As you no doubt have seen, the Federal Trade Commission (FTC) released its final changes to the Contact Lens Rule to the disappointment of many who advocated otherwise. The pendulum has swung from the protection of consumers (as it related to medical devices, such as contact lenses) to that of promoting fraudulent sales of contact lenses without eyecare practitioner involvement. The FTC Office of the Commissioner even went as far as to suggest that prescription requirements "strike the word 'manufacturer'" as an essential element of the prescription. That would obviously ignore important material and design elements associated with the contact lens fitting process required for successful fitting of the contact lens to the patient.
Jason J. Nichols, OD, MPH, PhD
Vision Expo West 2020 Cancelled
The Vision Council and Reed Exhibitions, organizers of Vision Expo, announced the decision to cancel Vision Expo West 2020, which had been scheduled to take place in Las Vegas from Sept. 23 to 26. Over the past several months, Reed Exhibitions’ Vision Expo team and The Vision Council worked together to prepare and plan for the highly anticipated event while closely monitoring the COVID-19 pandemic and its impact on members of the optical community. With the health and wellbeing of everyone in attendance at the show as the show organizers’ primary concern, Vision Expo, along with the Venetian Resort, developed a multi-layered, in-depth plan to ensure the safety of everyone planning on attending.
Despite these efforts and a strong interest from the industry to participate, the decision has been made to cancel Vision Expo West 2020 as a result of Nevada Governor Steve Sisolak’s announcement on June 26 sharing that Nevada "will remain in Phase 2 of reopening plans through the end of July due to current trends of the coronavirus infection."
Therefore, Vision Expo is launching a robust 365-digital platform dedicated to bringing the optical community together and allowing business to continue and flourish. The platform will include CE education and will allow for direct appointment setting, virtual product showcases, service and product sourcing, and much more.
COVID-19 Relief & Equality in Eye Health Fund
In response to COVID-19 and in solidarity with the recent protests against racism, Optometry Giving Sight is making available a COVID-19 Relief Fund for fellow eyecare nonprofits/charities that provide services within the United States and Canada. The funding will award small grant support for any one or more of the following considerations: to provide eye exams and low- or no-cost glasses to individuals in underserved communities; to provide special project funding that helps build sustainable vision care efforts; and to provide diversity and inclusion training to staff, volunteers, and board members.
There is $50,000 available with a max of $5,000 per grant. Applying organizations must have a 501(c)(3) or Canadian Registered Charity status. Interested organizations can submit an electronic application at https://www.givingsight.org/covid-relief-funding-form by July 31. Hard copies will not be accepted due to remote working conditions. Questions regarding U.S. grant requests should be sent to: email@example.com. Questions regarding Canadian grant requests should be sent to firstname.lastname@example.org.
CooperVision Producing Hand Sanitizer
As part of its ongoing COVID-19 pandemic response, CooperVision has begun producing hand sanitizer at its manufacturing sites in the United Kingdom and Puerto Rico. A portion of the gel is used to support internal requirements and employee hygiene needs, ensuring consistent supply and freeing commercial stocks for distribution elsewhere. Additional volumes are being donated to community organizations and to customers.
In other news, CooperVision has now extended the deadline of its Essential Hospital Workers Complimentary Contact Lens Program to Aug. 31, 2020. The program is designed for eyecare professionals who would like to offer complimentary lenses to their patients who are essential hospital workers in their communities, if they choose to do so.
For the most up-to-date COVID-19 news and tips for eyecare providers, visit bit.ly/2WxiFbA.
And, you can now sign up to receive the weekly PentaVision COVID-19 News Roundup newsletter, a joint publication from Contact Lens Spectrum, Eyecare Business, and Optometric Management.
Novartis Withdraws Marketing Application of Xiidra in Europe
Novartis has decided to withdraw its marketing application seeking approval of dry eye drug Xiidra (lifitegrast) in Europe. The decision comes after the European Medicines Agency (EMA) said that the drug’s benefits did not outweigh its risks. Novartis pulled the application on June 18 after the EMA considered that the effectiveness of Xiidra was not demonstrated across different symptoms of dry eye disease.
