Happy New Years! I never thought I would incorporate "that’s a wrap" and we're "off to the races" in the same sentence, but this time of year warrants it. It's a great time to reflect on our past, while thinking ahead to the days and years to come. We should all strive to do even better in 2017—both personally and professionally. There are many ways you can challenge yourselves and your practices. Try new lens designs. Incorporate new knowledge into your practice routines. Or, build specialties into your practice’s portfolio (e.g., a dry eye clinic).
For Contact Lenses Today, the New Year also brings some changes to our staff. After 10 years, Kathy Shafer is stepping down as managing editor of CLT and passing the editorial management torch to Deborah Fisher, associate editor of Contact Lens Spectrum. We want to thank Kathy for everything that she has done during her tenure, and look forward to another exciting 10 years working with Debby!
Whatever your focus may be in the New Year, we wish you our best wishes for a prosperous 2017!
Jason J. Nichols, OD, MPH, PhD
Alcon Ends Its UPP
Alcon recently received a ruling from the court in its attempt to block the enforcement of Utah’s Contact Lens Consumer Protection Act. The act prohibits various types of commercial practices by contact lens manufacturers, including minimum advertised pricing (MAP) and unilateral pricing policies (UPP) on contact lenses.
Alcon was the first company to file a lawsuit in the U.S. District Court for the District of Utah challenging the law and seeking a preliminary injunction against its enforcement. When the district court denied Alcon’s motion for preliminary injunction, permitting the law to take effect, Alcon appealed to the Tenth Circuit.
However, after the most recent judgment, Alcon believes that continuing its challenge to the Utah law will distract from efforts to serve customers to the best of its ability. Accordingly, Alcon is ending its UPP, effective immediately, to avoid maintaining the competitive imbalance the Utah law introduces between Utah contact lens retailers and customers in other states.
SynergEyes Partners with Tangible Science
SynergEyes, Inc. announced its licensing agreement with Tangible Science LLC. The alliance enables SynergEyes to offer Tangible Hydra-PEG, a polymer coating, to practices and patients.
SynergEyes received FDA clearance for Tangible Hydra-PEG in August 2016, and the lubricious coating is now available on Duette and Duette Progressive lenses. Both are currently available in the United States, and will be available internationally in 2017.
GSLS 2017 Around the Corner
The 2017 Global Specialty Lens Symposium (GSLS) will be held January 26-29, 2017 at the Rio Hotel in Las Vegas. The GSLS is a must-attend meeting, brought to you by Contact Lens Spectrum, focusing on the successful management of ocular conditions using today’s specialty contact lenses. The meeting includes insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.
The Registration Desk will open Wednesday, January 25 from 3:00 p.m. - 6:00 p.m., and will reopen on Thursday, January 26 at 7:30 a.m.
The International Association of Contact Lens Educators (IACLE) is offering educators around the world the chance to become IACLE Contact Lens Educator of the Year and travel to the British Contact Lens Association’s (BCLA) 40th Clinical Conference and Exhibition anniversary event in Liverpool, United Kingdom, which is being held from June 9-11, 2017. The awards are sponsored by CooperVision and supported by the BCLA. The winners will each receive a bursary of up to $3,000 toward the cost of attending the BCLA’s conference.
Additionally, the IACLE Travel Award, offered for the first time in 2013, is a travel bursary for an IACLE Educator Member starting out on his/her career who would not otherwise be able to attend a major international conference. The IACLE Travel Award is sponsored by IACLE and supported by the BCLA. The winner will receive a bursary of up to $3,000 toward the cost of attending BCLA 2017, where the award will be presented.
The deadline for entries for the 2017 awards is January 31. Entries should be submitted by email to IACLE Director of Operations Bonnie Boshart at firstname.lastname@example.org using the application forms to be found at www.iacle.org.
Novartis to Buy Encore Vision
Novartis has entered into a definitive agreement for the acquisition of Encore Vision, Inc., a privately held company in Fort Worth, TX that is focused on the development of a novel treatment in presbyopia. This acquisition would add a first-in-class disease modifying topical treatment for presbyopia to the Novartis ophthalmology pipeline, providing a potentially disruptive innovation to patients in a new therapeutic area of high unmet need and high prevalence, according to the company. The transaction is subject to customary closing conditions, including regulatory approval. The financial details of this transaction are not disclosed.
Encore Vision’s lead investigational product, EV06, is a topical treatment for presbyopia. In a phase I/II masked, placebo-controlled proof of concept study, 50 patients were treated daily for 90 days with topical EV06 and 25 patients with placebo. EV06 showed a statistical significant difference to placebo in distant corrected near vision at all time points measured (from day 8); at day 90, 82% of participants treated with EV06 had 20/40 near vision (or 0.30 LogMAR) versus 48% in the placebo group.
S. Barry Eiden, OD
Further Evidence of Myopia Progression Management with the Use of Soft Multifocal Contact Lenses…We Need to Take a Comprehensive Evidence-Based Approach
The awareness of both the increasing incidence rates and eye health implications of myopia is taking hold within the eye care community. Both optometry and ophthalmology are acknowledging the importance of attention to this “disease.” Ongoing research has lent credibility to a number of management approaches to potentially control both the onset and progression of myopia.
A recent study was published that looked to evaluate the effect of soft contact lenses with concentric ring bifocal and peripheral add multifocal designs on controlling myopia progression in school-aged children.1 A meta-analysis of research studies was conducted that searched MEDLINE, EMBASE, Cochrane Library, and reference lists of included trials. The authors identified five randomized controlled trials (RCTs) and three cohort studies with a total of 587 myopic children.
