Contact lens (CL) practice across the world is at a critical juncture, with some potential opportunities (such as contact lenses for myopia control, multifocal lenses for presbyopia, and specialty lenses) along with looming threats (such as increasing competition from online business). Anecdotal discussions with eyecare professionals have revealed different levels of optimism regarding the future of CL practice.
Hence, a partnership between Contact Lens Spectrum and organizations across the world—including the International Association of Contact Lens Educators and the British Contact Lens Association—has formed to better understand these issues.
We value your input. To help us gather what you perceive to be the opportunities and threats to CL practice, please take about 5 minutes to fill out this survey: https://forms.gle/7gPWKQemgnivZ6oH8. The findings of this study will help the industry to design targeted strategies to enhance CL practice and address the perceived threats.
Jason J. Nichols, OD, MPH, PhD
Alcon to Sell Pataday Over the Counter
Alcon announced that Pataday Once Daily Relief (olopatadine hydrochloride ophthalmic solution 0.2%) and Pataday Twice Daily Relief (olopatadine hydrochloride ophthalmic solution 0.1%) have been approved by the Food and Drug Administration (FDA) for sale over the counter (OTC) in the United States. The rights to the Rx-to-OTC switch were secured by Alcon as part of its separation from Novartis in April 2019.
Pataday Once Daily Relief and Pataday Twice Daily Relief are indicated for the temporary relief of itchy eyes due to pollen, ragweed, grass, animal hair, and dander for patients aged 2 years and older. Pataday Twice Daily Relief is also indicated for the temporary relief of red eyes.
U.S. commercial availability of Pataday Once Daily Relief and Pataday Twice Daily Relief will begin on March 2 in all major drug, food, and mass market retailers as well as through online retailers. The launch is supported by a multimillion-dollar media plan including a national TV advertising campaign and an online presence to reach eye allergy sufferers.
BCLA to Hold Scleral Lens Webinar
Scleral lenses will be the subject of a forthcoming British Contact Lens Association (BCLA) webinar. Dedicated to all-things scleral, the webinar will be hosted by Melissa Barnett, OD. It will provide an opportunity for practitioners to understand how they can incorporate scleral lenses within their practice by discussing scleral lens indications, fitting, evaluation, and after care. Tips and tricks for scleral lens handling will be reviewed, and those taking part will be able to quiz Dr. Barnett as she delves into the art and science of scleral lenses. The online session will be held on April 8, 2020 at 6:30 p.m. to 7:30 p.m. (BST). To register, visit www.bcla.org.uk.
Eyeris Releases Daily Disposable Contact Lens
Eyeris released its daily disposable contact lens. The Eyeris Daily boasts an 8.5mm base curve and a 14.3mm diameter in sphere powers of +6.00D to –13.00D (0.50D steps over –7.50D and +4.50D). According to the company, the Eyeris Daily Lens also has a custom-engineered mix of emollients, hydration agents, and a cushioning agent. In addition, the softness of the hioxifilcon A lens material and its hydration characteristics carry patients to the end of the day with comfort, according to Eyeris. The lens is only available through Eyeris’ network of eyecare practitioners.
Eyeris has also created trial lens packaging made from its own recycled contact lens molds. The case also utilizes radio frequency identification (RFID) technology in the lens parameter label for state-of-the-art inventory management; each night, the display self-counts and re-orders what the office needs, according to the company.
ABB Optical Group to Distribute Tangible Clean Solution
ABB Optical Group announced that ABB Contact Lens Specialty Vision Products is now a master distributor of Tangible Clean, a Food and Drug Administration-approved daily cleaning and disinfecting solution recommended for custom contact lenses coated with Tangible Hydra-PEG as well as for other GP or soft contact lenses.