Santen and Plano Form a Strategic Alliance to Tackle Myopia
Santen Pharmaceutical Co., Ltd. and Plano Pte. Ltd announced a strategic alliance to tackle the global burden of myopia. Under this strategic alliance, Plano has secured an investment from Santen. Santen, through Plano, will initiate to tackle the burden of myopia using both a holistic approach and innovative technological solutions.
Plano is an eye health tech company launched in 2017, founded by Associate Professor Mohamed Dirani. It is the first spin-off from the Singapore Eye Research Institute (SERI) - Singapore National Eye Centre (SNEC) Ophthalmic Technologies Incubator Programme, dedicated to accelerating highly promising ophthalmic R&D projects toward commercialization and medical deployment. Plano users can anticipate a new app interface for both parents and children, improved product functionality, and an artificial intelligence-driven calculator for the development, progression, and stabilization of myopia in children and teenagers.
In the Abstract section of the June 28, 2020 issue of Contact Lenses Today, we provided a recap of a study by Charles McMonnies titled "Diagnosis and Remediation of Blink Inefficiency." Requests for copies of the author’s blink instructions handout can be sent to email@example.com.
How frequently do you prescribe fully customized soft contact lenses?
Edward Boshnick, OD, Global Vision Rehabilitation Center, Miami
This is a photo of the left eye of a 21-year-old patient. This patient was given a sulfa drug at age 7 for an infection. Within several weeks, the patient developed Stevens-Johnson syndrome, which affected both of his eyes. Without this lens, the patient’s visual acuity is finger counting. The corrected acuity with this scleral lens is 20/200. This eye is the patient’s only functioning eye.
We thank Dr. Boshnick 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
Changes in Corneal Endothelial Morphology Following Long-Term Soft Contact Lens Wear
Soft contact lens wear has been shown to a be safe and effective means of vision correction for millions of people over the past four-plus decades. That being said, our goal remains to further improve upon the ocular health response to lens wear. A recent study was published that analyzed and compared the alterations in corneal endothelium morphology induced by different materials and durations of wear of soft contact lenses (CLs) among young adults.1
A total of 72 subjects (32 silicone hydrogel and 40 hydrogel CL wearers) and 24 non-CL wearers (control) participated in this study. The gender distribution for study subjects was 13 males and 59 females, with a mean age of 22.15 ± 1.84 years old. The duration of wearing CLs ranged from one to nine years. Subjects were later divided into two groups following duration of CL wear: Group 1 (< 5 years) and Group 2 (≥ 5 years) for analysis purposes. Standard ocular assessments were conducted using a slit lamp biomicroscope, and morphology of corneal endothelial cells (endothelial cell density [ECD], coefficient variation [COV], hexagonality [HEX], and central corneal thickness [CCT]) were evaluated using a non-contact specular microscope.
The researchers reported the statistical analysis utilizing analysis of variance (ANOVA), which showed significant alterations in ECD, COV, and HEX of CL wearers (p < 0.05), with more changes found in hydrogel CL and Group 2 (longer-term) wearers. No significant change was found in CCT.
The researchers concluded that soft CL wear induced alterations in the morphology of corneal endothelial cells. Contact lens material and duration of CL wear (in years) are factors that affect the alterations. Eyecare professionals are recommended to regularly evaluate the morphology of corneal endothelial cells in CL wearers and to provide necessary intervention when required.
Numerous influences can impact corneal endothelial cell morphology including hereditary endothelial disease, advancing age, and contact lens wear, among others. The term "contact lens endotheliopathy" has been used to describe the alterations in endothelial cell density, cell size, and cell shape. The long-term impact of contact lens endotheliopathy has been a topic of debate; however, intuitively, we all may agree that it would be best to avoid the development of this condition. Optimizing contact lens oxygen transmission is one key way to achieve this goal. Corneal endothelial cell morphology can be measured using specular microscopy. More systems that are clinically applicable are available to eyecare practitioners today and, as such, can be incorporated into routine contact lens management both as baseline data and periodically during contact lens wear.
