At this week’s Global Specialty Lens Symposium (GSLS), we were delighted to honor several colleagues with the GSLS Award of Excellence. This year’s awardees were honored as the "Authors" whose publications have educated and inspired generations of contact lens practitioners across the globe. They included Drs. Gerald Lowther, Robert Mandell and Anthony Phillips and we were delighted to surprise our very own Contact Lens Spectrum Clinical Features Editor, Dr. Ed Bennett, as an additional awardee. Stay tuned for a full GSLS meeting summary to be featured in our April 2016 issue of Contact Lens Spectrum.
Jason J. Nichols, OD, MPH, PhD
GSLS Draws Record Attendance
The 10th anniversary 2016 Global Specialty Lens Symposium set a record for attendance with close to 1,000 attendees and exhibitors from 25 countries, 45 states, and Puerto Rico. Participants enjoyed insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits. Watch for information on 2017 GSLS planned for January 19-22, 2017 at the Rio, Las Vegas, NV.
CooperVision Announces Limited Rollout of
Biofinity XR toric
CooperVision, Inc. announced the limited introduction of Biofinity XR toric, an addition to the company’s leading Biofinity range of monthly silicone hydrogel contact lenses. The product will be introduced to a few hundred accounts during the limited rollout period, before a broader rollout slated to begin in April. According to the company, the Biofinity XR brand is the only silicone hydrogel contact lens range from a major manufacturer designed for patients with prescriptions beyond the traditional stock range.
Biofinity XR toric incorporates a similar uniform horizontal ISO thickness and optimized ballast band as Biofinity toric, making it an easy-to-fit, stable toric lens with excellent visual acuity. Its optimized, continuous surface ensures that the eyelid interacts with a smooth lens surface on every blink, resulting in a more comfortable wearing experience.*
Like all Biofinity lenses, Biofinity XR toric features Aquaform Technology, which allows more oxygen to reach the eyes, helping to maintain clear, white eyes and healthier corneal physiology. The lens material is naturally and uniformly wettable, providing a soft and flexible lens.
Biofinity XR toric lenses will be available in sphere powers from +10.00D to -10.00D (0.50D steps after +/-6.00D), with cylinder powers from -2.75 to -5.75 (0.50 steps) and an axis of 5 degrees to 180 degrees in 5-degree steps, and +8.50D to +10.00D with cylinder powers from -0.75 to -2.25 (0.50 steps) and axis of 5 degrees to 180 degrees in 5-degree steps.
*This study compared the made to order (MTO) lens design of the Biofinity XR toric and stock Biofinity toric lens in the core range over 6 hours of lens wear.
Expert Progressive Design Awarded Patent
The Expert Progressive contact lens from Precilens has been granted a U.S. patent. (Patents have previously been issued in Europe, Canada, and Japan.) Precilens is a Paris-based soft and GP contact lens manufacturer with a particular focus on multifocals and myopia control designs.
Designed like an eyeglass progressive lens, Expert Progressive also features a unique edge technology that provides great comfort, according to the company.
Art Optical Contact Lens and Essilor Contact Lens Specialists manufacture and distribute the lens under license for U.S. and Canada.
Bausch + Lomb has made a $50,000 donation to Optometry Giving Sight. The donation will support a broad range of sustainable training and education programs that improve eye health for people in developing and under-served communities.
Optometry Giving Sight funds the development of sustainable eye and vision care projects in communities where these do not currently exist. These projects focus on local training and capacity building; infrastructure development and the delivery of accessible and affordable eye and vision care services.
In addition, Optometry Giving Sight is a member of VISION 2020: The Right to Sight, a joint program of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB). VISION 2020 aims to eliminate avoidable blindness through awareness raising, advocacy and resource mobilization, and the implementation of national eye health plans in all countries.
More than 600 million people worldwide are blind or vision impaired because they cannot access eye exams and correction. Optometry Giving Sight (GivingSight.org) is the only global fundraising initiative that specifically targets uncorrected refractive error, funding projects that help train local professionals, establish sustainable vision centers and deliver eye care where it’s needed most.
Keratoconus with Fibrovascular Growth Elise Kramer, OD, Miami, FL
This image shows a 15.6 mm reverse geometry scleral lens over eye with advanced Keratoconus, neovascularization, central scarring and haze (fibrovascular growth). The patient's vision with the lens is 20/25. His other eye is similar in appearance but the scarring is paracentral. The vision in that eye is 20/20. The patient is being followed by a corneal specialist who has him taking PredForte six times per day.
We thank Dr. Kramer 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.
Breathe Deep! ... Corneal Swelling Following Scleral Lens Wear
Over the past number of years there has been a dramatic shift in prescribing trends for gas permeable rigid lenses towards scleral designs. The advantages of improved comfort, reduced dryness and the ability to fully vault the cornea makes these lenses very attractive in the management of irregular corneas of various etiologies. More recently there has been a trend to utilize scleral lenses for the management of traditional refractive errors on normal/regular corneas due to the excellent centration characteristics, comfort response and optical quality of these lenses. Like many things, we always need to be concerned if things seem “too good to be true”! A number of studies have been published that suggest that scleral lenses, in their current forms, may not provide adequate oxygenation to the cornea.1,2
A recently published study again looked at the corneal response to scleral lens wear.3 The purpose of the study was to examine the change in corneal thickness and posterior curvature following 8 hours of mini-scleral contact lens wear. Scheimpflug imaging (Pentacam HR; Oculus) was captured before, and immediately following, 8 hours of miniscleral contact lens wear for 15 young (mean age 22 ± 3 years), healthy participants with normal corneas. Natural diurnal variations were considered by measuring baseline corneal changes obtained on a separate control day without contact lens wear. Results found that over the central 6 mm of the cornea, a small but highly statistically significant amount of edema was observed following 8 hours of miniscleral lens wear, after accounting for normal diurnal fluctuations. Posterior corneal topography remained stable following lens wear. The magnitude of posterior corneal topographical changes following lens wear did not correlate with the extent of lens-related corneal edema. Similarly, the initial central corneal vault (maximum post-lens tear layer depth) was not associated with corneal swelling following lens removal. The researchers concluded that, although a small amount of corneal swelling was induced following 8 hours of miniscleral lens wear (on average <2%), modern high Dk miniscleral contact lenses that vault the cornea do not induce clinically significant corneal edema or hypoxic-related posterior corneal curvature changes during short-term wear. Longer-term studies of compromised eyes (e.g. corneal ectasia) are still required to inform the optimum lens and fitting characteristics for safe scleral lens wear to minimize corneal hypoxia.
