The Global Specialty Lens Symposium is just a few days away, and we already have more than 850 attendees—our largest meeting yet! The program committee has an exciting program planned with something for everyone interested in contact lenses. We look forward to welcoming you to the meeting in Las Vegas this year. You can check out all of the education offerings at https://www.eiseverywhere.com/ehome/gsls19/agenda.
Jason J. Nichols, OD, MPH, PhD
Takeda Completes Acquisition of Shire plc
Takeda Pharmaceutical Company Limited announced the completion of its acquisition of Shire plc. The acquisition was originally announced in May 2018.
The combined annual revenue of the company exceeds $30 billion. Takeda’s R&D efforts are focused on its four therapeutic areas of oncology, gastroenterology, neuroscience, and rare diseases, with targeted R&D investment also committed to plasma-derived therapies and vaccines.
To fund the acquisition, Takeda has secured permanent financing with highly competitive rates, resulting in an overall blended interest rate for Takeda's total debt of approximately 2.3%.
Bausch + Lomb announced several new leadership changes across its Specialty Vision Products business unit.
Patrick Marsalek, senior director, Specialty Vision Products, has more than 25 years of experience working in the contact lens industry. In this new role, Mr. Marsalek will be responsible for driving acceleration and growth across the Bausch + Lomb Specialty Vision Products division. Keith Donley, senior director, Marketing, Daily Disposables and Specialty Vision Products, will expand his marketing role to include the company’s Specialty Vision Products business. Andrew White, senior manager, Global Labs, Specialty Vision Products, will be solely focused on the company’s global Boston materials business. In addition, Andy Moncrief, Patricia Torres, and Jeff Vincent will be specialty market managers, Specialty Vision Products. In this role, Mr. Moncrief, Ms. Torres, and Mr. Vincent will be responsible for supporting and driving growth of the Zenlens scleral lens brand as well as custom soft contact lenses and solutions that the company offers.
Contamac Launches New 200Dk GP Lens Material
Contamac has expanded its range of Optimum contact lens materials with the launch of Optimum Infinite, a GP material that the company says has the highest combination of oxygen permeability and flexural modulus on the market. According to Contamac, independent tests, conducted by Joe Benjamin, OD, MS, PhD, of Material Performance Assessments LLC, showed Optimum Infinite as having an oxygen permeability value of 200.4Dk; internal tests determined a high flexural modulus of 1341Mpa.
According to the company, Optimum Infinite is stable, wettable, and scratch-resistant and is ideally suited for scleral lenses, while also matching the requirements of corneal and ortho-k lens designs. Optimum Infinite includes an ultraviolet (UV) blocker, is compatible with Tangible Hydra-PEG (Tangible Science), and is available in customizable larger-diameter sizes.
Optimum Infinite has received 510(k) clearance from the U.S. Food and Drug Administration for a full range of indications, including myopia, hyperopia, astigmatism, and aphakia.
Euro-Asian Scleral Lens Academy Founded
In response to an increase in scleral lens interest and usage worldwide, the Euro-Asian Scleral Lens Academy (EASLA) was formed. According to the EASLA, it plans to be a meeting point in Europe and Asia, where there is a lack of education dedicated to scleral lenses.
The founders of EASLA are Russian Academy of Medical Optics and Optometry (RAMOO) from Russia, Carmen Abesamis-Dichoso, OD, from the Philippines, and Daddi Fadel, DipOptom, from Italy. Officers are Ms. Fadel, president; Elena Belousova, PhD, vice president; and Dr. Abesamis-Dichoso, secretary and treasurer.
Advanced Tear Diagnostics has announced the appointment of Jeffrey Anshel, OD, to its advisory board. Dr. Anshel is the founder and past-president of the Ocular Nutrition Society and will work with the company on the release of its new tear diagnostic system.
Natural Ophthalmics, Inc. Appoints New President
Following the sudden and unfortunate death of Brian Banks, founder and president, Natural Ophthalmics, Inc. has appointed Linda Axelrod as its new president. She has been with the company for 15 years and has become a familiar face at conferences and symposia across the country. Ms. Axelrod will concentrate on practitioner and patient education and new product development.
If you practice myopia control using atropine, what percentage do you use?
The image shows a left eye that had undergone radial keratotomy. The patient was wearing his scleral lens with microvault on the temporal side; this big bubble was present for a whole day. Note: This bubble is due to application, and the patient wasn’t aware of it.
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
Should We Think More About Customization for Multifocal CLs?
More and more eyecare professionals (ECPs) are prescribing multifocal contact lenses (CLs) than ever before. We have known for years that the demographics supported the need for effective multifocal CLs. The limitations were based on effectiveness of multifocal CL design performance and the need for changing attitudes of ECPs to choose multifocal CLs as the first contact lens option for management of presbyopia. Today, with more design options and improved performance, many ECPs are reaching for multifocals as option #1. That being said, performance limitations still pose a challenge.
A recent study looked to determine whether eyes that have spherical aberration (SA) that deviates significantly from the average level underperform when fit with a simultaneous-imaging CL that has a power profile calculated for an "average eye."1 Second, it also looked to determine whether CL customization can improve image quality in these eyes after fitting them with a multifocal CL.
Four bifocal power profiles were modeled: center-near (CN) or center-distance (CD) and two-zone or four-zone. All designs had 0.1mm-wide transition zones. Different levels of distance and add powers were modeled, using well-established computational wave-optics methods. Zone widths were optimized to obtain maximal multifocal efficiency (MFE).
