Hopefully you have been following the news and alerts from public health agencies reporting on the Coronavirus, 2019-nCoV, which was originally detected in Wuhan, China. It is a betacoronavirus, originating in bats, that genetically resembles Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The United States had its first confirmed person-to-person case on Jan. 20, 2020. The U.S. Centers for Disease Control and Prevention (CDC) released updated guidance for healthcare providers earlier this week (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html). Stay vigilant in your role of helping to prevent the spread of this dangerous virus.
Jason J. Nichols, OD, MPH, PhD
FDA Approves New CooperVision Biofinity Toric Multifocal Contact Lenses
The U.S. Food and Drug Administration (FDA) has granted CooperVision, Inc. approval for its new Biofinity toric multifocal contact lenses.
The product combines the optical designs of CooperVision’s Biofinity toric and Biofinity multifocal lenses to provide patients with both astigmatism and presbyopia vision correction, according to the company. The company plans to make the lenses available later this year to U.S. eyecare professionals, followed by other markets. In addition, lens parameters and other details regarding Biofinity toric multifocal will be made public in the coming months.
Valley Contax Introduces CS Twenty 20 Lenses
Valley Contax announced an extension to its Custom Stable line of lenses. CS Twenty 20 lenses have all of the same features of the original Custom Stable lenses including quadrant-specific adjustments and edge vault as well as spherical, toric, and multifocal options.
According to the company, the lenses offer advanced prolate options that use new technology to achieve healthy clearance over any ectasia, utilizing steeper center zones and more profiled prolate limbal curves. The lenses also offer an enhanced landing zone profile. In addition, with a new enhanced limbal curve compensation, lens weight can be transferred.
Three versions of the lens are available: CS Prime, which has a symmetrical landing zone; CS Elite, which has a bi-symmetrical toric landing zone, aligns to the sclera naturally, and is available in the traditional oblate design as well as in a prolate design for ectasias and more pronounced cones; and CS Aurora, which is a front-surface multifocal that features the same back surface as the Elite and that uses a dominant (distance-center)/nondominant (near-center) system that works in unison with the patient and accommodative demands.
BostonSight Partners with Eaglet Eye Scleral-IG
BostonSight announced a partnership with Eaglet Eye that involves the newly available Image-Guided feature from BostonSight Scleral: Scleral-IG. This partnership integrates a direct connection between Eaglet ESP and FitConnect, BostonSight’s web-based lens design and order management platform.
Three optometry students presented scientific posters at the 2020 Global Specialty Lens Symposium in Las Vegas as winners of the Optometry Student Challenge, a program designed by ABB Optical Group, in collaboration with Paragon Vision Sciences, to foster the study of contact lenses. The winners were Shuyi (Suzy) Chen, of the State University of New York (SUNY) College of Optometry, for the topic of the use of orthokeratology to treat myopia regression after small incision lenticule extraction (SMILE) surgery; Preet Dhami, from the Massachusetts College of Pharmacy and Health Sciences (MCPHS) School of Optometry, for the topic of the use of scleral notches to maximize coverage of the ocular surface in patients with exposure keratoconjunctivitis; and Elton Wong, also from SUNY College of Optometry, for the topic of selecting the best lens out of four for the treatment of epithelial basement membrane dystrophy (EBMD) plus irregular corneal astigmatism.
More than 86 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, which is hosted yearly, is open to students in their third and fourth years of study. Abstracts are judged on academic merit by a panel of industry experts.
2020 CLMA Award Winners
The Contact Lens Manufacturers Association (CLMA) bestowed the following awards on Jan. 25, 2020 at its Rising Stars Reception held at The Tropicana - Las Vegas.
Honorary Recognition Award – In appreciation for a lifetime of dedication and service to the contact lens industry. Gretchyn M. Bailey
Adam W. Farkas, MD, MBA
Industry Enhancement Award – For unselfish dedication to the CLMA and the contact lens industry. Ron Walker
Trailblazers Award – For outstanding achievement in product development to the enhancement of the contact lens industry. Jerome A. Legerton, OD, MS, MBA
The Leonardo da Vinci Award – For vision in establishing the focus of the CLMA and dedication to the achievement of its goals. C. Lee Dickerson
The Dr. Josef Dallos Award – For outstanding contribution to the development and advancement of the contact lens industry and for service to humanity. Karla Zadnik, OD, PhD
2018 GPLI Practitioner of the Year – For outstanding professional expertise in fitting customized contact lenses to benefit patients with improved vision and corneal health and to advance the contact lens field. Jeffrey J. Walline, OD, PhD
I-Med Pharma to Launch I-Drop MGD
I-Med Pharma Inc. announced that the company has plans to launch I-Drop MGD, a preservative-free artificial tear that helps relieve symptoms associated with evaporative dry eye. According to the company, the formulation includes osmoprotectants and bioprotectants that stabilize and enhance the lipid layer while reducing evaporation of the tear film.
