The 2020 Global Specialty Lens Symposium (GSLS) is in the books, and what a fantastic meeting it was! In addition to the great educational programs, there was record attendance, with 800 delegates (and more than 1,200 total attendees) representing 33 countries and Puerto Rico. We heard about exciting new products and fitting approaches for specialty lenses. And, we also hosted our first-ever interactive workshops on scleral lens fitting and ocular surface disease management. Look forward to upcoming calls for continuing education course abstracts, papers, posters, and clinical images for the 2021 GSLS!
Jason J. Nichols, OD, MPH, PhD
Visionary Optics Expands Product Line with Europa Elevate Fitting Set
Visionary Optics announced a new addition to its product line: the 16mm diameter Europa Elevate Fitting Set. As an extension of the Europa Fitting Set, the Europa Elevate Set includes new advancements and resolves decentration complications, according to the company. The fitting set has eight quadrant-specific and six toric-haptic (extended range) lenses to help quantify fitting challenges. It also utilizes Visionary Optics’ exclusive scleral shape data to offer resolution.
OME to Present Live CE Events
Optometric Management Education (OME) will present a series of live CE courses covering myopia management, dry eye and ocular surface disease, or practice management tools.
The series launched with a two-hour CE course titled “Mythbusters: Myopia Edition,” which provided attendees with a dynamic understanding of the current landscape for myopia care. The course, presented by OME faculty members April Jasper, OD, and Mark A. Bullimore, MCOptom, PhD, offered insights into myopia, including current research related to myopia progression and management, practical steps on how optometrists can be proactive in helping myopic patients and their parents; and assumptions about myopia management compared with what the current research reveals. It was sponsored by Luxottica and Paragon. The program was held on Jan. 16 in Springfield, IL. Another session will be held on Feb. 13 in New York City.
Other upcoming courses in this OME series include:
Dr. Art Epstein Teaches Dry Eye and Ocular Surface Disease — Feb. 15 in Philadelphia; Feb. 29 in Houston; March 21 in Tampa, FL; and April 4 in San Jose, CA.
2020 and Beyond — Feb. 28 in Oahu, HI; March 20 in West Palm Beach, FL; April 17 in Tysons Corner, VA; May 17 in Seattle; Apr. 14 in Columbus, OH; Sept. 11 in Pittsburgh; and Nov. 20 in Sacramento, CA.
OME, which specializes in producing clinical and practice management educational events, is a joint venture between PentaVision LLC (publisher of Contact Lens Spectrum and Contact Lenses Today) and Distinctive Strategies and Leadership, LLC. For more information or to register, visit https://www.optometricmanagementeducation.com.
Johnson & Johnson Vision Care Appoints Dr. Charissa Lee as Head, North America Professional Affairs
Johnson & Johnson Vision announced that Charissa Lee, OD, has been appointed to the position of head, North America professional affairs. In this capacity, Dr. Lee will be responsible for professional relations, professional education, and advocacy efforts for Johnson & Johnson Vision Care while also continuing to oversee the Johnson & Johnson Institute.
Since May 2014, she has served as director of Professional Education, where she revitalized the focus on emerging practitioners and oversaw the Johnson & Johnson Institute. Over the last five years, she has been involved in Vision Care product launches and has also worked on multiple projects in ocular surface disease and surgical vision.
Prior to joining Johnson & Johnson Vision Care, Dr. Lee operated a private practice in Irvine, CA and was a professional affairs consultant and program director at the Johnson & Johnson Institute. She is a current member of the American Optometric Association and a Fellow of the American Academy of Optometry.
B+L and TerraCycle Partner to Launch Recycling Program in Canada
Bausch + Lomb (B+L) announced that it has partnered with TerraCycle to launch the Bausch + Lomb Every Contact Counts recycling program in select eyecare offices across Canada. Through the joint initiative, Canadians who wear contact lenses now have a way to responsibly recycle their traditionally non-recyclable disposable contact lenses and blister pack packaging, according to the companies.
Through the Bausch + Lomb Every Contact Counts recycling program, consumers can search for their nearest participating eyecare professional on the interactive map found at www.terracycle.com/en-CA/brigades/bausch-and-lomb-en-ca to recycle all brands of disposable contact lenses and blister pack packaging through that location. After being collected at a designated recycling location, the lenses and blister packs are shipped to a TerraCycle recycling facility where they are separated and cleaned. The metal layers of the blister packs are recycled separately, while the contact lenses and plastic blister pack components are melted into plastic that can be remolded to create new products. In addition to Canada, Bausch + Lomb also has similar contact lens recycling programs in The Netherlands, the United States, and Australia.