So, we have a study here that suggests that current scleral lens designs do not induce clinically significant corneal edema while others express concern that they potentially do. From my perspective what needs to be done is to continue to develop new and improved vaulting contact lens designs. Our goal should be to develop designs that minimize vault over the entire corneal surface, minimize lens thickness profiles, and are fabricated from the most oxygen permeable materials available. The “holy grail” of contact lenses is still out there for us to discover!
1. Michaud L, van der Worp E, Brazeau D, Warde R, Giasson C. Predicting Oxygen Transmissibility for Scleral Lenses. Cont Lens Anterior Eye. 2012 Dec;35(6):266-71.
2. Jaynes JM, Edrington TB, Weissman BA. Predicting scleral GP lens entrapped tear layer oxygen tensions. Cont. Lens Anterior Eye. 2014 Oct 13.
3. Vincent SJ, Alonso-Caneiro D, Collins MJ, Beanland A, Lam L, Lim CC, Loke A, Nguyen N. Hypoxic Corneal Changes Following Eight Hours of Scleral Contact Lens Wear. Optom Vis Sci. 2016 Jan 12. [Epub ahead of print]
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
I am fascinated by the exquisite environment of the lid margin---what normal looks like, what abnormal looks like, the mechanism of its pathology. Generally associated with pathology is an inflammatory process. Disruption in the balance of bioburden, that is, the amount of bacteria living on a surface that has not been sterilized, may lead to an inflammatory response of the lid margin and its surrounds. Additionally, bacterial biofilm (an assemblage of surface-associated microbial cells enclosed in a self-generated extracellular matrix) is associated with inflammation and disease. Biofilm is one of the major factors affecting the virulence of bacteria.
A recent study highlighted the concern of biofilm formation in patients who underwent routine cataract surgery.1 The authors report that even after standard pre-operative povidone-iodine washing of the hemifacial skin, periocular area, eyelids and eyelashes and conjunctiva before cataract surgery, microorganisms that remained at the end of surgery had the capacity to produce biofilm and had high antibiotic resistance.
This study reinforces the benefit of routine eyelid hygiene: tempering bacterial loads and biofilm on the lid margin and eye lashes may reduce the chance of post-operative endophthalmitis.
1. Kıvanç SA, Kıvanç M, Bayramlar H. Microbiology of corneal wounds after cataract surgery: biofilm formation and antibiotic resistance patterns. J Wound Care. 2016 Jan 2;25(1):12-9. doi: 10.12968/jowc.2016.25.1.12.
Myopia Control with Bifocal Contact Lenses: A Randomized Clinical Trial
Most studies have reported only minimal reductions in myopia progression with bifocal or progressive multifocal spectacles, although somewhat larger, although mostly still clinically insignificant, effects have been reported in children with near point esophoria and/or accommodative dysfunctions. The CONTROL study was a 1-year, prospective, randomized, clinical trial of bifocal contact lenses for control of myopia in children with eso fixation disparities at near.
Eighty-six myopic subjects, aged 8 to 18 years, were enrolled in the study after passing the screening examination. Of these, 79 completed lens assignment and 78 completed the study. The mean refractive error of these 79 subjects was -2.69 ± 1.40D (SD), and all had progressed by -0.50D or more since their last examination. All subjects also had eso fixation disparity at near. Subjects were randomly assigned to wear either Vistakon Acuvue 2 (single-vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal (bifocal soft contact lenses [BFSCLs]). Bifocal adds were selected to neutralize the associated phoria. Treatment outcomes included cycloplegic autorefraction and axial length, assessed in terms of changes after 6 and 12 months of treatment from pretreatment baseline values.
The BFSCLs significantly slowed myopia progression, with statistically significant differences between the treatment groups after 6 months. After 12 months of treatment, the SVSCL group had progressed by -0.79 ± 0.43D compared with -0.22 ± 0.34D for the BFSCL group (cycloplegic objective spherical equivalent, average of two eyes). Corresponding axial length changes were 0.24 ± 0.17 mm and 0.05 ± 0.14 mm, respectively. All of these differences were found to be statistically significant (unpaired t-tests, p < 0.001).
The researchers concluded that the distance center bifocal contact lenses tested in this study achieved greater control over myopia progression and axial elongation (>70%) compared with most published results with multifocal spectacles. Further studies are warranted to identify the critical factors and mechanisms underlying this myopia control effect.
Aller TA, Liu M, Wildsoet CF. Myopia Control with Bifocal Contact Lenses: A Randomized Clinical Trial. Optom Vis Sci. 2016 Jan 18. [Epub ahead of print]