The Global Specialty Lens Symposium is less than two weeks away, and it will be the most exciting and topical meeting yet! This year’s program has been updated to include two cutting-edge workshops: one is on scleral lens fitting, and the other is on dry eye management and treatment. These sessions will kick-off the conference activities in the evening on Wednesday, Jan. 22. Then, on Thursday, Jan. 23 at 1 p.m., we commence the meeting with “Clinical Controversies in Myopia Management,” during which six experts will debate the pros and cons of the hottest topics in myopia management. We are looking forward to these events and everything else that GSLS 2020 has to offer. See you in Las Vegas soon!
Jason J. Nichols, OD, MPH, PhD
B+L Launches Expanded Parameters for Biotrue Oneday for Astigmatism Lenses
Bausch + Lomb (B+L) announced the U.S. launch of expanded parameters for Biotrue Oneday for Astigmatism daily disposable contact lenses. The expanded parameters include 30 new axes. The lenses are now available in plano to –6.00D (in 0.25D steps) with cylinder powers of –0.75D, –1.25D, and –1.75D in axes of 10° to 180° (in 10° steps) and of –2.25D in axes of 10°, 20°, 70° to 110°, and 160° to 180° (in 10° steps); –6.50D to –9.00D (in 0.50D steps) with cylinder powers of –0.75D, –1.25D, and –1.75D in axes of 10°, 20°, 60° to 120°, and 160° to 180° (in 10° steps) and of –2.25D in axes of 10°, 20°, 90°, and 160° to 180° (in 10° steps); and +0.25D to +4.00D (in 0.25 steps) with cylinder powers of –0.75D, –1.25D, and –1.75D in axes of 10°, 20°, 70° to 110°, and 160° to 180° (in 10° steps) and of –2.25D with axes of 10°, 20°, 80° to 100°, and 160° to 180° (in 10° steps).
Art Optical Introduces No-Worry Warranty Program
Art Optical introduced a new comprehensive and simplified specialty lens warranty program for 2020 and beyond. Highlights of the No-Worry Warranty program include a longer fitting period of 120 days, unlimited exchanges for parameter and prescription adjustments, full cancellation privileges, an online credit request process, the elimination of all material recovery fees, and no lens returns required on fit and Rx changes. The warranty is offered on the complete product portfolio of lens designs manufactured by Art Optical.
CPT Codes for Home OCT Established
Notal Vision, Inc., a privately held ophthalmic diagnostic services company, announced that the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel has established three new Category III codes (0604T, 0605T, 0606T) to report patient-initiated remote retinal optical coherence tomography (OCT) scans, which are performed using Notal Vision’s home-based OCT pipeline technology.
The new CPT codes allow for billing for the initial device provision, setup, and patient education on use of the home OCT; they also supply a means for the company’s Notal Vision Diagnostic Clinic to provide technical support, data analyses, and reports to physicians and patients. Prescribing physicians or other qualified healthcare professionals will be able to bill for reviewing, interpreting, and reporting data analyses every 30 days. The full list of the new CPT codes and their descriptors have been published on the AMA CPT Website: https://www.ama-assn.org/practice-management/cpt/category-iii-codes. Notal Vision’s home-based OCT pipeline technology received U.S. Food & Drug Administration (FDA) Breakthrough Device designation at the end of 2018.
Optical Women’s Association Announces 2020 Award Honorees
The Optical Women’s Association (OWA) has announced its 2020 OWA Award Honorees. Millicent Knight, OD, senior vice president, customer development group at Essilor of America, will receive the OWA Pleiades award to recognize her role in advancing the leadership role of women in the optical industry. Jean Sabre, owner of Uptown Vision, will receive the Pyxis award to honor her as an OWA member who actively participates in the organization and contributes to its continuing growth. Sheena Taff, optician and optical writer, will receive the newly created 2020 Visionary Award, which recognizes her as an OWA member who demonstrates progressive thinking and actively cultivates the professional development of women. The 2020 award winners will be honored at International Vision Expo East during the OWA’s Annual Champagne Breakfast on March 26 in New York City.
