Bedside manners are very important to a patient’s clinical experience and overall health-related outcome, and there is no doubt that some practitioners lack in this area. However, what has become more and more clear is that many of today’s patients are also lacking in bedside manners.
It is not uncommon to hear stories of patients "shaming" doctors and practices regarding services and fees that patients consider to be unreasonable or that are otherwise misunderstood. For instance, I heard of a colleague who was publicly ridiculed for charging a fee to adjust spectacles that were purchased online rather than at the practice. Ironically, some online distributors will reimburse patients for this out-of-pocket expense.
In the end, it is likely that bedside manners on our part go a long way toward improving relations with all of our patients.
SynergEyes, Inc. launched the SimplifEyes 1Day daily disposable lens. SimplifEyes 1Day lenses are enhanced by Dual Tangible Polymers (Tangible Science) that provide one polymer coating on the lens surface and another polymer in the solution. According to the company, they are designed to provide enhanced wettable surfaces, less debris buildup, and comfort.
SimplifEyes 1Day is available in powers of +0.50D to +4.00D and –0.50D to –6.00D in 0.25D steps. Lenses are available with an 8.6mm base curve and a 14.2mm diameter. The etafilcon A lens also has an ultra-thin edge design and UV blockers. The new lens is currently available in the United States.
SimplifEyes 1Day lenses are supported by the new MyContactLens Online Ordering System, which is a portal that is currently in beta and is accessible through independent eyecare professionals’ practice websites.
BCLA Offers Members Exclusive Webinar
For the first time, the British Contact Lens Association (BCLA)’s traditional "Evening Scientific Meeting" will be presented as an online webinar, which will allow members to tune in for free wherever they are in the world.
The session, titled "It’s in their hands! How to optimise contact lens compliance and ensure our patients love their lense" will be hosted by Professor Philip Morgan and Sarah Morgan from 6.30 p.m. to 7.30 p.m. on March 12, 2019. Members need to register via the BCLA website for access to the webinar.
Bruder Announces Eyeleve Contact Lens Compress
Bruder Healthcare announces the immediate availability of the Eyeleve Contact Lens Compress, which the company says delivers consistent, therapeutic moist heat that alleviates symptoms of meibomian gland dysfunction and contact lens-related dry eye. By stimulating glands and increasing oil production, Eyeleve helps stabilize the ocular surface to reduce dryness and extend comfortable wear time of contact lenses, according to Bruder Healthcare.
The Eyeleve Contact Lens Compress utilizes silver ion MediBeads and an anti-microbial EyeOnic fabric. Bruder says that the EyeOnic material has anti-microbial threads woven into the fabric of the compress, reducing the risk of infections. Together, these features help address eyelid hygiene and reduce the risk of corneal infection in contact lens wearers, according to the company. Finally, Eyeleve features a patent-pending ergonomic pod design and a contoured comfort stitch to reduce pressure on the eyes, according to the company.
Founders of The Lens Butler Announce Boxsee
Beth Samenuk and Allison Granger, formerly of The Lens Butler, announced their new company and brand, Boxsee. The new company represents a new vision for the future of their partnered contact lens subscription service and reflects the evolution of the company and the partnerships that they are building with others as they increase their offerings to private eyecare professionals (ECPs) and the value to patients. Boxsee provides continuity for ECPs who are looking for a competitive subscription contact lens offering to online retailers and big box stores, according to the company.
CooperVision Costa Rica Manufacturing Plant Earns LEED Silver Certification
The CooperVision contact lens manufacturing facility in Alajuela, Costa Rica has been awarded LEED Silver certification for its environmentally conscious design and operation. The 100,000-square-foot site, opened in 2016, produces Clariti 1-day silicone hydrogel contact lenses. It is believed to be the only LEED Silver-certified contact lens manufacturing site in the world.
The LEED Silver certification reflects only a portion of CooperVision environmental initiatives focused on saving water; conserving energy; reducing, reusing, and recycling resources; and empowering people within the company and the communities in which it operates.
Three optometry students presented scientific posters at the 2019 Global Specialty Lens Symposium in Las Vegas as winners of the Optometry Student Challenge, a program designed by ABB Optical Group, in partnership with Paragon Vision Sciences, to foster the study of contact lenses.
