As you will note from our 2015 Annual Report on contact lenses (http://www.clspectrum.com/articleviewer.aspx?articleID=113689) the daily disposable category once again saw tremendous growth such that it now appears to represent around 30% of the US market. Of course, we know daily disposables are used in even higher rates in other areas around the globe. As manufacturers improve materials, and expand designs into this category (e.g., torics, multifocals) we are certain to see this category grow even further. Stay tuned for more notable trends in the contact lens market as we proceed in 2016.
Jason J. Nichols, OD, MPH, PhD
Ball Appointed Division Head and CEO Alcon
Novartis announced that Michael Ball has been appointed Division Head and CEO Alcon, effective February 1, 2016. Ball will be a member of the Executive Committee of Novartis (ECN). He joins Novartis from Hospira, where he was CEO from 2011 until recently. Prior to Hospira, he spent five years as President of Allergan, where he held a series of leadership positions over 16 years with the company. Ball succeeds Jeff George, who has decided to leave Novartis.
A Novartis’ press release accessing the Novartis Q4/Full Year results also discussed the corporation’s growth plan for Alcon. According to the release, Novartis is focusing the Alcon Division on its core Surgical and Vision Care business. Within this business, the corporation has identified key actions to accelerate growth in 2016 and beyond. These include:
Optimizing IOL innovation and commercial execution
Prioritizing and investing in promising pipeline opportunities
Ensuring best-in-class service, training and education for eyecare professionals
Improving sales force effectiveness
Investing in DTC behind key brands
Novartis is transferring Alcon's pharmaceutical products (sales of USD 3.8 billion in 2015) to the Pharmaceuticals Division, thereby creating the world leading ophthalmology business with approximately USD 6 billion in sales, according to the company.
Menicon America Introduces LacriPure
In response to industry demand for a safe alternative to tap water rinsing of all types of contact lens, Menicon America has sought and received FDA approval for LacriPure, a unit dose, non-preserved saline for rinsing contact lenses and lens cases. Indicated for use with both soft and rigid gas permeable lenses, LacriPure is packaged in 5ml unit-dose vials.
In addition to the indication as a rinsing solution, LacriPure has been approved as a scleral lens insertion solution. This first of its kind approval gives ECPs and their patients an alternative to off-label insertion solutions such as irrigation saline, or to larger bottles of non-preserved saline that may prove a sterility risk. Because LacriPure contains no buffers or preservatives, the risk of a toxic reaction is significantly reduced, according to the company.
LaciPure’s 5ml blow-fill-seal vials are appropriately sized for all scleral lens diameters and offer the safety of single-use bottles that help to prevent contamination. LacriPure unit-dose saline is packaged in a 98 vial box that provides patients with a convenient seven week supply.
Menicon LacriPure joins Menicon Unique pH multi-purpose solution and Menicon Progent protein remover to complete the company’s comprehensive GP lens care system. Menicon lens care products are available direct from the Menicon WebStore at store.meniconamerica.com, from online retailers amazon.com, walgreens.com and drugstore.com, and from GP laboratories that carry lens care products.
Shire Resubmits NDA for Lifitegrast to US FDA
Shire plc has resubmitted the New Drug Application (NDA) to the US Food and Drug Administration (FDA) for its investigational candidate, lifitegrast, for the treatment of signs and symptoms of dry eye disease in adults. Shire resubmitted the NDA in response to the complete response letter (CRL) the company received from the FDA on October 16, 2015.
Addressing the FDA request for an additional study, Shire included in its NDA resubmission package data from OPUS-3, a Phase 3 efficacy and safety trial with a primary endpoint of patient-reported symptom improvement. The resubmission package also included information requested by the FDA regarding product quality.
The new drug application for lifitegrast now includes data from one Phase 2 study, three Phase 3 efficacy and safety studies (OPUS-1, OPUS-2 and OPUS-3), and one long-term (one-year) Phase 3 safety study (SONATA).