Lunch & Learn at GSLS
New this year! Sign up for one of our sponsored Lunch & Learn talks being held on Thursday Jan. 23 from 12 p.m. to 1 p.m. Enjoy a boxed lunch while you listen to these exciting presentations! Registration required. Already coming to GSLS? Existing registrants should refer to their confirmation email to log back into the system to sign up for the Lunch & Learn session that they wish to attend. Not registered for GSLS yet? You can sign up for the Lunch & Learn as part of the registration process.
Kyriakos Telamitsi, Limassol, Cyprus
This image shows an Intacs intracorneal ring segment that is broken. I realized that this was the case during this patient’s scleral lens fitting.
We thank Kyriakos Telamitsi 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
Where We May Be Heading
Now that corneal cross-linking (CXL) utilizing an epithelium-off technique is approved by the U.S. Food & Drug Administration (FDA), we can say that CXL for progressive keratoconus has become a standard of care worldwide. Practitioners are now moving forward technologically in CXL to evaluate epithelium-on, accelerated, and focal application methods (all yet to be FDA approved). For the most part, CXL is now being used with high degrees of success to control the progressive nature of keratoconus. Future applications will be targeted toward not only progression control, but also toward some degree of vision improvement for cases in which patients have already suffered some degree of disease-induced visual compromise.
A recent study was published that evaluated the safety and efficacy of topography-guided customized excimer laser subepithelial ablation combined with accelerated collagen cross-linking technique in the treatment of early keratoconus.1 Nineteen patients (20 eyes: 13 males/14 eyes and six females/six eyes), aged 12 to 44 years (24.7 ± 8.0 years), were diagnosed with keratoconus by three-dimensional corneal topography and tomography, clinical history, and examinations and were classified as KC1 to KC3. Based on the classical excimer laser epithelial keratomileusis (LASEK) method, topography-guided laser ablation was performed with an excimer laser system (WaveLight EX500, Alcon). After laser ablation, the corneal stromal bed was immersed with 0.1% riboflavin for 10 minutes and then was irradiated by ultraviolet light (KXL, Avedro) at 30 mW/cm2 for four minutes. All the patients were followed up for more than 12 months. The uncorrected visual acuity (UCVA), diopter, best-corrected visual acuity (BCVA), corneal topography, central corneal endothelial cell density (ECD), hexagonal cell percentage (HEX), coefficient of variation (CV), and other indicators were observed.
Analysis of the results indicated that there was no loss of BCVA at 12 months postoperatively; 20% of the eyes had no change of BCVA, 15% of the eyes gained one line of BCVA, 15% of the eyes gained 2 lines of BCVA, and 50% of the eyes gained three lines and more of BCVA. There was no significant difference in UCVA, BCVA, manifest refractive spherical equivalent (MRSE), and the cylinder at three months postoperatively (P > 0.05). The BCVA was significantly improved at six and 12 months postoperatively compared with those before operation (t = 3.10, 3.08, P < 0.05). Although there was no significant difference in UCVA and MRSE, the cylinder was significantly reduced at six and 12 months postoperatively (t = –2.89, –2.44, P < 0.05). Apex curvature (Kapex) and mean pupil power (MPP) within 4.5mm of the central cornea decreased significantly (Z = –2.90, P < 0.01; Z = –2.67, P < 0.01). Even though the thinnest corneal thickness decreased from pre-operational (461.9μm ± 31.1μm) to post-operational (416.6μm ± 27.0μm) (Z = –3.06, P < 0.01), the cornea became regular, with keratometric asymmetry index of the anterior corneal surface decreased (Z = –2.67, P < 0.01). The corneal optical quality parameters were improved. There was no significant difference in ECD, HEX, and CV at 12 months postoperatively (P > 0.05). Twelve months after the procedure, grade 0, 0.5, 1, and 2 haze was seen on 20%, 55%, 20%, and 5% of corneas, respectively.
The researchers concluded that the topography-guided excimer laser ablation combined with accelerated CXL is safe and effective in treatment of early stage keratoconus. It can significantly improve corneal regularity while preventing keratoconus progression, improving the BCVA postoperatively.
