As you will note in the monthly Quick Poll results posted below, nearly 40% of practitioners ask their scleral lens wearers to remove and reapply their contact lenses at some point each day. The reasons are probably numerous, but most likely relate to the so-called midday fogging phenomenon experienced by many scleral lens wearers.
Although management strategies have been adopted, we still do not understand the etiology of the fogging, nor do we understand the factors associated with it (e.g., lens fitting characteristics, patient factors, etc.). Stay tuned for our editorial supplement on scleral lenses, which will appear with the October issue of Contact Lens Spectrum.
Jason J. Nichols, OD, MPH, PhD
In Memoriam: Timothy J. Bowden
Timothy J. Bowden, FADO (Hons) CL, FFDO, died suddenly this past week at the age of 65. He was a well-respected contact lens optician who had specialized in contact lens fitting and aftercare for more than 30 years, having started in optics more than 40 years ago. Until recently, he was a visiting lecturer in the contact lens department of City and Islington College in London, and he was a contact lens examiner for the Association of British Dispensing Opticians at the time of his passing.
In 1983, he and his optometrist wife Lis opened their first independent practice in Gravesend followed by another in Herne Bay, Kent. Their current practice is in Gillingham, Kent.
Tim Bowden is well known for Contact Lenses: The Story, a book that details how contact lenses developed and the pioneers who invented them. The research for the book spawned the Contact Lens Collection at the BOA Museum in London, co-founded with Andrew Gasson, which is the only actively administered specialist contact lens collection open to the public in the world. It also spawned a project to erect commemorative plaques to honor contact lens pioneers both in the United Kingdom and elsewhere.
He held a variety of posts within UK optical professional organizations and researched and wrote various articles on contact lens history and on the habits and opinions of contact lens wearers. In 2012, he was presented with the Otto Wichterle Gold Medal for his services to the contact lens industry by the Czech Contact Lens Society. He also was honorary treasurer of the International Society of Contact Lens Specialists, editor of Ophthalmic Antiques, a national committee member of Optometry Giving Sight and a contributor to the Oxford Dictionary of National Biography and the International Association of Contact Lens Educators (IACLE) Contact Lens Course (ICLC).
He is survived by his wife Lis, and their two sons, Ben and Chris.
Southern College of Optometry Opens Telemedicine Clinic
Southern College of Optometry (SCO) opened FocalPoint, the first facility of its kind in the United States to offer completely paperless telemedicine via EyecareLive. FocalPoint’s 8,000-square-foot clinic has four practitioners and offers several technological advances for eye health and exclusive new eyewear lines. The clinic also provides additional clinical instruction space for the college’s students. SCO states that the paperless facility allows patients to digitally check in, manage their records, and follow up with doctors on the telemedicine platform.
FocalPoint is also among 12 U.S. locations to offer customizable eyewear through Hoya’s Yuniku system. Using 3-D scanning, parametric design automation, and 3-D printing, the platform is designed to create eyewear to uniquely fit individual facial characteristics.
FocalPoint also shares space with Church Health Eye Care. The walls-down facility integrates care to serve patients across varying demographics and socioeconomic profiles.
OpTranslate App Available on the Apple and Google Play App Stores
The OpTranslate is a mobile app that helps eyecare practitioners to conduct eye exams on non-English- speaking patients. It is compatible with iPhone, iPad, and Android phones and tablets. The app was developed by Dmitriy Richter, a third-year student at the New England College of Optometry (NECO). NECO students Eva Ho served as the graphic designer, and NECO student Victoria Gagnon provided French translations for the mobile app. NECO alumnus Dr. Jason Chin helped develop the contact lens section of the app.
It currently is available in Spanish, French, Portuguese, and Hatian Creole; future languages in development include Mandarin, Russian, Hindi, Korean, and Viatnamese. The app also features a full comprehensive eye exam split into six sections, which are available in all languages. Additional sections include contact lens exams, binocular vision testing, and pre-written diagnoses. Helpful written explanations, patient education resources, and labeled diagrams make the practitioner-patient connection stronger than ever, according to the company. In addition, a simple and intuitive layout, comprehensive glossary, offline capability, and language quizzes can help train the eyecare practitioners into a multilingual providers. While not intended to replace professional medical interpreters and translating services, OpTranslate does seek to provide language translation tools to help optometrists better conduct eye exams on non-English- speaking patients, according to Richter.
OpTranslate is 100% free of advertising. It is available in all countries and territories for $4.99; there are no monthly subscription fees, no in-app purchases, and no future paid upgrades.