The FDA has 30 days after resubmission of an NDA to acknowledge receipt and determine if the submission is a complete response. Upon acceptance, the FDA will provide Shire with a PDUFA date anticipated to be within six months of the date of submission.
sMap3D Corneo-Scleral Topography System Launched in US
The sMap3D corneo-scleral topography system, manufactured by Precision Ocular Metrology, is now available in the United States through Visionary Optics, the exclusive US distributor. The sMap3D uses a structured light approach for 3-dimensional mapping to obtain micro precision measurements of the cornea and sclera with a 22mm maximum field of view.
The sMapPro software is able to stitch together multiple images, which produces a complete 3-dimensional model of the patient’s eye. Stitching is a necessary step to obtain maximum area of the sclera that is occluded by the lids in a straight gaze view despite the eyelids being held open. This ability is critical for scleral lens fitting using elevation topography.
The sMapPro software provides sagittal depth data at any specified chord. Corneo-scleral topography and elevation maps can be evaluated. As well, scleral toricity can be calculated from any specified radius from center. The virtual fit screen allows the practitioner to send the data directly to Visionary Optics for analysis and design of a customized Europa scleral lens. Alternatively, the practitioner can tailor lens fit using the software’s virtual fitting plots. sMapPro software allows for complete specification of any lens parameter to virtually adjust for corneal and limbal clearance, peripheral lens alignment, as well as customized back surface toricity.
Corneo-scleral topography and 3D mapping have been designed to significantly advance scleral lens fitting. According to the company, rather than relying on guestimates from diagnostic lenses, corneo-scleral topography and scleral lens fitting software will allow practitioners to virtually fit scleral lenses that are customized for each particular eye. The goals of virtually fitting customized scleral lenses are to decrease chair time, reduce remakes and improve patient satisfaction.
CareCredit Enters into Advertising Agreement with AllAboutVision.com
CareCredit and AllAboutVision.com announced an exclusive advertising agreement promoting patient financing. The campaign will use targeted display ads to reach consumers who are researching LASIK, cataracts, eyeglasses and contact lenses. Under the terms of the agreement, consumers can link directly from AllAboutVision.com to CareCredit’s website, where they can apply for a CareCredit credit card and, if needed, find an eye care professional.
For 15 years, it has been the mission of AllAboutVision.com to provide consumers with hundreds of pages of information on vision correction and eye health, all reviewed by an editorial advisory board consisting of leading optometrists, ophthalmologists and opticians. The site is expected to serve 45 million unique visitors this year. Search engines account for about 90 percent of the visitors to AllAboutVision.com, with the top sources of traffic being Google, Yahoo!, Bing, Ask.com and AOL.
CareCredit research shows the importance of financing options being available to consumers considering healthcare procedures, products and services. According to a 2014 study on how consumers approach their healthcare decisions, more optical consumers considered or researched financing (69%) than researched procedures or treatments (63%). The same study showed 62% of eye care patients viewed care as an absolute necessity, and nearly half (49%) said they were likely to apply for or use CareCredit as the cost of care approached $1,000.
Eyelash Under Scleral Lens Shane McDonald, OD, Portland, OR
We were resolving presumed fungal keratitis OD with scleral lens wear for protection of the ocular surface. Patient complained of slight irritation. Here we see the central imprint of the eyelash and two air bubbles that were trapped underneath the contact lens. Removal of the eyelash resolved the discomfort.
We thank Dr. McDonald 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.
CARE SOLUTION CORNER Andrew D. Pucker, OD, MS, FAAO
Methods for Improving Compliance
In a recent article I noted that up to 90% of contact lens wearers are at least partially noncompliant.1 This staggering figure needs to change, and we are the ones who need to make it happen. But what should we be doing?
Improving compliance starts with providing good patient education and sometimes with changing patients’ attitude towards the importance of contact lens care.2-4 The following is a list of tips that could help make your patients more compliant.
