Contact lens dropout—it is arguably the single biggest factor that challenges the growth of the contact lens market. Although it is well documented that dropout occurs after years of contact lens wear, which is primarily due to discomfort and dryness, recent data (see the abstract below) are providing a new wrinkle to the story.
Remarkably, dropout appears to significantly impact our new contact lens wearers as well; an alarming 26% of all new contact lens wearers drop out of contact lens wear in the first year of being fitted with contact lenses! As noted, nearly 42% of these dropouts did so for visual reasons. Additionally, for 71% of these dropouts, no alternative contact lenses were fitted. These numbers are staggering and serve as a loud call for us to be even more proactive in our follow-up care of new contact lens wearers.
Jason J. Nichols, OD, MPH, PhD
Novartis Considers Alcon Spin-Off
In last week’s Q4 earnings call, Novartis AG CEO Joe Jimenez stated that Novartis is considering spinning off its Alcon eyecare business. He noted that one of the company’s priorities was to improve Alcon’s performance, but that it fell short, even though there was some improvement. Mr. Jimenez noted that the company will review Alcon during 2017 and look at various options, including retaining the business, a sale, an IPO, or a spin-off. Novartis also announced a $5 billion share buyback.
Essilor Releases ProLook Scleral Contact Lens
Essilor Contact Lenses announced the ProLook Scleral Contact Lens. It is a 16.6mm scleral lens with controlled flexing. The set includes a toric PC trial lens to help determine if toric PCs are needed and how much toricity to use. The lenses can be customized, if needed, to have any amount of reverse geometry. In addition, the sizes and heights over different areas of the cornea can be easily individually adjusted, if required.
Paragon CRT Contact Lenses Approved by ANVISA
Paragon Vision Sciences has received approval from the Brazilian Health Regulatory Agency (ANVISA) for its corneal reshaping/orthokeratology brand, Paragon CRT Contact Lenses. The contact lenses are a non-surgical treatment option for managing myopia and are now available in 51 countries around the world, including the United States and China. The lenses will be widely available to eye care practitioners within the next few months.
IACLE and BCLA Launch Monthly Research Updates
Research Update is the latest resource essential to contact lens educators and practitioners worldwide, and available exclusively to International Association of Contact Lens Educators (IACLE) and British Contact Lens Association (BCLA) members.
Members of each association will receive a monthly email summarizing key papers on contact lenses and anterior eye appearing in peer-reviewed journals. The aim is to ensure that educators, their students, and those currently in practice keep up to date with current research and the latest developments, to the ultimate benefit of contact lens wearers.
The first issue was sent out in January 2017 and all issues will be archived for IACLE and BCLA members’ exclusive access on the associations’ respective websites, www.iacle.org and www.bcla.org.uk.
Blanchard Contact Lenses Announces Spring Scleral Lens Workshop Tour
Blanchard Contact Lenses released the cities and dates for its upcoming spring Beyond the Limbus Scleral Lens Workshop tour. Beyond the Limbus workshops, in their seventh year, are a component of Blanchard University, the company’s educational division. These intensive, one-day workshops deliver comprehensive, hands-on training, and tools to ensure eye care professionals leave with the skills and confidence they need to successfully incorporate Blanchard’s scleral lens designs into their practice.
Attendees will learn how to fit Blanchard’s Onefit scleral lenses for healthy and compromised corneas, as well as msd Select scleral lenses for highly irregular corneas. Blanchard will also be discussing their new Onefit Asian design lenses, as well as XLC - the new Extra Limbal Clearance option that simplifies fitting of Onefit lenses even further.
Registrations are now being accepted for the following workshops:
March 19: Arlington, VA
March 19: San Diego
March 26: Dallas
April 2: McAllen, TX
April 9: Los Angeles
April 23: King of Prussia, PA
April 30: Columbus, OH
May 7: Sacramento, CA
June 4: Fort Lee, NJ
June 4: Honolulu
June 11: Chicago
ABB Optical Group Offers Free Scleral Lens Education Workshops
ABB Optical Group is offering a series of free hands-on workshops and luncheons featuring the new ICD FlexFit scleral lens. Led by research scientist and clinical instructor Randy Kojima the three-hour training and education program for novice and advanced scleral fitters will provide practitioners with a comprehensive understanding of scleral lenses and the confidence to introduce scleral lenses into their practices. Participants will learn about candidacy, diagnostics lens selection, initial evaluation, post settling analytics, custom lens construction, and trouble shooting. Additionally, participants will have a hands-on chance to evaluate fits through group instruction, as well as an opportunity to apply, evaluate, and remove lenses on themselves or colleagues. Limited seating is available.
All upcoming workshops will be held from 11:30 a.m. – 2:30 p.m. Dates and locations include:
February 19 – Miami.
March 12 – Newport Beach, CA
March 18 – Sacramento, CA
April 22 – Salt Lake City
May 27 – Kansas City, MO
This is an eye with trauma. The right image shows the patient’s eye two months ago; note that the picture was taken after a dilated eye exam. The left image shows a successful fit with a specialty contact lens. Most important is that the eye now shows no bulbar conjunctival redness, limbal redness, nor hyperemia.
We thank Telamitsi Kyriakos 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.
CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
Tear Film Deposits
Contact lenses begin to accumulate deposits shortly after patients begins to wear their contact lenses; deposits then typically accrue with increasing amounts of wear time.1 Deposits/soiling may stem from sources external to the patient like the air or cosmetics.2 They may also result from exposure to the patient’s own tears, a topic that has received much attention in the literature.3
The literature has primarily focused on the deposition of proteins and lipids onto soft contact lenses, though other tear molecules like mucins and salts are also likely deposited onto the lenses.3 Deposition patterns vary widely by material, though some trends do exist. In general, conventional hydrogel contact lenses are more likely to accumulate proteins than lipids, while silicone hydrogel contact lenses typically have the opposite trend.3 With that said, these relationships are highly material- and biomolecule-dependent, and there are exceptions to these trends.4
Regardless of the source or type of deposit, patients need to combat contact lens deposits by either wearing daily disposable contact lenses (single use prevents deposit from building up over time) or by regularly cleaning their contact lenses with a recommended care system.5 While no-rub care systems exist, it is generally believed that rubbing a contact lens is more effective at removing deposits compared to omitting the rub step. Therefore, in my opinion, a rub step should always be included.5,6 Educating your patients about the need for removing these microscopic deposits will not only lead to more comfortable eyes, but it should also lead to healthier eyes.3,7,8
1. Carney FP, Nash WL, Sentell KB. The adsorption of major tear film lipids in vitro to various silicone hydrogels over time. Invest Ophthalmol Vis Sci. 2008 Jan;49:120-124.
2. Ng A, Evans K, North RV, Jones L, Purslow C. Impact of Eye Cosmetics on the Eye, Adnexa, and Ocular Surface. Eye Contact Lens. 2016;42:211-220.
3. Nichols JJ. Deposition on silicone hydrogel lenses. Eye Contact Lens. 2013 Jul;39:20-23.
4. Pucker AD, Thangavelu M, Nichols JJ. In vitro lipid deposition on hydrogel and silicone hydrogel contact lenses. Invest Ophthalmol Vis Sci. 2010 Dec;51:6334-6340.
5. Cho P, Cheng SY, Chan WY, Yip WK. Soft contact lens cleaning: rub or no-rub? Ophthalmic Physiol Opt. 2009 Jan;29:49-57.
6. Tam NK, Pitt WG, Perez KX, Hickey JW, Glenn AA, Chinn J, Liu XM, Maziarz EP. Prevention and removal of lipid deposits by lens care solutions and rubbing. Optom Vis Sci. 2014 Dec;91:1430-1439.
7. Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol. 1977 May;83:697-708.
8. Truong TN, Graham AD, Lin MC. Factors in contact lens symptoms: evidence from a multistudy database. Optom Vis Sci. 2014 Feb;91:133-141.
MATERIALS & DESIGNS
David Kading, OD
Is There a Time to Stop Lens Wear?
Contact lenses are neutral—they are neither good nor evil. They are simply material pieces of plastic combined with water. However, put in the hands of the right practitioner and on the eyes of the right patient, they work magnificently. But every lens is not for every patient, and despite what we may think, not every patient is right for any lens. This is my first posting of this type, but this statement needs to be said: I believe that there may be a point in some patients’ lives where they should be removed from full-time lens wear, because their ocular surface will no longer match up with lens wear.
We all know that contact lenses alter the tear film in some ways. And in the eyes of the right patient who has a robust tear film, this is not a problem because they have ample excess. But when the tear film is already altered and the lacrimal glands damage and inflammation is so severe, or when the meibomian glands are so altered that they cannot produce oil to overcome desiccating stress, we need to seriously consider removing our patients from lens wear regardless of the level of symptoms.
So many of our dry eye patients have already altered their lens wear that this is usually not an issue. However, what if they have minimal symptoms but aggressive disease? We generally attempt to reduce the likelihood of this happening by aggressively treating the ocular surface issues when they are early on by using thermal pulsation and T-cell mediated drops.
If we do decide to alter their lens wear, we educate them on the effect that lens wear is having regarding progression of their ocular surface disease and that their eyes are no longer able to support lens wear full time. We do not eliminate lens wear all together, but rather move them into daily disposable lens wear for part time and occasional use. Ultimately, I want to make my patient happy in the long term and save their eyes. Are you willing to remove a patient from lens wear?
Factors in the Success of New Contact Lens Wearers
A study was conducted to determine the first-year retention rate for patients fitted with contact lenses (CLs) and identify factors associated with retention and dropout. This multi-site study was a retrospective chart review of the status of neophyte CL wearers fitted in representative U.K. eye care practices.
Consecutive records for 524 patients at 29 sites were reviewed. The mean age at dispensing was 34 years (range 8 to 79 years), 68% were under 45 years and 61% were female. Soft CLs were fitted to 98% of patients. After 12 months, 388 were still CL wearers, a retention rate of 74% (95% CI: 70.1-77.6). Of the 136 lapsed wearers, 25% discontinued during the first month and 47% within 60 days. The main reasons cited for discontinuation included poor distance vision (26%; of those, 37% were toric and 51% multifocal), poor near vision (16%), discomfort (14%), and handling problems (15%). In 32% of cases, the reasons for discontinuation were unknown. For 71% of dropouts, no alternative lens or management strategy had been tried. Significant factors associated with retention in univariate analysis were: age (younger), sphere power (higher), lens type (sphere versus multifocal), and purchase frequency (regular). Multivariate analysis showed lens sphere power, purchase frequency, and lens material to be significant factors. There was a wide variation in retention rates between sites (40% to 100%).
The study concluded that during the first year of CL wear, the overall retention rate for neophyte CL wearers was 74% (spherical CLs–79%, torics–73%, and multifocals–57%), with many lapsing during the first two months. Factors associated with retention and dropout in these patients include: lens power, material and type, and purchase frequency. While handling and comfort are the most commonly cited performance-related reasons for discontinuing in new spherical lens wearers, visual problems are the most common among new wearers of toric and, in particular, multifocal CLs.
Sulley A, Young G, Hunt C. Factors in the success of new contact lens wearers. Cont Lens Anterior Eye. 2017 Feb;40:15-24.