Leo Lens Pharma Focuses on Myopia Management
Leo Lens Pharma (formerly DBA as Leo Lens Technology Co., Inc.) has received a notice of allowance from the U.S. Patent and Trademark Office for a patent for the use of its proprietary MediPrint process to manufacture a contact lens capable of providing enhanced myopia management. According to the company, the novel product will allow patients who are suffering from, or at a high risk of developing, myopia to wear a contact lens that can automatically and continuously deliver a drug to control myopia (such as low-dose atropine) to a patient’s eye. The company says that the MediPrint process is compatible with a variety of base contact lenses, allowing Leo Lens Pharma to pair its drug delivery technology with contact lenses designed to help slow the progression of myopia.
CooperVision Becomes Global Patron of IAPB
CooperVision has become a Global Patron of the International Agency for the Prevention of Blindness (IAPB). The company joins a select group that supports IAPB at the highest level, including Allergan, Bayer, Novartis, and Standard Chartered Bank. As part of the relationship, CooperVision and IAPB will collaborate to bring greater awareness and action to the growing prevalence and severity of myopia in children worldwide.
Johnson & Johnson Vision Calls on Individuals to Prioritize Your Eyes in 2020
Johnson & Johnson Vision launched Prioritize Your Eyes, a worldwide effort to raise awareness about the connection of eye health to overall health. According to the company, Prioritize Your Eyes encourages everyone to take the single most important step to protect their eyes—getting an eye exam—and is part of its ongoing commitment and collaboration with various partners and professional organizations to elevate eye health and make 2020 the year of greater eye health awareness.
Which of the following scleral lens designs do you generally prefer fitting?
This image shows silicone oil in the anterior chamber of a patient who has a history of retinal surgery.
We thank Dr. Kaur 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.
S. Barry Eiden, OD
No Pain, No Gain? Management of Post-Epi-off Corneal Cross-Linking
Now that corneal cross-linking (CXL) utilizing an epithelium-off technique is U.S. Food and Drug Administration-approved, practitioners need to address the realities of the procedure. One of the most challenging is immediate post-procedural pain management.
A recent study out of the Netherlands looked at a number of methods to address the post-procedural healing period.1 The purpose of their investigation was to evaluate the effect of three regimens on pain and wound healing after epithelium-off CXL. Consecutive progressive keratoconus patients who underwent 9 mW/cm2 epithelium-off CXL were included. Patients received a bandage contact lens (n = 20), occlusive patch (n = 20), or antibiotic ointment (n = 20) after treatment. Pain scores and quality of life—measured by the McGill Pain Questionnaire and Visual Analogue Scale (VAS)—were analyzed. Epithelial healing after two days, correlations between pain and psychological factors that influence pain perception (depression anxiety stress score and pain catastrophizing score), and oral pain medication were evaluated.
The results indicated that, on average, patients experienced considerable pain after CXL (median VAS score 6.2, range 0 to 10). The postoperative regimen did not significantly affect pain scores, although the antibiotic ointment group reported a higher VAS score (median VAS score 7.2 versus 6.7 and 6.0; P = 0.57). Occlusive patching showed a trend to quicker resolution of epithelial defects (85% completely healed versus 65% with lenses and 70% with antibiotic ointment; P = 0.43). Correlations with pain-modulating psychological factors were weak (R < 0.3) and not significant. The use of pain medication corresponded poorly to the prescribed use. The authors concluded that this study demonstrated clinical equivalence of the three regimens in combating postoperative pain after routine CXL. Wound healing appeared quicker in the occlusive patch group and, therefore, might be the best standard of care after CXL. They believe that the clinical tradition of using bandage contact lenses should be reevaluated.
One of the most important elements in management of patients undergoing CXL is setting realistic expectations on the patients’ part. First and foremost is their understanding that current CXL is being performed to halt the progression of their disease (with success rates in the upper 90% range). Any reduction in severity of disease is a wonderful secondary outcome, but currently not one on which we can bank. Next is the patients’ understanding about the post-procedural expectations. Short-term pain is expected and should not be underestimated by an eyecare practitioner. If patients find the discomfort to be insignificant, then that would be a wonderful outcome. The issues pertaining to instability of corneal shape and vision changes during the initial weeks and months following epi-off CXL also need to be addressed.