Management of keratoconus is developing at amazing rates. Practitioners now have the ability to halt progression in a high percentage of cases, and as such, early diagnosis is imperative, hopefully prior to any significant impact on vision. However, new technologies are being developed that can both control progression and positively impact visual function. Hold tight, we are on quite a ride in this arena! Let’s watch for what happens in 2020. Happy New Year to all of our readers.
1. Wang LC, Chen YG, Zhang Y, Yang HY, Zhao R, Xia YJ. [Clinical study on topography-guided laser ablation combined with accelerated corneal collagen cross-linking for early keratoconus]. Zhonghua Yan Ke Za Zhi. 2019 Dec 11;55:904-910.
OCULAR SURFACE UPDATE
Katherine Mastrota, MS, OD
The Role of Vitamin D in Dry Eye Disease
A past installment of Contact Lenses Today explored the role of vitamin D in the efficacy of topical artificial tears in patients who have dry eye disease (DED) (https://www.clspectrum.com/newsletters/contact-lenses-today/january-20,-2019). Data suggested that the efficacy of topical carbomer-based lipid-containing artificial tears and hyaluronate in patients who have DED was dependent on serum 25-hydroxyvitamin D. It was concluded that cholecalciferol (a type of vitamin D) supplementation enhanced the efficacy of topical treatment and may be a useful adjuvant therapy for patients who have DED refractory to topical lubricants.1
Adding evidence to the role of vitamin D in DED is a December 2019 study that analyzed the relationship between serum vitamin D levels and dry eye parameters in primary Sjögren’s syndrome (SS).2 This study included 74 patients diagnosed with primary SS. Dry eye parameters included tear breakup time, Schirmer I value, corneal staining score, conjunctival staining score, and Ocular Surface Disease Index (OSDI) score. The serum concentration of 25(OH)D3 was evaluated.
The mean serum 25(OH)D3 level was 20.4ng/mL ± 8.0ng/mL; 20ng/mL to 50ng/mL is considered adequate for healthy individuals, and a level less than 12ng/mL indicates vitamin D deficiency. In the aforementioned study, there were strong negative correlations between serum 25(OH)D3 level and corneal and conjunctival staining scores. The Schirmer I value and tear breakup time showed significant positive correlations with the serum 25(OH)D3 level. The OSDI did not show any significant correlation with the serum 25(OH)D3 level. This study demonstrates that serum 25(OH)D3 level might be associated with dry eye severity in primary SS.
This information again begs the following questions: Should vitamin D serum testing be part of our DED workup? And, is vitamin D supplementation prophylactic for DED? Hopefully, with more data, practitioners can answer these questions and have yet another avenue of therapy for their ocular surface disease patients.
1. Hwang JS, Lee YP, Shin YJ. Vitamin D Enhances the Efficacy of Topical Artificial Tears in Patients With Dry Eye Disease. Cornea. 2019 Mar;38:304-310.
2. Lee JH, Kim SJ, Byun YS, Lee J, Park SH, Chung SH. The Association of Serum Vitamin D Level With the Severity of Dry Eye Parameters in Primary Sjögren Syndrome. Cornea. 2019 Dec 20. [Epub ahead of print]
Biological Mechanisms of Atropine Control of Myopia
Myopia is a global problem that is increasing at an epidemic rate in the world. Although the refractive error can be corrected easily, myopes, particularly those who have high myopia, are susceptible to potentially blinding eye diseases later in life. Despite a plethora of myopia research, the molecular/cellular mechanisms underlying the development of myopia are not well understood, preventing the search for the most effective pharmacological control. Consequently, several approaches to slowing down myopia progression in the actively growing eyes of children have been underway. So far, atropine, an anticholinergic-blocking agent, has been most effective and is used by clinicians in off-label ways for myopia control. Although the exact mechanisms of its action remain elusive and debatable, atropine encompasses a complex interplay with receptors on different ocular tissues at multiple levels and, hence, can be categorized as a shotgun approach to myopia treatment. This review will provide a brief overview of the biological mechanisms implicated in mediating the effects of atropine in myopia control.
Upadhyay A, Beuerman RW. Biological Mechanisms of Atropine Control of Myopia. Eye Contact Lens. 2020 Jan 2. [Epub ahead of print]