49th European Contact Lens and Ocular Surface Congress to Be Held in Paris
The European Contact Lens Society of Ophthalmologists (ECLSO) will be holding the 49th European Contact Lens and Ocular Surface Congress on Sept. 18 and 19 in Paris. The event will include sessions on keratoconus, scleral lenses, ocular surface disease, and myopia. One highlight will be a summary of interesting topics that were introduced at other international symposia and congresses. The Kersley Lecture will be presented by Dr. Ebru Toker, former ECLSO vice president. EACCME accreditation is pending. For more information or to register, visit https://www.eclso.eu.
EyePoint Pharmaceuticals, Inc. and Ocumension Therapeutics announced an exclusive license agreement for the development and commercialization of Dexycu (dexamethasone intraocular suspension) 9% for the treatment of postoperative inflammation following ocular surgery in Mainland China, Hong Kong, Macau, and Taiwan. Dexycu is currently marketed by EyePoint in the United States. EyePoint maintains worldwide development and commercialization rights outside of the territories licensed to Ocumension.
BHVI Opens a New Research Center in Vietnam
Brien Holden Vision Institute’s (BHVI) research collaborator Hai Yen Eye Care has opened a research center in Ho Chi Minh City, Vietnam. The Hai Yen Vision Research Institute is the first of its kind in Vietnam, a research arm in the private ophthalmology sector. According to BHVI, its collaboration with Hai Yen Eye Care reaffirms BHVI’s commitment to increase its global reach in the area of myopia management.
Think About Your Eyes Launches Enhanced Website
Think About Your Eyes, a national public awareness campaign by The Vision Council and the American Optometric Association, launched its new website—thinkaboutyoureyes.com. Featuring new content and a modern, easy-to-navigate design, the new platform provides information on eye health, eye conditions, vision correction options, and treatment, and it enables consumers to find an eyecare practitioner and schedule an exam, according to the organizations.
The new platform includes a range of new and interactive content, including a dynamic section called “Eyes Across the Country.” Content on this page includes interactive quizzes about eye health and information regarding special events. Eyes Across the Country will also feature real-life eye health stories, including the recently announced #seebeyond2020 contest winners. Additionally, the new website features a section for industry partners and practitioners to download resources for use in office for patient education or in their own marketing efforts. Resources include email, press release, and social media copy as well as images and graphics. In addition to new content, the website will include new features to further improve the user experience, including a new practitioner locator that will be introduced later in 2020.
Which of the following scleral lens designs do you generally prefer fitting?
This 30-year-old female, who has keratoconus, presented for a GP lens review after complaining of irritation for two years in her right eye as the day progressed. Slit lamp exam showed a central vertical pooling of sodium fluorescein (NaFL) in what appeared to be an anterior “split” in the cornea. Optical coherence tomography (OCT) of the cornea showed an area of extreme thinning down to 80μm. She will be refit with a scleral lens to ensure clearance from the peak K.
We thank Andrew Bowden for these images 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
Scleral Lenses, Scleral Lenses, Scleral Lenses!
Scleral lenses are everywhere and in every continuing education session, but they are not without complications or controversies. One specific area in which eyecare providers and clinical scientists are interested is hypoxia. With the recent introduction of super-oxygen-transmissible polymers, we have to wonder whether we have found the holy grail to this complication. Probably not, but it's complicated.
Theoretical models of oxygen diffusion suggest that the ideal corneal vault of a scleral lens is about 200 microns (less than half of the width of the cornea). Theoretical models also postulate that scleral lens oxygen transmission should be as high as possible (> 150 Dk) to counter the thickness of the scleral lens and to avoid clinical signs of hypoxia such as corneal neovascularization, corneal edema, and subsequent haze.1 Studies show that the cornea swells approximately 4% during sleep or prolonged eyelid closure, and it swells approximately 1% to 1.4% under a scleral lens.2 However, Esen and Toker noted no significant difference in corneal swelling after eight hours of wear in patients fitted with varying clearances of as low as 100 microns to higher than 300 microns. But they did observe a trend toward greater levels of edema in corneas fitted with lower vaults in the clinical study.3
Many practitioners fit outside of the boundaries of the clinical model, and it takes greater than 5% corneal swelling to be clinically observable (i.e., observable light scattering and corneal haze formation).4 So, does switching to a higher-oxygen-transmissible material provide enough oxygen to your patients’ eyes to be sustainable over a long period of time? The verdict is still out, and researchers agree that more long-term studies are warranted. Until then, it’s nice to have options.
1. Michaud L, van der Worp E, Brazeau R, Warde R, Giasson CJ. Predicting estimates of oxygen transmissibility for scleral lenses. Cont Lens Anterior Eye. 2012 Dec;35 266-271.
2. Walker MK, Bergmanson JP, Miller WL, Marsack JD, Johnson LA. Complications and fitting challenges associated with scleral contact lenses: A review. Contact Lens Anterior Eye. 2016 Apr;39:88-96.
3. Esen F, Toker E. Influence of apical clearance on mini-scleral lens settling, clinical performance, and cornea thickness changes. Eye Contact Lens. 2017 Jul;43:230-235.
