Although I am sure some would argue with this statement, I believe that we do not have a really comprehensive scientific understanding of comfort differences associated with different contact lens polymers (or designs for that matter). Sure, we will occasionally see head-to-head studies comparing some select materials (and/or designs) and we all have experience with our patients with different contact lenses, but these perspectives are not really what I mean in a comprehensive sense. I think such a perspective would be of significant value and serve as a strong basis in understanding the complexities of contact lens discomfort experienced by so many of our patients.
Jason J. Nichols, OD, MPH, PhD
Parion Initiates Phase 2 Clinical Trial of P-321 for the Treatment of DED
Parion Sciences announced it has initiated a phase 2 clinical trial of P-321 Ophthalmic Solution in patients with Dry Eye Disease (DED). P-321 is a potent inhibitor of the epithelial sodium channels (ENaC) on the ocular surface, and according to the company, is expected to restore the tear film on the ocular surface in those patients with dry eye disease. Earlier this year the results of a Phase 1/2a safety, tolerability, and pharmacokinetics study in subjects with dry eye were presented.
The new trial, study P-321-202, is an assessment of the impact of P-321 on dry eye symptoms as well as clinical signs of dry eye disease and safety. Parion expects to enroll approximately 60 patients in the randomized, double-masked, parallel group study of P-321 Ophthalmic Solution compared to placebo in patients with dry eye disease over 28 Days. The purpose of this study is to evaluate the effect of treatment with P-321 Ophthalmic Solution on dry eye symptoms. Patient enrollment has begun and the first patient has been enrolled in the trial. For additional information on this study, please refer to the following link on ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/NCT02831387.
The epithelial sodium channel (ENaC) plays a key role in the regulation of tear film fluid and is therefore an attractive target for the treatment of dry eye, according to the company. Studies with preclinical models of dry eye disease have demonstrated that by blocking ENaC, the tear film volume could be restored, maintaining its protective and lubricating actions on the ocular surface. P-321 is the result of a comprehensive research effort to develop a potent ENaC inhibitor with unique pharmacokinetic and pharmacodynamic characteristics designed for topical ocular administration, metabolic stability and limited systemic exposure.
Comfort Vision announced the addition of a 90-Pack configuration for ProOcular daily disposable contact lenses, which provide patients with the benefits of trusted polymacon material and the advantages of a unique Duel Aspheric Lens design - resulting in a healthier and more comfortable contact lens-wearing experience, according to the company.
ProOcular daily contact lenses were added to Comfort Vision’s product portfolio through the company’s pharmaceutical company Carlsbad Tech. Until now, ProOcular daily disposable lenses were available only in 30-pack cartons.
Papers and Posters GSLS 2017 Submission Deadline Approaching
The Educational Program Committee of the Global Specialty Lens Symposium invites the submission of abstracts for the Free Paper Section and the Scientific Poster Competition. Papers and posters related to presbyopia, keratoconus, corneal topography, post penetrating keratoplasty or related irregular corneal surface, myopia control, orthokeratology and lens care topics are welcome.
The GSLS will be held January 19-22, 2017 at The Rio Hotel in Las Vegas, Nevada. Visit www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2016.
Marisa Tomei to Help Raise Awareness of Chronic Dry Eye
Actress Marisa Tomei is partnering with Allergan plc to raise awareness and educate consumers about Chronic Dry Eye disease (CDE). Tomei was recently diagnosed with a type of CDE and hopes that by sharing her story she can help others learn more about the disease and encourage them to speak with their eye doctors.
As part of this partnership, it was also announced that Allergan will be donating $1 for every Dry Eye Quiz taken on Restasis.com to Guide Dogs for the Blind, a charitable organization that empowers the lives of the visually impaired by fostering exceptional partnerships between people, dogs and communities.* This donation reflects Allergan's ongoing commitment and dedication supporting eye health.
* For every Dry Eye quiz taken on Restasis.com from July 25, 2016 through December 31, 2016, Allergan will donate $1 to Guide Dogs for the Blind, with a minimum donation of $50,000 and a maximum donation of $100,000.
AOF 2016 Student Giving Matching Travel Grant Recipients
The American Optometric Foundation (AOF) announced the recipients of the 2016 AOF Student Giving Matching Travel Grant Program. The program was created in 2014 to increase participation in the American Academy of Optometry student chapters and create a climate of giving to the AOF. Students are encouraged to raise $750 and the AOF will match it in order to support travel for students to attend the Academy annual meeting.
The 2016 recipients and the participating institutions are: Jennifer M. Sitko, Indiana University School of Optometry; Sara Marie Siebert, Indiana University School of Optometry; Thomas B. Lambert, University of Missouri -St. Louis College of Optometry; Taylor Dahms, University of Missouri -St. Louis College of Optometry; Jacqueline Duong, Northeastern State University Oklahoma College of Optometry; Amy Field, Northeastern State University Oklahoma College of Optometry; Catherine D'Ardenne, State University of New York College of Optometry; Ryan Nguyen, State University of New York College of Optometry; Katharine Funari, Pennsylvania College of Optometry at Salus University; and Samantha Myers, Pennsylvania College of Optometry at Salus University.