Results indicated that when the four power profiles were assessed in eyes that have non-average levels of ocular SA, the MFE decreased with higher levels of SA (eye and CL combined) for all designs. Some of this reduction in MFE could be prevented by adjusting the nominal distance and add power of the bifocal profiles to compensate for the increased or decreased level of combined SA. The authors concluded that eyes that had SA levels differing significantly from the average level underperform when fitted with simultaneous-imaging CLs with power profiles calculated for average eyes. The findings suggest that visual performance at distance and near when wearing bifocal CLs can be improved by using a semi-customized approach.
What this study says to me is that we need to screen for individual factors that might suggest that standard multifocal CLs would not function optimally for a patient. In these cases, utilizing customizable multifocal designs potentially could be the difference between success and failure. Thankfully, we have access to numerous multifocal lens designs that are customizable (soft, corneal GP, and scleral GP). Modifying powers, zone sizes, and eccentricity values, and even decentration of optics, are just a few modifiable parameters. This may be an activity that only a minority of practitioners might undertake, but their patients surely will appreciate their efforts!
1. Faria-Ribeiro M, González-Méijome JM. Multifocal contact lenses: towards customisation? Ophthalmic Physiol Opt. 2019 Jan;39:37-45.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Dry Eye? Drink Milk.
In my practice, my patients’ full medical and drug therapy is readily available. In reviewing them, I noticed that many patients (including myself) have been prescribed oral vitamin D supplements (cholecalciferol) to boost their serum levels of Vitamin D.
A December 2018 study in Cornea investigated the efficacy of topical carbomer-based lipid-containing artificial tears (CLAT) and hyaluronate (HU) in patients who have dry eye disease (DED) based on serum 25-hydroxyvitamin D (25HD) levels and cholecalciferol supplementation.1 The study was comprised of 116 patients who had DED. The participants were divided into the vitamin D deficiency (VDD) and the non-VDD groups according to their serum 25HD levels. Ocular Surface Disease Index (OSDI) score, visual analog pain scale score, lid hyperemia, tear breakup time (TBUT), corneal fluorescein staining score, and Schirmer test were compared between baseline and two weeks post-treatment after topical applications of artificial tears and between before and after cholecalciferol supplementation.
The OSDI and visual analog pain scale scores of both VDD and non-VDD groups decreased after application of topical CLAT and HU compared with baseline values. TBUT, corneal fluorescein staining score, and lid hyperemia in the VDD group remained unaffected by topical CLAT and HU, whereas those in the non-VDD group were improved. OSDI score, TBUT, and lid margin hyperemia were improved in the cholecalciferol supplementation group compared with pretreatment.
The data of this study suggest that the effect of topical CLAT and HU was dependent on serum 25HD levels. The authors conclude that cholecalciferol supplementation enhanced the efficacy of topical treatment and may be a useful adjuvant therapy for patients who have DED refractory to topical lubricants.
1. Hwang JS, Lee YP, Shin YJ. Vitamin D Enhances the Efficacy of Topical Artificial Tears in Patients With Dry Eye Disease. Cornea. 2018 Dec 7. [Epub ahead of print]
Determination of Central Corneal Clearance in Scleral Lenses with an Optical Biometer and Agreement with Subjective Evaluation
The purpose of this study was to compare three methods to measure central corneal clearance (CCC) during scleral lens wear: subjective (slit lamp), image processed (ImageJ), and with an optical biometer. The optical biometer technique was validated in comparison to optical coherence topography (OCT) in the first part of the study.
Twenty-two eyes (11 subjects) that had healthy corneas were recruited. Three measurements of OCT with scleral lenses and 10 measurements of axial length (AL) with IOLMaster (Zeiss) (with and without lens) were performed. For the second part, 61 eyes (35 subjects) enrolled in a clinical study were selected. Measurements of CCC were done with IOLMaster, slit lamp, and ImageJ.
The measurements of CCC indirectly obtained with IOLMaster had a strong correlation with anterior segment (AS)-OCT measurements (r = 0.981), showing a mean difference of 122.18μm ± 46.05μm (higher with IOLMaster). Regarding the second part, measurements of CCC were 238.66μm ± 95.94μm, 250.16μm ± 124.31μm, and 263.15μm ± 90.60μm for the IOLMaster, slit lamp, and ImageJ, respectively. The correlations were higher for ImageJ versus subjective measure (r = 0.891) than for intraocular lens (IOL) versus subjective (r = 0.748) and IOL versus ImageJ (r = 0.745). Analysis of differences and correlations between slit lamp and ImageJ through time showed a mean difference of –32.28μm ± 89.95μm (r = 0.683) at V1month, 12.53μm ± 59.46μm (r = 0.850) at V6months, and 11.57μm ± 32.95μm (r = 0.940) at V12months.
The researchers determined that it is possible to measure CCC with IOLMaster, considering AL measured with and without lenses and lens thickness. The three methods tested have good correspondence, showing that IOLMaster and ImageJ could be objective techniques to measure CCC. Also, it is possible to improve the agreement of subjective measures when compared to objective measures through time.
Macedo-de-Araújo RJ, Amorim-de-Sousa A, Queirós A, van der Worp E, González-Méijome JM. Determination of central corneal clearance in scleral lenses with an optical biometer and agreement with subjective evaluation. Cont Lens Anterior Eye. 2018 Nov 28 [Epub ahead of print]