More than 90 optometry students submitted contact lens-related abstracts focused on study projects or student-based case histories for the chance to win a travel stipend of $1,500 to attend the symposium and convert their abstracts into scientific posters. The challenge was open to students in their third and fourth years of study. Abstracts were judged on academic merit by a panel of industry experts.
Nha Cao, a fourth-year student and founder of the contact lens club at Midwestern University Arizona College of Optometry, focused on the effect of freezing temperatures on senofilcon A soft contact lenses. Julie Ervin, a fourth-year student and member of the American Optometric Student Association, covered treatment of keratoconjuctivitis sicca secondary to sicca syndrome with scleral lenses. Ilya Volk, a fourth-year student and member of the contact lens club at Western University of Health Sciences, presented on the benefit of a scleral lens in the treatment of a post-corneal-transplant epithelial defect.
EyePoint Pharmaceuticals Appoints David Guyer, MD, to Board of Directors
EyePoint Pharmaceuticals, Inc. announced the appointment of David Guyer, MD, to the company’s board of directors. He will also serve on the company’s Science Committee. Dr. Guyer has led several public and private biotechnology companies focused on ocular diseases and has held leadership positions in academia and at healthcare venture capital firms. Dr. Guyer currently serves as executive chairman of Ophthotech Corporation, a publicly traded biopharmaceutical company specializing in gene therapy treatments for ocular diseases, which he co-founded.
Are scleral contact lenses impacting the rate of corneal transplants in your practice?
A 14-year-old patient who had advanced keratoconus and who developed hydrops on his right eye was referred for scleral lens fitting. Acute hydrops is a marked corneal edema that occurs when the aqueous leaks through a tear in the Descemet’s membrane. It often resolves with a scar. Vision in this patient’s right eye deteriorated to the extent to which he did not have facial recognition even at a very close range.
He was previously fit with GP lenses for both eyes by a different optometrist; however, the lens on the right eye kept popping out. Topography showed the central cornea to be steep superiorly at the 70D range and flat inferiorly at the 50D range. The variation of the curvature posed a challenge in GP lens fitting. With scleral lenses, his best-corrected visual acuity OD was 20/40.
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S. Barry Eiden, OD
Everything Old Is New Again! Retinoscopy Screening for Keratoconus
All of us have been instructed on the utilization of retinoscopy for the detection of the classic "scissors reflex" in keratoconus. In fact, the most commonly referenced prevalence statistics used for keratoconus (one in 2,000 individuals) is based on a study that used this retinoscopic abnormality as a diagnostic criterion.1 Recent studies have incorporated more advanced diagnostic techniques in their determination of keratoconus prevalence rates, which have resulted in significantly greater prevalence values (one in 375 individuals).2
We would expect to find a higher prevalence of keratoconus if we utilized diagnostic determinants based upon technologies that were more sensitive in detecting earlier and less advanced cases of the disease. Interestingly enough, a recent study was conducted that once again looked at retinoscopy to detect keratoconus.3 The researchers investigated the validity and reliability of retinoscopy in screening for keratoconus using the rotating Pentacam Scheimpflug camera as the gold standard comparison.
Patients between the ages of 10 and 30 years who were referred to the outpatient clinic and who had keratoconus; suspect keratoconus; reduced vision, eye discomfort, or frequent change of glasses or who were referred for refraction or refractive surgery were screened by two independent and masked retinoscopists for the presence of scissoring reflex. Patients then underwent vision testing, slit lamp examination, and Pentacam imaging. A diagnosis of keratoconus by Pentacam was made if the final D index in the Belin and Ambrósio Display was ≥ 2.69. The results of retinoscopy and Pentacam examinations were compared to assess the validity and reliability of the test.
Results showed that of a total of 123 patients comprising 245 eyes, there were 87 eyes that had keratoconus based on the Pentacam analysis. Using the Amsler-Krumeich classification, 67.8%, 26.4%, 2.3%, and 3.4% of the eyes had stage I, II, III, and IV, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of retinoscopy were 97.7%, 79.9%, 70.8%, and 98.4%, respectively. There was excellent agreement between the two retinoscopists (Cohen’s kappa value 0.84).