4. Dawson D, Edelhauser H. Corneal Edema In Levin LA, Albert DM, eds. Ocular Disease. Available at https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/cornea-edema. Accessed Jan. 30, 2020.
MATERIALS & DESIGNS
David L. Kading, OD
Being Vulnerable Makes Me Better
I don’t know it all, and neither do you. Let’s be honest with ourselves: Sometimes we think we know more than most people do and become a little heavy headed. I get to travel all over the world to share my experiences about dry eye, specialty contact lenses, myopia management, and how I have used the three to grow a practice. That makes me a pretty important guy, or does it?
To be frank, I am not the smartest guy. I don’t have all the answers, and I struggle in business sometimes. Over the last 15 years, I have put a lot of contact lens fits through my slit lamp, I have written my share of prescriptions, and I have performed dry eye procedures on a lot of patients, but I feel like I am on the precipice of my greatest learning. Here is the deal: I am comfortable. That comfort allows me to rest on what I know, what I have seen, what I have done, and my accomplishments. And according to some people’s measuring stick, it would be pretty darn good. But, as I head into my next 15 years of practice, I do not want it to be downhill. I want to be vulnerable. I want to be open. I want to work as hard as I ever have for my patients. I want to keep reading multiple articles a week, I want to meet regularly with other practitioners to talk about the latest research, I want to talk to industry people about what is on the horizon, and I want to talk to younger colleagues and residents and find out from them what they think is innovative. If you are good, if you are accomplished, if you are safe in practice, I want you to find a way to be vulnerable with me. When we are open, we learn. When we are humble, we seek knowledge. Anytime that you think you know more than someone else, scold yourself and ask that person, right there and then, “What’s new in your practice that is exciting you?” You may be accomplished in the eyes of your mother and some of your patients, but both of those don’t want you to be good; they want you to be great. Become vulnerable and realize that your skills and knowledge could use some improvement, then become great and then greater.
Interventions to Slow Progression of Myopia in Children
The purpose of this study was to assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents, in slowing myopia progression in children. The authors did a search of CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. In addition, they included randomized controlled trials (RCTs). The researchers excluded studies in which most participants were older than 18 years at baseline. They also excluded studies in which participants had less than –0.25D spherical equivalent myopia. The data collection and analysis followed standard Cochrane methods.
The study included 41 studies (6,772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or the United States. Except one, all studies included children 18 years old or younger. Many studies were at high risk of performance and attrition bias.
Spectacle lenses: Undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15D (95% confidence interval [CI] –0.29 to 0.00; n = 142; low-certainty evidence) more compared with those wearing fully corrected single-vision lenses (SVLs). In one study, axial length increased 0.05mm (95% CI –0.01 to 0.11) more in the undercorrected group compared with those in the fully corrected group (n = 94; low-certainty evidence). The analysis also indicated that multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14D (95% CI 0.08 to 0.21; n = 1,463; moderate-certainty evidence) less compared with children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers compared with SVL wearers (–0.06mm, 95% CI –0.09 to –0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral-plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence).
Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single-vision SCLs (mean difference (MD) 0.20D, 95% CI –0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers compared with single-vision SCL wearers (MD –0.11mm, 95% CI –0.14 to –0.08; n = 300; low-certainty evidence). Two studies investigating GP contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI –0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD –0.28mm, 95% CI –0.38 to –0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical-aberration SCLs with single-vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence).
Pharmaceutical agents: At one year, children receiving atropine eye drops (three studies; n = 629), pirenzepine gel (two studies; n = 326), or cyclopentolate eye drops (one study; n = 64) showed significantly less myopia progression compared with children receiving placebo: MD 1.00D (95% CI 0.93 to 1.07), 0.31D (95% CI 0.17 to 0.44), and 0.34D (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD –0.35mm, 95% CI –0.38 to –0.31; n = 502) and pirenzepine (MD –0.13mm, 95% CI –0.14 to –0.12; n = 326) compared with those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopia progression (MD 0.07D, 95% CI –0.09 to 0.24) nor on axial elongation (MD –0.03mm, 95% CI –0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD –0.05D, 95% CI –0.21 to 0.11; n = 95; low-certainty evidence).
Combinations of interventions: two studies reported that children treated with atropine plus multifocal spectacles progressed 0.78D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs progressed (n = 191; moderate-certainty evidence). One study reported –0.37mm (95% CI –0.47 to –0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) compared with participants receiving placebo (n=387; moderate-certainty evidence).
The authors concluded that antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective compared to SVLs in slowing axial elongation. They also found only low- or very low-certainty evidence to support RGPCLs and spherical-aberration SCLs.
Walline JJ1, Lindsley KB2, Vedula SS3, et al. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2020 Jan 13;1:CD004916.