We all know that contact lens discomfort is a significant problem in our contact lens wearers. However, I do not think we have a good approach to objectively quantify it (let alone manage it) although we have made some strides in imaging technologies and point-of-care diagnostics. Given we are on the cusp of seeing some revolutionary technologies incorporated into contact lens wear that should see growth, in addition to some market segment stagnation, I think it is more important than ever that we move the needle in managing contact lens-related dry eye.
Jason J. Nichols, OD, MPH, PhD
Who Are the Most Influential People in Contact Lenses?
Contact Lens Spectrum’s 30th Anniversary Issue will publish in September 2016. We are doing some noteworthy things to commemorate our 30 years, including a redesign that will be phased in over the next few months. We will also run a feature article on the 30 most influential people in the field of contact lenses over the last 30 years (1986-2016) in the anniversary issue. The list may include anyone (practitioners, researchers, educators and industry leaders) who has made a significant impact in the field of contact lenses over the last 30 years. We are looking for people who have contributed or are contributing to the betterment and/or advancement of contact lenses during this period.
We are asking you to nominate people for this honor. There is no limit to your nominations, so please put forward whomever you think is worthy of this distinction. If you have any comments about the specific accomplishments of your nominees, we welcome those as well. Please send your nominations to email@example.com.
Thank you in advance for your support of Contact Lens Spectrum.
AccuLens Featured in Spotlight Broadcast on VisionLive.TV
Elissa Masler, AccuLens National Sales Director, was interviewed for a spotlight feature in the premier episode of VisionLive.TV. The new live streaming internet television program, created for the eyecare industry, aired its first episode on February 17th. VisionLive will feature news and interviews covering everything from the hottest fashion trends to cutting edge technology.
Questions and comments to VisionLive will be accepted through email and social media. Please go to www.visionlive.tv to view the February 17th program and for more information.
Blanchard Announces 2016 Scleral Lens Workshop Tour
Blanchard Contact Lenses has released the cities and dates for a large part of their 2016 Beyond the Limbus Scleral Lens Workshop tour. The Beyond the Limbus workshops, in their sixth year, are a component of Blanchard University, Blanchard’s educational division. Blanchard University furthers the company’s commitment to partnering with eyecare professionals, providing them with the tools and training they need to be successful in this ever-changing industry, utilizing Blanchard’s innovative scleral lens designs.
Planning is now underway for the following workshops:
April 3rd: Charlotte, NC
April 10th: Ft. Lauderdale, FL
April 17th: Uniondale, NY
April 24th: Kansas City, KS
May 1st: Rockville, MD
May 8th: San Francisco, CA
May 15th: Houston, TX
Dates are also in the works for Los Angeles, CA, Anaheim, CA, Manchester, NH and Boston, MA.
Attendees can look forward to a high impact workshop, with well-prepared information, valuable hands-on experiences, and takeaways that will ensure their success, along with Blanchard’s commitment to ongoing support.
Practitioners wishing to attend a Beyond the Limbus workshop should contact their respective Blanchard Sales representative or email firstname.lastname@example.org. Space is limited and sessions fill up quickly. Visit Blanchard Contact Lenses on the web at www.blanchardlab.com or call (800) 367-4009.
Novaliq GmbH has begun enrolling patients in a Phase 2 clinical trial that will evaluate the safety, efficacy and tolerability of CyclASol for the treatment of moderate to severe dry eye disease (DED). CyclASol is a clear, preservative free ophthalmic solution of cyclosporine in SFA (semifluorinated alkanes).
This Phase 2 study is a randomized, double-masked, placebo-controlled, multicenter trial, designed to evaluate the safety, efficacy and tolerability of topical CyclASol for the treatment of moderate to severe DED. Patients will be randomized to one of four treatment groups that include two CyclASol groups, a placebo (vehicle control) group and an open label cyclosporine A 0.05% ophthalmic emulsion group. Study subjects will self-administer one drop twice daily, returning for examination periodically and at the end of the trial at four months. The study is being conducted in approximately four sites in the U.S., and total planned enrollment is 200 patients.