CARE SOLUTION CORNER Andrew D. Pucker, OD, PhD, FAAO
Health Literacy and Ophthalmic Care
Health literacy has been defined as “the ability to apply reading and numeracy skills in a health care setting.”1 While understanding medical terminology may seem easy to health care professionals, it is not a trivial task for the more than 75 million Americans who have inadequate health literacy skills.1 Also, an understanding of health literacy is particularly important in eye care because patients with reduced visual acuity are more likely to have lower health literacy.2 The health literacy epidemic is highlighted by Williams et al.’s seminal work on the topic.3 In their 1995 study, Williams et al. found that up to 33% of patients were unable to understand the instructions for a common medical procedure when the instructions were given at a fourth-grade reading level, up to 58.2% of patients were unable to understand the directions for taking a medication, and up to 20% of patients were unable to correctly answer questions about their next scheduled appointment.3 America’s influx of immigrants and increasing population age are expected to further decrease health literacy in the coming years.1 These findings are particularly alarming because not following a doctor’s instructions has been associated with severe illness and even death.1,3
Since this early health literacy research, the ophthalmic community has made efforts to reduce the reading level of educational materials; however, many documents are still at a level beyond what some patients can comprehend without significant help.1 With this in mind, I encourage you to review your own documents and think about how to present information in a way that patients of all levels can comprehend. You may consider improving compliance by taking time to speak with your patients and having them repeat the plan back to you.1 You could also create educational documents (e.g., contact lens care instructions) that have lots of “white space” and are at a low reading level (grade 4), so your patients are not intimidated by your materials.1 These principles should be applied to all patients because there is no easy way to identify patients with low health literacy.3 Research has also found that most patients with high health literacy prefer easy to follow documents, so you should not need to worry about offending your highly educated patients with low reading level documents.1
1. Muir KW, Lee PP. Health literacy and ophthalmic patient education. Surv Ophthalmol. 2010;55:454-459.
2. Press VG, Shapiro MI, Mayo AM, Meltzer DO, Arora VM. More than meets the eye: relationship between low health literacy and poor vision in hospitalized patients. J Health Commun. 2013;18 Suppl 1:197-204.
3. Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274:1677-1682.
I was discussing soft keratoconus lenses with my contact lens fellow and student intern this past week prior to us fitting a patient into a design. Doing so brought us to the discussion of what makes these lenses so unique and complex. Although these are soft lenses, and we all might consider soft lenses more of a “commodity”, the uniqueness of a custom soft lens needs to be appreciated and reflected upon to truly understand its beauty.
Like a GP lens, most of our soft lenses start off as a hard button. The lens is lathed down to its specified parameters through techniques similar those used to make a custom GP lens. Then the real magic happens. The lens needs to go through a hydration process. This process has to be carefully regulated in order to keep the multiple base curves, diameters of the overall lens and zones. Additionally, the power and prism ballast need to be maintained.
I don’t know about you, but I constantly marvel at how our modern lathing creates our specialty GP and scleral lenses with such precision. But understanding that the calculation of all the parameters of the lens need to be taken into account for a finished hydrated lens prior to the lathing just blows my mind.
Our laboratory partners maintain a level of quality assurance for these processes that would just baffle most of us. Remember to thank them for their precision the next time you speak to them.
Subjective Comfort and Physiology with Modern Contact Lens Care Products
These researchers wanted to compare subjective comfort and ocular physiology with three multipurpose solutions (MPSs) to that of a peroxide-based system with three different soft contact lens materials.
Habitual soft contact lens wearers (n = 236) were enrolled at three sites and completed a washout period with no contact lens solution for ≥4 days. Subjects were randomly assigned to one of three lens types: etafilcon A, galyfilcon A, or senofilcon A. A new lens of the assigned type was worn for 10 to 14 days each while using one of four care solutions, in random order (A—polyaminopropyl biguanide + polyquaternium, B—POLYQUAD + Aldox, C—alexidine + polyquaternium-1, and D—hydrogen peroxide) with a washout period (≥4 days) between each solution. After each care solution, biomicroscopy was performed and subjective comfort was assessed using the Contact Lens User Experience (CLUE) questionnaire and other instruments including comfortable wear time (CWT). Linear mixed models were used for analysis. Comfort and biomicroscopy signs with each MPS were compared to that of the peroxide solution.
CLUE Comfort score across all lens types with each MPS was not significantly different than with the peroxide solution (p = 0.98). There were no differences in CWT between each MPS and the peroxide solution for any lens type (range of differences: −0.8 to 0.8 h; all p ≥ 0.13). Six MPS/material combinations had no clinically meaningful change in corneal staining versus peroxide (<0.5 units); three combinations could increase staining by up to 0.57 units. Staining was <grade 1 for all combinations.
Researchers concluded that comparable levels of comfort were found between the latest generation of MPSs compared to peroxide disinfection. Three MPS/material combinations tested could result in increased corneal staining of up to 0.57 units versus a peroxide solution. Overall, these data suggest the care systems investigated are generally appropriate for use with the contact lenses tested.
Berntsen DA, Hickson-Curran SB, Jones LW, Mathew JH, Maldonado-Codina C, Morgan PB, Schulze MM, Nichols JJ; Performance of Contact Lens Solutions Study Group. Subjective Comfort and Physiology with Modern Contact Lens Care Products. Optom Vis Sci. 2016 Aug;93(8):809-19.