Nicox Receives Formulation Patent Extending NCX 470 U.S. Patent Coverage to 2039
Nicox SA has received approval from the U.S. Patent and Trademark Office of a formulation patent for NCX 470, extending the U.S. patent coverage to 2039. NCX 470 is a novel second-generation nitric oxide (NO)-donating bimatoprost analog for the lowering of intraocular pressure in patients who have open-angle glaucoma or ocular hypertension. NCX 470 is covered by a composition of matter patent until 2029, which is potentially eligible for up to a five-year patent term extension based on the period of regulatory review.
Aerie Pharmaceuticals Appoints Michelle Senchyna, PhD, as Vice President, Clinical Development and Medical Affairs
Aerie Pharmaceuticals, Inc. appointed Michelle Senchyna, PhD, as vice president, Clinical Development and Medical Affairs, reporting to David A. Hollander, MD, MBA, Aerie’s Chief Research & Development Officer. Dr. Senchyna will lead and direct the clinical development and medical affairs strategy for the company. She most recently served as executive director of Ophthalmology at Allergan, where she oversaw the clinical development of pharmaceutical, consumer, and device products for anterior and posterior segment diseases. Prior to joining Allergan, she held leadership positions in R&D and Medical Affairs at Alcon and Panoptica. She began her career as an associate professor at the University of Waterloo, School of Optometry, with research focused on ocular surface diseases and contact lens biomaterial development.
Priscilla Sotomayor, OD, Weston, FL
These are before and after pictures of a young patient who developed a large, dense central scar in a neurotrophic cornea from persistent epithelial defects as a result of presumed herpes simplex virus (HSV) keratitis. The patient’s cornea was rehabilitated with the help of a deep anterior lamellar keratoplasty (DALK) and a scleral lens.
We thank Dr. Sotomayor 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.
S. Barry Eiden, OD
The Impact of Higher-Order Aberrations in Keratoconus
Most eyecare practitioners (ECPs) are aware that distortions of vision induced by the corneal irregularities in keratoconus can have a dramatic effect on patients’ visual performance and quality of life. Typically, we measure visual acuity as an indicator of visual performance; however, due to the presence of elevated higher-order aberrations, vision is negatively impacted in ways that simply can’t be determined by a visual acuity finding.
A recent paper was published that explored retinal image quality (IQ) of keratoconic eyes with the use of computational analysis.1 This computational study determined changes in IQ (peak IQ, best focus, and depth of focus [DOF]) of 12 subjects who had manifest keratoconus in both eyes (KCE cohort), nine subjects who had very asymmetric ectasia (VAE cohort) with and without their GP contact lenses (RGP CLs), and 20 age-matched controls, using a higher-order aberration (HOA)-based through-focus analysis performed over a 5mm pupil diameter following cycloplegia.
Results indicated that all IQ parameters were significantly worse in the KCE cohort with their native HOAs, relative to controls, and in the ectatic eye of the VAE cohort, relative to the fellow non-ectatic eye (p ≤ 0.008 for all). Reduction in HOAs of these eyes that had RGP CLs resulted in a significant improvement in all IQ parameters, but they all remained significantly poorer compared to controls (p ≤ 0.02 for all). The unaided higher-order root mean square (HORMS, a quantification of total HOAs) of eyes that have keratoconic ectasia was approximately five-fold larger than that of controls, and this difference reduced to about two-fold with RGP CLs.
The authors stated that these results provide the optical basis for two clinical observations on keratoconus: 1) optical performance of keratoconic eyes is significantly better with RGP CLs compared to with spectacles or unaided conditions; and 2) the endpoint of subjective refraction is elusive in keratoconic eyes, relative to healthy controls or to the non-ectatic eye in bilaterally asymmetric ectasia. They also stated that further reductions in an eye’s HOAs, for instance, with custom-designed wavefront-optimized CLs, may improve the peak IQ of these ectatic eyes even further than what is reported in this study.
Realizing that patients who have keratoconus suffer from significantly greater degrees of HOAs when compared to normal eyes is of no surprise to us. The fact that correcting vision with rigid CLs only partially reduces residual HOAs should make us think a bit deeper.
From where are these residual HOAs emanating? The first source that should come to mind is the influence of the posterior cornea. Due to the much lower difference in index of refraction from the posterior cornea to the aqueous compared to that of air to anterior cornea, the influence of posterior corneal irregularity impacts total HOAs to a significantly lesser degree. However, once the anterior corneal irregularity has been “masked” by the rigid CL, the influence of posterior corneal-induced HOAs becomes more apparent. Taking things to the next level, as noted in the above referenced paper, Sabesan and Yoon reported that the monocular logMAR acuities of keratoconic eyes remained poorer than in controls even after full correction of the eye’s wavefront aberrations using an adaptive optics system.2 These results imply that those who have keratoconus may experience a neural loss in visual performance following prolonged exposure to poor retinal image quality, thereby restricting the full visual benefit of the optical correction.