The researchers concluded that retinoscopy appears to be a very sensitive and reliable test for detecting keratoconus, including early disease. Such a test may be implemented in population-based screening programs for keratoconus.
We are currently faced with a dilemma in eye care with regard to our approach to early diagnosis of keratoconus. In light of our ability to halt progression with the application of corneal cross linking treatment, it is critically important for eyecare professionals to detect keratoconus as early as possible to avoid irreversible vision loss. Although this study suggests that simple retinoscopy may still be sensitive and specific in detecting keratoconus, the question remains as to whether it is useful in detecting mild and early onset disease.
It is more likely that advanced technologies such as Scheimpflug corneal tomography and others will still be able to detect keratoconus at a much earlier phase. The dilemma is how to get such advanced technologies in the hands of primary eyecare providers so that they can screen for this not-so-uncommon disease. Until we can figure this out, we will still need to pull out our old retinoscopes!
1. Kennedy RH, Bourne WM, Dyer JA. A 48-year clinical and epidemiologic study of keratoconus. Am J Ophthalmol. 1986 Mar 16;101:267-273.
2. Godefrooij DA, de Wit GA, Uiterwaal CS, Imhof SM, Wisse RP. Age-specific Incidence and Prevalence of Keratoconus: A Nationwide Registration Study. Am J Ophthalmol. 2017 Mar;175:169-172.
3. Al-Mahrouqi H, Oraba SB, Al-Habsi S, et al. Retinoscopy as a Screening Tool for Keratoconus. Cornea. 2019 Jan 9. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Glue … Sometimes You Need It
Of late, there has quite a lot of concern regarding the detrimental effects of cyanoacrylate-containing glues that are used in the application of cosmetic eyelash extensions.1 On the reverse side, consider the use of tissue adhesives in ocular surface repair.
Closure of ocular wounds after an accident or surgery is typically performed by suturing, which is associated with numerous potential complications including suture breakage, inflammation, secondary neovascularization, erosion to the surface and secondary infection, and astigmatism. For example, more than half of post-corneal-transplant infections are due to suture-related complications. Tissue adhesives provide promising substitutes for sutures in ophthalmic surgery. Ocular adhesives are not only intended to address the shortcomings of sutures, but they are also designed to be easy to use and can potentially minimize postoperative complications.2
There are two main classes of ocular adhesives: synthetic adhesives based on cyanoacrylates, polyethylene glycol (PEG), and other synthetic polymers; and adhesives based on naturally derived polymers, such as proteins and polysaccharides. There is continued progress in the design, synthesis, and application of ocular adhesives along with their advantages and limitations.2 Continued advances in this area can help improve both patient satisfaction and clinical outcomes. Stay tuned.
1. Amano Y, Sugimoto Y, Sugita M. Ocular disorders due to eyelash extensions. Cornea. 2012 Feb;31(2):121-125.
2. Trujillo-de Santiago G, Sharifi R, Yue K, et al. Ocular adhesives: Design, chemistry, crosslinking mechanisms, and applications. Biomaterials. 2019 Jan 7;197:345-367. [Epub ahead of print]
Contact Lens Materials: A Materials Science Perspective
More is demanded from ophthalmic treatments using contact lenses, which are currently worn by more than 125 million people around the world. Improving the material of contact lenses (CLs) is now a rapidly evolving discipline. These materials are developing alongside of the advances made in related biomaterials for applications such as drug delivery. Contact lens materials are typically based on hydrogel or silicone hydrogel, with additional manufacturing technologies employed to produce the final lens. These processes are simply not enough to meet the increasing demands from CLs and the ever-increasing number of CL users.
This review provides an advanced perspective on contact lens materials, with an emphasis on materials science employed in developing new CLs. The future trends for CL materials are to graft, incapsulate, or modify the classic CL material structure to provide new or improved functionality.
In this paper, the authors discuss some of the fundamental material properties, present an outlook from related emerging biomaterials, and provide viewpoints of precision manufacturing in CL development.
Musgrave CSA, Fang F. Contact Lens Materials: A Materials Science Perspective. Materials (Basel). 2019 Jan 14;12(2).