Primary Eyecare Network (PEN), a division of ABB Optical Group is offering eyecare practitioners the following two educational webinars this March:
March 2 – HIPAA and OIG Audit Update, 12:30 - 1:30 pm PST
CS EYE President John Weeding, a compliance specialist, will lead a webinar about HIPAA Phase 2 audits and the Office of Inspector General's focus on small eye care practices. Learn how to ensure your credentialing practices are complaint to avoid fraudulence and criminal charges. Free for PEN members; $15 for non-members
March 16 – Meal and Rest Period Policies: Ensuring Compliance and Avoiding Vulnerabilities, 12:30 - 1:30 pm PST
Led by human resources expert Kathy Kennady of JMA, a professional employer organization for small-to-medium sized businesses, this webinar will cover compliant meal and rest period policies and other guidelines to help eyecare practices avoid legal vulnerabilities. Free for PEN members; $15 per practice for non-members
Optometry Giving Sight announced the consolidation of its Global Board and Global Development Board, creating a new Board structure with 11 members. The new members are:
Dr. Glenn Ellisor – Executive Chairman, Vision Source
Marc Ferrara – CEO Information Services, Jobson Medical Information
Pat McNeil – Chief Communications Officer, VSP Global
Dr. Howard Purcell – Senior Vice President, Customer Development Group, Essilor of America
Dr. Alan Ulsifer – President and Chair, FYidoctors
Dr. Rick Weisbarth – VP Professional Affairs, Alcon
Dr. Juan Carlos Aragon (Chairperson) – Senior Vice President, Southern & Central Eastern Europe, CooperVision
Peter Ackland – CEO, International Agency for the Prevention of Blindness
Dr. Susan Cooper – Immediate Past President, World Council of Optometry
Amanda Davis – COO, Brien Holden Vision Institute - Public Health
Yvette Waddell – COO, Brien Holden Vision Institute
The announcement followed the first meeting of the new Board which was held on February 4th and which approved $1.5 million of funding for 39 Projects in 24 countries. These include support for Schools of Optometry in Haiti, Nicaragua, Mexico, Vietnam, Malawi, Eritrea, Mozambique, Kenya and Uganda.
Other funded projects include training programs for optometrists, optometric technicians and ophthalmologists; child eye health programs; community education and advocacy.
20 Year-Old FSA Lens Cyril Kahloun MOptom, Jerusalem, Israel
This 42 year-old patient, a high +7.00 hyperop who was fittted with a fluorosilicone acrylate (FSA) lenticular GP lens 20 years ago, came into my office to order new GP lenses. In 20 years he had never changed the lenses. He often used tap water for insertion and cleaning, and wore the lenses 24/7.
This is a slit-lamp picture of the patient's right lens with circular bullseye and central deposits.
The patient was refitted into high Dk FSA and re-educated about lens care and handling.
We thank Cyril Kahloun 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.
“All You Had to Do Was to Tell Me” … How Patient Education Can Influence the Bacterial Bioburden of Contact Lens Cases and Potentially Avoid Increased Risk of MK
A study was conducted in order to measure the changes in the bacterial bioburden in corneal reshaping contact lens storage cases using the DNA dot hybridization assay (DHA) after forewarning patients about their bacterial contamination severity.1
Thirty-one corneal reshaping lens wearers were prospectively enrolled in this study. Dot hybridization assay was used for serial measurements of bacterial bioburden in the storage cases after lenses had been soaked for approximately 6 hours. After the first assessment, the subjects were informed of the extent of case contamination and the possible risk of microbial keratitis (MK). They were then educated about best practices for lens care and lens case hygiene was reviewed and reinforced. A second assessment by the same DHA method was performed after approximately 6 months of lens wear.
The results found that two universal bacterial probes confirmed a significant decrease in bacterial bioburden at the second assessment (P<0.01 and P<0.001). Genus-specific probes showed significant reductions in Acinetobacter and Klebsiella (P=0.02 and P=0.01), but not in Pseudomonas (P=0.42).
The authors concluded that by making corneal reshaping lens wearers aware of the bacterial bioburden in their lens cases there would be an improvement in the quality of case care and reduced bioburden. The results suggest that a strategy of bioburden assessment with forewarning could be a useful method to decrease the incidence of corneal reshaping related microbial keratitis.
So, after reading this study do we think that it is necessary to initially allow our patients to improperly care for their lenses, measure the bacterial bioburden on their cases and then re-instruct them in proper lens wear and care? I think not. However, I believe that this study simply emphasizes the importance of appropriate initial patient education regarding the risks of inappropriate lens wearing behaviors. The question becomes, what is the most effective way to do this? I have always believed that our patients in general are intelligent and want to have the healthiest contact lens experience possible. It is incumbent upon us as their eyecare professionals to put in place an organized and effective educational system not only at the time of initial dispense and instructions but on an ongoing basis. With proper wear and care we all know that contact lenses are an amazingly safe and effective modality for vision correction.