1. Mohd-Ali B, Chen LY. The Morphology of Corneal Endothelial Cells in Long Term Soft Contact Lens Wearers in Kuala Lumpur. Cont Lens Anterior Eye. 2020 Jul 2;S1367-0484:30119-3. [In Press]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
The Eye Bone Is Connected to the Gut Bone
The human gastrointestinal tract has a complex microbial ecosystem, and its composition is believed to be highly associated with human health.1 Research has established the critical role of the gut microbiome in both healthy and disease states due to its involvement in human metabolism, nutrition, physiology, and immune function. Gut microbiota imbalance (dysbiosis) has been linked with many abnormal conditions such as inflammatory bowel disease, irritable bowel syndrome, obesity, diabetes, and cardiovascular diseases. As such, regulating the gut microbiome has become a potential therapeutic approach for many chronic diseases.2
Consider recent research demonstrating that Sjögren’s patients showed significant gut dysbiosis as well as environmental dry eye syndrome compared to controls, while dry eye patients showed compositional changes of gut microbiome somewhere in between Sjögren’s and controls. Additionally, dysbiosis of the gut microbiota was partly correlated to dry eye severity.3 Perhaps we should be administering the Dysbiosis Questionnaire4 along with a Dry Eye questionnaire to our patients.
1. Falk PG, Hooper LV, Midtvedt T, Gordon JI. Creating and maintaining the gastrointestinal ecosystem: what we know and need to know from gnotobiology. Microbiol Mol Biol Rev. 1998 Dec;62:1157-1170.
2. Carding S, Verbeke K, Vipond DT, Corfe BM, Owen LJ. Dysbiosis of the gut microbiota in disease. Microb Ecol Health Dis. 2015 Feb 2;26:26191.
3. Moon J, Choi SE, Yoon CH, Kim MK. Gut Dysbiosis Is Prevailing in Sjögren’s Syndrome and Is Related to Dry Eye Severity. PLoS One. 2020 Feb 14;15:e0229029.
4. Dysbiosis Questionnaire and Score Sheet. Available at https://www.grdhealth.com/files/attachments/3%20Dysbiosis%20Questionnaire.pdf. Accessed June 6, 2020.
Intraocular Pressure Changes in Neophyte Scleral Lens Wearers: A Prospective Study
The purpose of this study was to examine the variation in intraocular pressure (IOP) during the first six months of scleral lens wear.
Thirty-two neophyte scleral lens wearers were recruited, and IOP was measured using Goldman applanation tonometry before and after one and six months of scleral lens wear (following lens removal). All scleral lenses were designed based on scleral topography or an impression of the ocular surface. Central corneal thickness and the central post-lens fluid reservoir thickness were quantified using optical coherence tomography.
Post-lens removal IOP displayed an increasing trend after one and six months of lens wear, but the magnitude of change was not clinically or statistically significant using several repeated measures analyses to account for sporadic missing longitudinal data (mean increase of 1 mmHg or less, p > 0.05). Central corneal thickness and the central post-lens fluid reservoir remained stable throughout the first six months of lens wear.
The authors determined that IOP measured following lens removal did not vary significantly during the first six months of lens wear in scleral lens neophytes. Further research is required to determine whether IOP varies during lens wear, following lens removal, or after longer-term lens wear due to suction forces or tissue compression beneath the landing zone.
Kramer EG, Vincent SJ. Intraocular Pressure Changes in Neophyte Scleral Lens Wearers: A Prospective Study. Cont Lens Anterior Eye. 2020 Jun 2;S1367-0484:30111-30119. [Online ahead of print]