Compared with the control group, concentric ring bifocal soft contact lenses showed less myopia progression with a weighted mean difference (WMD) of 0.31D (95% CI, 0.05~0.57D, p = 0.02) and less axial elongation with a WMD of -0.12mm (95% CI, approximately -0.18mm to -0.07mm, p < 0.0001) at 12 months. Relative to the control group, peripheral add multifocal soft contact lenses showed less myopia progression with a WMD of 0.22D (95% CI 0.14~0.31D, p < 0.0001) and less axial elongation of -0.10mm (95% CI -0.13~0.07mm, p < 0.0001) at 12 months, respectively. The soft contact lenses with concentric ring bifocal and peripheral add multifocal designs produced additional myopia control rates of 30~38% for slowing myopia progression and 31~51% for lessening axial elongation within 24 months. The authors concluded that both concentric ring bifocal and peripheral add multifocal soft contact lenses are clinically effective for controlling myopia in school-aged children, with an overall myopia control rates of 30~50% over two years.
Today, we have three evidence-based methods to effectively control myopia progression in young people: atropine therapy, corneal reshaping/orthokeratology, and the use of daytime wear multifocal contact lenses (both center distance/peripheral near add and concentric ring designs). Each modality has clinical advantages and disadvantages that can be tailored to each individual case. Further research and development will hopefully provide additions to the myopia management armamentarium.
As clinicians who see patients who are at risk for myopia progression, we should act proactively and incorporate a comprehensive myopia management strategy in our practices. Or, we should at least identify these patients and refer them to practices that provide such important services. It is important to note, however, that some of these are still off-label uses. There is surely sufficient evidence out there now, we need to take the proverbial bull by the horns and act accordingly.
1. Li SM, Kang MT, Wu SS, Meng B, Sun YY, Wei SF, Liu L, Peng X, Chen Z,5, Zhang F, Wang N. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis. Ophthalmic Physiol Opt. 2016 Nov 23 [Epub ahead of print].
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
New Thoughts on an Well-Covered Topic
Published this month in Clinical Ophthalmology is a new theory unifying dry eye disease and blepharitis.1
In this treatise, the authors propose a new way of looking at dry eye, both evaporative and tear insufficiency, as the natural sequelae of decades of chronic blepharitis. The authors offer that dry eye is simply the late manifestation of blepharitis. They also suggest the use of a new term in describing this: Dry Eye Blepharitis Syndrome (DEBS).
The hypothesis is that bacteria colonize the lid margin within biofilm. The biofilm allows for bacterial population densities that initiate quorum-sensing gene activation. These newly activated gene products consist of inflammatory virulence factors—such as exotoxins, cytolytic toxins, and super-antigens—which are then present for the rest of the patient’s life. The biofilm never goes away; it only thickens with age, producing increasing quantities of bacterial virulence factors, and thus, increasing inflammation. It is put forth that these virulence factors are likely the culprits that first cause follicular inflammation, then meibomian gland dysfunction, aqueous insufficiency, and finally, after many decades, lid destruction.
The authors suggest that there are four stages of DEBS that correlate with the clinical manifestations of folliculitis, meibomitis, lacrimalitis, and finally lid structure damage evidenced by entropion, ectropion, and floppy eyelid syndrome. The stages depend purely on anatomy and years of biofilm presence.
The authors recommend that dry eye should be treated and prevented by early and routine biofilm removal through electromechanical lid margin debridement.
1. Rynerson JM, Perry HD. DEBS - a unification theory for dry eye and blepharitis. Clin Ophthalmol. 2016 Dec 9;10:2455-2467.
Ocular Straylight with Different Multifocal Contact Lenses
Multifocal contact lenses have been growing in popularity as a modality to correct presbyopic eyes, although visual side effects such as disability glare have been reported. One prospective randomized, comparative study was performed to investigate the effect of multifocal contact lenses on disability glare by means of ocular straylight.
The study included 16 subjects free of ocular pathology. Straylight was measured using a commercial straylight meter with the natural and dilated pupil. Participants were fitted with CooperVision’s Proclear Multifocal (Distance/Near), Acuvue Oasys for Presbyopia, and Alcon’s Air Optix Aqua Multifocal randomized to the left or right eye. Straylight measurements were repeated with the contact lens in situ after the pupil dilation. Results obtained with the dilated pupil without contact lens acted as a control.
The authors found that a difference in measured straylight was found between the studied multifocal lenses. Results showed that the diameter of the natural and dilated pupil was 2.87mm ± 0.40mm and 7.45mm ± 0.86mm, respectively (P < .001). After pupil dilation, straylight increased from 0.92 ± 0.13 log(s) to 1.04 ± 0.11 log(s) (P < .001). Of the four studied lenses, a significant difference was only found between Air Optix and the control group (P = .006). The latter showed also slightly increased light scatter.
After reviewing the results, the authors concluded that observed variability and the straylight-pupil size dependency should be taken into account to avoid elevated straylight in multifocal contact lens wearers. The reason for the observed differences in straylight must be the subject of future studies.
Łabuz G1, López-Gil N, van den Berg TJ, Vargas-Martín F. Ocular Straylight with Different Multifocal Contact Lenses. Optom Vis Sci. 2016 Dec 22. [Epub ahead of print]