Valley Contax Offers Custom Stable Fridays
Valley Contax has developed Custom Stable Fridays, one-day workshops that utilize the company’s Custom Stable scleral lens. The events take place every two months at Valley Contax’s location in Springfield, OR. Attendance is limited to 10 practitioners per session. Attendees begin the day with a tour of the manufacturing facilities. Practitioners learn about the design and fitting of the lens during lunch, and after lunch they use Custom Stable Elite fitting kits to fit each other and then send their lens orders to the lab. Once the lenses have been made, attendees troubleshoot and finalize their fits. The workshop wraps up with a Q&A session. Practitioners can learn more about Custom Stable Friday workshops by visiting the Valley Contax website at valleycontax.com. The next sessions with available spots are on Oct. 6 and Dec. 1, 2017.
Kate Sickler Joins Alden Optical
Kate Sickler has joined Alden Optical, a part of Bausch + Lomb Specialty Vision Products (SVP), as a fitting consultant where she will leverage her expertise fitting custom and specialty lenses. She will support practitioners by providing assistance on the intricacies of fitting Alden’s custom contact lenses, especially Zenlens and Zen RC scleral lenses.
With nearly two decades of specialty lens fitting experience in commercial and private practice, Ms. Sickler is a Fellow of the Contact Lens Society of America, a National Contact Lens Examiner Master, and is certified by the American Board of Opticianry.
Hyderabad to Host the 2017 World Congress of Optometry
The World Council of Optometry (WCO) will hold its second World Congress of Optometry in India at Hyderabad International Convention Center on Sept. 11 to 13, 2017. The congress will be hosted by the India Vision Institute (IVI) in partnership with WCO and is expected to attract around 2,000 delegates and 70 exhibitors from across the world.
Optometric experts and health professionals from various countries will discuss the issues of blindness, refractive error, and vision care. The theme of the Congress is “Accessible, quality vision and eye health,” and is part of the World Health Organization’s (WHO) Universal Eye Health: A Global Action Plan 2014-20172019. More information about the congress can be found at http://worldcongressofoptometry.org.
Do you ask your scleral lens wearers to remove and reapply their contact lenses midday, each day?*
*Note: Results are rounded.
Trevor Fosso, OD, Sartell, MN
This image shows corneal epithelial whorl keratopathy secondary to central bearing of a scleral contact lens on a patient who has advanced keratoconus.
We thank Dr. Fosso 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
Give It Time: Temporal Dynamics of Scleral Lens Central Vault and Centration
The utilization of scleral contact lenses has gained great popularity over the past few years for the management of both diseased and, to some extent, normal eyes. Optimal performance of scleral lenses is achieved when the lenses vault the entire cornea (especially over the sensitive limbal corneal zone) and land with appropriate alignment on the bulbar conjunctiva overlying the sclera. Excess corneal vault of scleral lenses can contribute to inadequate oxygen transmission. Inappropriate peripheral landing of the lenses can result in discomfort and ocular surface inflammation, most notably when impinging on the conjunctival surface. Decentration of the lens can have a negative impact both on optical performance and physiological response.
A recent study was published that evaluated the fitting response of a 16.5mm diameter scleral contact lens.1 Determination of both lens centration and central corneal clearance (or vault) was made over time to discover the temporal changes of these parameters. Repeated high-resolution optical coherence tomography (OCT) images were captured over an eight-hour period of mini-scleral contact lens wear (using a rotationally symmetric 16.5mm diameter lens) in 15 young, healthy participants who had normal corneas. Central corneal clearance and lens decentration were derived from OCT images using semi-automated image processing techniques.
The study determined that central corneal clearance decreased exponentially over time, by 76μm ± 8μm over eight hours. Fifty percent of this reduction occurred within 45 minutes of lens wear and 75% within two hours, with thinning of the post-lens tear layer plateauing four hours after lens application. Lens translation exhibited a similar pattern of change (0.18mm ± 0.04mm temporal and 0.20mm ± 0.09mm inferior decentration), stabilizing 1.5 to two hours after application.
The change in the lens fit over time resulted in a small reduction in the power of the post-lens tear layer (–0.12D ± 0.01D) and induced a prismatic effect of 0.01 ± 0.16 Δ base out and 0.50 ± 0.19 Δ base down relative to the pupil center.
The authors concluded that for the mini-scleral contact lens studied, horizontal and vertical lens decentration followed an exponential decay over eight hours that plateaued approximately two hours after lens application, while central post-lens tear layer thinning plateaued after four hours of lens wear.