Use non-technical language (verbal and written) that can be easily understood, and make sure to use words that make your point (e.g., use “slime” instead of “biofilm”).5
Use pictures when possible, so patients can better visualize what you are describing.5
Provide patients with a written list of instructions, and verbally walk through the instructions to reinforce the most important points.5
Avoid overloading patients with information; try to break up instructions over multiple visits. Send electronic copies of instructions and email reminders about healthy tips throughout the year, so patients are less likely to lose and more likely to remember your instructions.3,5
Provide treatment-specific instructions (e.g., unique handouts for different wear schedules).3
Some patients may intentionally be noncompliant because they do not understand the consequences.3,4 Combat this by providing patients with referenced scientific justification as reasons why they should perform tasks.5
Create an education check list, so your office does not forget an important education topic.3
Fighting noncompliance is a never-ending struggle that we should all be battling. Actively implementing the above suggestions should help us get closer to winning the fight.
1. Robertson DM, Cavanagh HD. Non-compliance with contact lens wear and care practices: a comparative analysis. Optom Vis Sci. 2011;88:1402-8.
2. Cardona G, Llovet I. Compliance amongst contact lens wearers: comprehension skills and reinforcement with written instructions. Cont Lens Anterior Eye. 2004;27:75-81.
3. McMonnies CW. Improving patient education and attitudes toward compliance with instructions for contact lens use. Cont Lens Anterior Eye. 2011;34:241-8.
4. Bui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: perceptions, awareness, and behavior. Eye Contact Lens. 2010;36:334-9.
5. McMonnies CW. Improving contact lens compliance by explaining the benefits of compliant procedures. Cont Lens Anterior Eye. 2011;34:249-52.
If you think about it, we as contact lens fitters really have it easy compared to how things were 10, 20, and 30 years ago. For instance, 30 years ago we were using lathes that only allowed us to cut lenses with three curves and then we tried to blend them to fit people with keratoconus and other pathologies. As I walked the recent exhibit hall at the Global Specialty Lens Symposium, I was again wowed. It was the 10 year anniversary and I have attended the meeting every year. Over the years the number of vendors and companies has really grown. In fact, to realize how many of those companies were not around 10 years ago is astonishing.
I am really impressed by the arsenal of tools that we have. I urge you to think about your options for your patient. “Fine” and “Good Enough” are two ways to describe contact lens fits when you have nothing better available for fitting your patient. After walking the exhibit halls and listening to lectures, I am as convinced as ever that we have to be constantly evolving and innovating our patient care. Companies around us are doing it; they are coming out with the products to help us, but it is up to us to help the patient. As a fitter, do something astonishing this month and fit someone into a contact lens that you have never used before. You may be surprised at how impactful it can be.
Cinnamon Oil: A Possible Alternative for Contact Lens Disinfection
The researchers’ objective was to investigate the antibacterial activity of cinnamon oil alone and in combination with a multipurpose contact lens disinfectant solution (MPS) as well as tobramycin against multi-drug resistant conjunctival bacteria both in planktonic and sessile forms.
Minimum inhibitory concentrations (MIC) of tobramycin and cinnamon oil against 19 bacterial strains were investigated against planktonic and sessile cells by micro-dilution methods. Synergistic effects were determined by well diffusion and micro-dilution tissue culture plate methods for planktonic and sessile cells respectively. Time kill assay was performed to study the bactericidal effect of cinnamon oil in concentrations ranging from 5% to 0.312% combined with an MPS with respect to time.
MICs of cinnamon oil against planktonic bacteria ranged from 0.04% to 1.25% versus 0.156% to 5% for sessile cells. Combination of cinnamon oil with tobramycin had a synergistic effect against most tested organisms. The MIC values of cinnamon oil in combination with tobramycin was significantly lower than cinnamon oil alone against biofilm production (P=0.004). Time kill assay revealed that combination of cinnamon oil and disinfectant successfully eradicated the tested microorganisms at all tested concentrations within 2 hours contact time except for 0.312% concentration (3 hours) versus 24 hours for MPS alone.
The authors concluded that cinnamon oil has a promising antimicrobial effect. It could be a probable candidate for contact lens disinfection.
Bassyouni RH, Kamel Z, Abdelfattah MM, Mostafa E. Cinnamon oil: A possible alternative for contact lens disinfection. Cont Lens Anterior Eye. 2016 Jan 18. pii: S1367-0484(16)30001-7. doi: 10.1016/j.clae.2016.01.001. [Epub ahead of print]