I typically employ the policy of “underpromise and overdeliver” in all of my ophthalmic treatments. I have experienced great results utilizing this policy throughout my career and continue to utilize it with my CXL patients.
1. Soeters N, Hendriks I, Godefrooij DA, Mensink MO, Wisse RPL. Prospective 3-arm study on pain and epithelial healing after corneal crosslinking. J Cataract Refract Surg. 2020 Jan;46:72-77.
OCULAR SURFACE UPDATE
Katherine Mastrota, MS, OD
Dry Eye—What a Headache
Reports in the literature have conflicting findings about an association between dry eye disease (DED) and migraine headaches.
One 2019 large population study was designed to determine the strength of the association between DED and migraine headaches.1 This retrospective case-control study consisted of 72,969 patients older than 18 years from the University of North Carolina-affiliated health care facilities (May 2008 to May 2018), including 41,764 men (57.2%) and 31,205 women (42.8%). Of these, 5,352 patients (7.3%) had a diagnosis of migraine headache, and 9,638 (13.2%) had a diagnosis of DED. The odds of having DED given a diagnosis of migraine headaches were 1.72 times higher than that of patients who did not have migraine headaches (95% CI, 1.60 to 1.85). After accounting for multiple confounding factors, the odds of having DED given a diagnosis of migraine headaches were 1.42 times higher than that of patients who did not have migraine headaches (95% CI, 1.20 to 1.68).
These findings suggest that patients who have migraine headaches are more likely to have comorbid DED compared with the general population. Although this association may not reflect cause and effect, these data suggest that patients who have migraine headaches may be at risk of carrying a comorbid diagnosis of DED.
Suggestion: When performing dry eye workups, ask patients about their headache history.
1. Ismail OM, Poole ZB, Bierly SL, et al. Association Between Dry Eye Disease and Migraine Headaches in a Large Population-Based Study. JAMA Ophthalmol. 2019 May 1;137:532-536.
Myopia Outcome Study of Atropine in Children (MOSAIC): An Investigator-Led, Double-Masked, Placebo-Controlled, Randomised Clinical Trial Protocol
The Myopia Outcome Study of Atropine in Children (MOSAIC) is an investigator-led, double-masked, placebo-controlled, randomized clinical trial (RCT) that aimed to explore the efficacy, safety, acceptability, and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population.
During Phase 1 of the trial, 250 children aged 6 to 16 years who had progressive myopia instilled eye drops once nightly in both eyes from randomization to month 24. No treatment is given during phase 2 from month 24 to 36 (washout period) for those participants who were initially randomized to the intervention arm (n = 167), during which any potential rebound effects on cessation of treatment will be monitored. All participants initially assigned to the placebo (n = 83) cross over to the intervention arm of the study for phase 2 and, from month 24 to 36, instilled 0.01% atropine eye drops in both eyes once nightly. Further treatment and monitoring beyond 36 months is planned (phase 3) and will be designed dependent on the outcomes of phase 1.
The primary outcome measure is cycloplegic spherical equivalent refractive error progression at 24 months. Secondary outcome measures include axial length change as well as the rebound, safety, and acceptability profile of 0.01% atropine. Additional analyses will include the mechanisms of action of 0.01% atropine for myopia control.
The authors concluded that the generalizability of results from previous clinical trials investigating atropine for myopia control is limited by the predominantly Asian ethnicity of previous study populations. MOSAIC is the first RCT to explore the efficacy, safety, and mechanisms of action of unpreserved 0.01% atropine in a predominantly White population.
McCrann S, Flitcroft I, Strang NC, et al. Myopia Outcome Study of Atropine in Children (MOSAIC): an investigator-led, double-masked, placebo-controlled, randomised clinical trial protocol. HRB Open Res. 2019 Jul 23;2:15.