Recognition of the temporal change characteristics of scleral lens fitting is quite important when assessing such lenses, both at initial fitting visits as well as at after-care visits. Various lenses will exhibit different “settling” characteristics. These factors must be considered to achieve the desired optimal physical fitting outcomes.
1. Vincent SJ, Alonso-Caneiro D, Collins MJ. The temporal dynamics of miniscleral contact lenses: Central corneal clearance and centration. Cont Lens Anterior Eye. 2017 Jul 14. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
There’s a Gizmo for That
Thinking about eye drug usage–in particular, the application of bottled or vialed eye drops–patient compliance to therapy is challenged by drug cost, accessibility, and availability; remembering to apply the drug daily; inconvenience; iatrogenic drug discomfort or irritation; and poor vision.1 Contamination of the dropper tip is always a topic to be considered and addressed. Sometimes, ineffective communication or sub-par understanding of medication use is the culprit of therapy non-adherence.2 Compromised dexterity or grip strength and poor aim makes eye drop instillation difficult, with frustrating product waste commonplace.
In 1976, Fraunfelder, considering gravity, blinking, lid closure, head position, and area of eye drop drug application on ocular contact time, investigated the best way to instill eye drops.3 To date, we recommend the same instructions outlined in this study.4
I have evaluated gadgets to squeeze dropper bottles and guide drops into the eye as well as a new device that delivers eye drops via the laws of physics (surface tension and capillary action).5
Do you recommend a specific device for your patients to instill eye drops? Is there any appliance that you have found to be especially effective? E-mail me at KatherineMastrota@msn.com and let me know.
1. Hennessy AL, Katz J, Covert D, Protzko C, Robin AL. Videotaped evaluation of eye drop instillation in glaucoma patients with visual impairment or moderate to severe visual field loss. Ophthalmology. 2010 Dec;117:2345-2352.
2. Slota C, Sayner R, Vitko M, Carpenter DM, Blalock SJ, Robin AL, Muir KW, Hartnett ME, Sleath B. Glaucoma Patient Expression of Medication Problems and Nonadherence. Optom Vis Sci. 2015 May;92:537-543.
3. Fraunfelder, FT. Extraocular fluid dynamics: how best to apply topical ocular medication. Trans Am Ophthalmol Soc. 1976;74:457-487.
4. Glaucoma Research Foundation. Is There a “Best Technique” for Putting in Eye Drops. Available at www.glaucoma.org/gleams/eyedrop-techniques-questions-and-answers-from-dr-bradley-schuster.php. Accessed on July 22, 2017.
5. Magic Touch Eye. Available at https://magictoucheye.com. Accessed on July 24, 2017.
MiSight Assessment Study Spain: A Comparison of Vision-Related Quality-of-Life Measures Between MiSight Contact Lenses and Single-Vision Spectacles
Recent research has shown that concentric contact lenses (CLs) can be a way to control the progression of myopia. The purpose of the current study was to compare vision-related quality-of-life measures in children wearing distance single-vision (SV) spectacles versus MiSight (CooperVision) CLs, a specific concentric design for myopia control.
Subjects aged eight to 12 years old with myopia from –0.75D to –4.00D and astigmatism less than 1.00D were allocated to the lenses study group (MiSight) or control group (SV). A Pediatric Refractive Error Profile (PREP) questionnaire was administered at 12- and 24-month intervals to evaluate children’s perceptions in overall vision, near vision, far distance vision, symptoms, appearance, satisfaction, activities, academic performance, handling, and peer perceptions. The mean score of all items was calculated as the overall score.
In total, 74 children completed the study: n = 41 in the MiSight group, and n = 33 in the SV group. In the MiSight group, the ratings at 12 and 24 months for appearance, satisfaction, effect on activities, handling, and peer perceptions were significantly better than were those given by children in the SV group (P < 0.001), as was the overall score.
However, near vision was significantly better in the SV group at both 12 and 24 months (P < 0.001).
The authors concluded that MiSight CL wear for controlling myopia improves vision-related quality of life in children when compared with spectacle wear.
Pomeda AR, Pérez-Sánchez B, Cañadas Suárez MDP, Prieto Garrido FL, Gutiérrez-Ortega R, Villa-Collar C. MiSight Assessment Study Spain: A Comparison of Vision-Related Quality-of-Life Measures Between MiSight Contact Lenses and Single-Vision Spectacles. Eye Contact Lens. 2017 Jul 14. [Epub ahead of print]