. Eye Contact Lens. 2010 Nov;36:330-333.
2. van der Worp E. A Guide to Scleral Lens Fitting [monograph online]. Forest Grove, OR: Pacific University: Pacific University Libraries at CommonKnowledge 2010.
3. Ritzmann M, Caroline P, Walker M, et al. Understanding scleral shape with the Eaglet Eye Surface Profiler. Poster presented at the Global Specialty Lens Symposium. Las Vegas, Jan. 2015.
4. Visser ES, Visser R, Van Lier HJ. Advantages of toric scleral lenses. Optom Vis Sci. 2006 Apr;83:233-236.
5. DeNaeyer G, Sanders D, Farajihan T. Surface coverage with single vs. multiple gaze surface topography to fit scleral lenses. Cont Lens Anterior Eye. 2017 Jun;40:162-169.
MATERIALS & DESIGNS
David L. Kading, OD
Are you getting sick of hearing about scleral lenses? We have been talking about how sexy they are for the past 10 years, and they have experienced some major hype in the last five years. But, as they have become more mainstream, perhaps you are getting sick of hearing about them. As soon as we become comfortable with something and feel that we have learned all that needs to be learned, we become complacent and ignore what needs to be heard. Warning: This is when you need to be listening the most.
Researchers are looking for better and healthier contact lens wear at all times. Do you know all of the risks that patients may experience when wearing scleral lenses? You are aware of the good, but do you know the bad? What is the tear chamber doing to the ocular surface? Is it good to have an eye in contact with a solution that does not change over as frequently? What is happening to the anterior chamber and nerve fiber layer as a result of the pressure force of a scleral lens being on the eye? Is all of this normal, or should we be concerned?
Sclerals have certainly altered my practice over the last 15 years. My experience with them has made me a referral source in my community. However, it is my obligation to be on the front line. I cannot afford to become comfortable or complacent with my lens awareness, and neither can you. Look to our sister publication, Contact Lens Spectrum, and peer review journals, as well as the Global Specialty Lens Symposium and other major meetings for the latest and newest research to help you know when it is right to fit any type of contact lens.
Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 2 Report
The purpose of this study was to evaluate the efficacy and safety of 0.05%, 0.025%, and 0.01% atropine eye drops over two years to determine which is the optimal concentration for longer-term myopia control. The randomized, double-masked trial extended from the Low-Concentration Atropine for Myopia Progression (LAMP) Study.
Three hundred eighty-three of 438 children (87%) aged 4 to 12 years who had myopia of at least –1.0D and who were originally randomized to receive atropine 0.05%, 0.025%, 0.01%, or placebo once daily in both eyes in the LAMP phase 1 study were continued in this extended trial (phase 2). Children in the placebo group (phase 1) were switched to receive 0.05% atropine from the beginning of the second-year follow up, whereas those in the 0.05%, 0.025%, and 0.01% atropine groups continued with the same regimen. Cycloplegic refraction, axial length (AL), accommodation amplitude, photopic and mesopic pupil diameter, and best-corrected visual acuity (BCVA) were measured at four-month intervals. Changes in spherical equivalent (SE) and AL and their differences between groups were measured.
Over the two-year period, the mean SE progression was 0.55D ± 0.86D, 0.85D ± 0.73D, and 1.12D ± 0.85D in the 0.05%, 0.025%, and 0.01% atropine groups, respectively (P = 0.015, P < 0.001, and P = 0.02, respectively, for pairwise comparisons), with mean AL changes over two years of 0.39mm ± 0.35mm, 0.50mm ± 0.33mm, and 0.59mm ± 0.38mm (P = 0.04, P < 0.001, and P = 0.10, respectively). Compared with the first year, the second-year efficacy of 0.05% and 0.025% atropine remained similar (P > 0.1) but improved mildly in the 0.01% atropine group (P = 0.04). For the phase 1 placebo group, the myopia progression was reduced significantly after switching to 0.05% atropine (SE change, 0.18D in the second year versus 0.82D in the first year [P < 0.001]; AL elongated 0.15mm in the second year versus 0.43mm in the first year [P < 0.001]). Accommodation loss and change in pupil size in all concentrations remained similar to the first-year results and were well tolerated. Visual acuity and vision-related quality of life remained unaffected.
The authors concluded that, over two years, the efficacy of 0.05% atropine that was observed was double the amount that was observed with 0.01% atropine, and it remained the optimal concentration among the studied atropine concentrations in slowing myopia progression.
Yam JC, Li FF, Zhang X, et al. Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 2 Report. Ophthalmology. 2019 Dec 21. [Epub ahead of print]