Since adding aberrometry to our clinical approach at our practice, we have become so much more aware of the complexity of the eye’s optical system. This paper surely confirms what we are seeing each and every day at our practice as we evaluate visual performance of our keratoconus patients.
1. Nilagiri VK, Metlapally S, Schor CM, Bharadwaj SR. A computational analysis of retinal image quality in eyes with keratoconus. Sci Rep. 2020 Jan 28;10:1321.
2. Sabesan R, Yoon G. Visual performance after correcting higher order aberrations in keratoconic eyes. J Vis. 2009 May 13;9:6.1-6.10.
OCULAR SURFACE UPDATE
Katherine Mastrota, MS, OD
Got Dry Eye? Exercise!
A very small January 2020 study (n = 12) suggests that an acute bout of exercise may attenuate symptoms of environmentally induced dry eye.1 In this study, 12 participants who did not have dry eye disease completed three experimental visits: 1) control condition seated for one hour at a relative humidity (RH) of 40% (CONT); 2) dry condition seated for one hour at a RH of 20% (DRY); and 3) exercise condition seated for 40 minutes followed by 20 minutes of cycling exercise at a RH of 20% (EXER). Tear volume, tear matrix metalloproteinase-9 (MMP‐9), perception of dry eye symptoms (frequency and severity), core temperature, and ocular surface temperature (OST) were measured at the end of each exposure.
There was no difference in tear volume among the trials. Despite this finding, the DRY condition elicited a greater perception of dry eye symptom frequency, and there was an actual increase of MMP‐9 in tears. Although perception of dry eye frequency and MMP‐9 concentration were significantly higher in DRY compared to CONT, there were no differences in EXER compared to CONT, suggesting that exercise blunted the dry eye symptoms in this dry eye group.
Could a quick trip to the gym at lunchtime or before dinner temper the effects of a dry-eye-provoking day? We certainly can’t argue with the overall health benefits and blood sugar control impact of physical activity. Perhaps practitioners should “prescribe” some spin classes for their dry eye patients?
1. Peart DJ, Walshe IH, Sweeney EL, et al. The effect of acute exercise on environmentally induced symptoms of dry eye. Physiol Rep. 2020 Jan;8(2):e14262.
Evaluation of Meibomian Glands in Obstructive Sleep Apnea-Hypopnea Syndrome
The purpose of this study was to evaluate the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on the meibomian glands, ocular surface, and tear parameters.
The study included 59 individuals (32 subjects who had OSAHS, 27 control subjects) who underwent polysomnography in the Chest Diseases Clinic. The right eyes of all individuals were evaluated in the Ophthalmology Clinic. The first noninvasive tear breakup time (f-NTBUT) and the average noninvasive tear breakup time were measured, and a Schirmer test was applied. Meibography was taken, and a meiboscore was used for indexing the meibography. Finally, a sample was taken for conjunctival impression cytology.
In the study and control groups, the median of f-NTBUT was 2.1 seconds [interquartile range (IQR); 1.5 to 5.0 seconds] and 5.7 seconds (IQR; 2.9 to 8.8 seconds), and the median of average noninvasive tear breakup time was 5.6 seconds (IQR; 3.6 to 9.5) and 7.2 seconds (IQR; 4.2 to 10.7), respectively (P = 0.007 and P = 0.487, respectively). The mean Schirmer value was 16.3mm ± 5.9mm (range; 5mm to 25mm) and 17.3mm ± 6.6mm (range; 5mm to 30mm) in the study and control groups (P = 0.60). In upper eyelid meibography, the median of loss in the meibomian glands was 20.10% (IQR; 11.60% to 40.80%) in the study group and 14.70% (IQR; 10.40% to 21.30%) in the control group (P = 0.043). In lower eyelid meibography, the median of loss in the meibomian glands was 19.00% (IQR; 13.60% to 35.30%) in the study group and 12.40% (IQR; 9.10% to 16.40%) in the control group (P = 0.002). The median of the Nelson grade in conjunctival impression cytology was 1 (IQR; 0 to 1) in the study group and 1 (IQR; 0 to 1) in the control group (P = 0.45).
The researchers determined that the loss in the meibomian glands together with the shortened f-NTBUT shows that there could be a predisposition in OSAHS for evaporative dry eye originating from meibomian gland damage.
Muhafiz E, Ölçen M, Erten R, Bozkurt E. Evaluation of Meibomian Glands in Obstructive Sleep Apnea-Hypopnea Syndrome. Cornea. 2020 Jan 14. [Epub ahead of print]