1. Fang PC, Lo J, Chang TC, Chien CC, Hsiao CC, Tseng SL, Lai YH, Kuo MT. Bacterial Bioburden Decrease in Orthokeratology Lens Storage Cases After Forewarning: Assessment by the DNA Dot Hybridization Assay. Eye Contact Lens. 2016 Feb 8. Epub ahead of print.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Holistic Treatments Part 2
In my last Ocular Surface Update, I discussed a patient who describes her natural-remedy “cure” for the systemic and ocular “fallout” (conjunctival redness and chemosis) of EKC.
Briefly, this patient reported a rapid and remarkable positive response to using an eye wash of diluted apple cider vinegar in conjunction with ingestion of the same. Note: this is Bragg’s Apple Cider vinegar (organic raw unfiltered, unheated, unpasteurized and 5% acidity that contains the Mother. The Mother of vinegar is a substance composed of a form of cellulose and living acetic acid bacteria) not chemically processed vinegar.
The use of vinegar to fight infection and other acute conditions dates back to Hippocrates (460-377 BC). Indeed, vinegar has been demonstrated to have antimicrobial activity.1 A PubMed review for antiviral activity of acetic acid yields little information, however one study in murine ulcerative colitis suggests that acetic acid may reduce inflammation via suppression of chemical inflammatory molecules (and boosting gut populations beneficial gut bacteria).2
Although the possibility of having an adjunctive therapy to curtail the significant infectious and inflammatory response to ocular viral infection is exciting, keep in mind the singularity, and timeframe of this case. Remember there is no established protocol or consistent scientific evidence to support the use of apple cider vinegar in disease therapy.3 Comments here are anecdotal and informational only, and it is up to the practitioner’s discretion if they be employed. I, however, will continue to clinically explore this and other “remedies” in the weeks ahead.
1. Rutala WA, Barbee SL, Aguiar NC, Sobsey MD, Weber DJ. Antimicrobial activity of home disinfectants and natural products against potential human pathogens. Infect Control Hosp Epidemiol. 2000 Jan;21(1):33-8.
2. Shen F, Feng J, Wang X, Qi Z, Shi X, An Y, Zhang Q, Wang C, Liu M, Liu B, Yu L. Vinegar Treatment Prevents the Development of Murine Experimental Colitis via Inhibition of Inflammation and Apoptosis. J Agric Food Chem. 2016 Feb 10;64(5):1111-21. doi: 10.1021/acs.jafc.5b05415. Epub 2016 Feb 1.
3. Johnston CS, Gaas CA. Vinegar: Medicinal Uses and Antiglycemic Effect. MedGenMed. 2006; 8(2): 61.
Conjunctival Impression Cytology vs. Routine Tear Function Tests for Dry Eye Evaluation in Contact Lens Wearers
Prolonged contact lens wear is often accompanied by dryness of the eyes. The aim of this study was to compare conjunctival impression cytology (CIC) and tear film tests such as tear film break up time (TBUT) and Schirmer test for dry eye evaluation in contact lens wearers and measure their correlation with dry eye symptoms.
A case control study was done at three referral eye centers. The eyes of 230 contact lens users were compared to 250 eyes of age- and sex-matched controls. Participants were recruited based on their response to a questionnaire of dry eye symptoms, (Dry Eye Scoring System, DESS) and measurements of TBUT, Schirmer test, and CIC was done. A correlation analysis between symptom severity and tear film tests was performed. Pearson's coefficient, R(2) > 0.5 was considered significant.
As compared to controls (r (2) = 0.010), Nelson grade correlated significantly with dry eye symptoms (r (2) = 0.765), among cases. However, there was moderate correlation between dry eye symptoms, Schirmer test, and TBUT (r (2) = 0.557 and 0.530, respectively) among cases and a weak correlation among controls (r (2) = 0.130 and 0.054, respectively). The sensitivity of TBUT was 86.4%, specificity was 82.4%, positive likelihood ratio (LR) was 4.50 [95% confidence interval (CI) 3.46-5.85)], and negative LR was 0.09. The sensitivity of the Schirmer test was 48.2%, specificity 88%, LR 2.12 (95% CI 1.48-2.96), and negative LR 0.83.
The researchers concluded that CIC correlates better than Schirmer and TBUT with dry eye symptoms. It may be the most appropriate test for dry-eye evaluation in contact lens wearers.
Kumar P, Bhargava R, Arora YC, Kaushal S, Kumar M. Conjunctival impression cytology versus routine tear function tests for dry eye evaluation in contact lens wearers. J Cytol. 2015 Oct-Dec;32(4):261-7. doi: 10.4103/0970-9371.171242.