While increasing the replacement frequency of contact lenses can help prevent lenses from spoiling, we know that soft lens materials deposit within minutes to hours on the eye. While understanding the correlation between deposition and clinical performance of contact lens materials is not always straightforward, most would agree that deposition is generally problematic.
For example, proteins associated with the tear film can become denatured when bound to contact lenses, and lipids associated with the tear film could make lens materials more hydrophobic given that most of the meibum is composed of wax and cholesterol esters (both of which are highly hydrophobic). Yet, at the same time, some deposition could help contact lens materials improve biocompatibility with the ocular surface.
Ultimately, understanding this complex relationship between deposition and clinical performance of contact lens materials is critical to helping contact lens wearers achieve long-term success.
Jason J. Nichols, OD, MPH, PhD
Allergan Introduces Refresh Optive Mega-3
Allergan plc launched the over-the-counter (OTC) artificial tear Refresh Optive Mega-3, which is formulated with flaxseed and castor oil, two natural, plant-based oils that protect tears from evaporating while nourishing the lipid layer damaged by dry eye and providing essential hydration to all three layers of the tear film, according to the company.
Mega-3 also contains carboxymethylcellulose (CMC), an active lubricant found in all Refresh Optive formulas. All Optive products also contain the patented osmoprotectant formula that includes three compatible solutes—glycerin, I-carnitine, and erythritol—all of which deliver added protection to the corneal epithelial cells against hypertonic stress, according to Allergan. Refresh Optive Mega-3 contains a fourth osmoprotectant, trehalose.
Mega-3 is available in 30-count single-use vials and can be found nationwide at various retail locations where OTC eye drops are sold.
Dry Eye Is the Focus of New BCLA Education Program
The British Contact Lens Association (BCLA) launched a new CET-accredited program that will focus on clinical skills for Ocular Surface Health (OSH) and Dry Eye, allowing BCLA members to gain CET points while working toward a Dry Eye certificate or a higher level to lead to a BCLA Fellowship. According to the BCLA, the program is in response to what is seen as the “changing face of the profession.”
A BCLA Dry Eye Certificate will be issued on successful completion of the course. The certificate can be achieved by any optometrist or CLO who attains six credits and a final OSCE-style examination. The six credits are available from five online modules and one relevant Dry Eye or OSH workshop, peer review, or lecture (GOC approved validated with CE number). This certificate will need to be renewed every four years.
In unrelated news, Dr. Michael Read, new technologies manager at Eurolens Research in the Faculty of Biology, Medicine and Health at The University of Manchester, has been appointed as BCLA Fellowship Consultant and will be tasked with overseeing the current scheme and developing it in the years to come.
Since the scheme was launched in 2006, a total of 222 professionals from the international contact lens community have become BCLA Fellows following viva voce assessment at the BCLA Clinical Conference and BCLA Asia. For more information about BCLA Fellowships, visit www.bcla.org.uk.
GPLI Develops Student Scleral Lens Program
The GPLI’s GP Lens Committee announced the development of a new Student Scleral Lens Program. The program will be scaled based on the number of students at each North American school or college of optometry. There will be a basic or advanced program, which will include an introduction lecture from a local GPLI Advisory board member followed by a hands-on workshop. These will be running continuously throughout the year based on the requested time frame by each school or college of optometry.
AOA Launches Health Policy Institute
The American Optometric Association (AOA) launched the AOA Health Policy Institute (HPI), a policy think tank that will develop evidence-based research, analysis, and solutions in healthcare policy.
HPI will be under the direction of past president Steven A. Loomis, OD, and AOA staff member Rodney Peele, JD, as director. According to the organization, HPI will build on and supplement the work begun by the National Commission on Vision and Health (NCVH) almost 10 years ago. The NCVH, a national, non-partisan group of public health leaders—including leading doctors of optometry—works to improve the nations’ visual health by helping assure access to vision care as an integrated part of public health programs at the national, state, and local levels.
Novaliq Appoints Gabriela Burian as Chief Medical Officer
Novaliq GmbH appointed Gabriela Burian, MD, MPH, as its Chief Medical Officer (CMO). Dr. Burian brings more than 25 years of international clinical experience to the company. She is responsible for leading the company’s global clinical development and regulatory efforts as well as expanding the company’s proprietary ocular therapeutics pipeline. Previously, Dr. Burian held various leadership positions at Novartis Pharma and F. Hoffmann-La Roche. She founded and directs GB Biomed Advisors GmbH and serves as CMO for Iconic Therapeutics, Inc. She is a faculty member of the European School for Advanced Studies in Ophthalmology. Dr. Burian will join Novaliq’s executive management team, reporting to the company’s managing director and CEO Christian Roesky, PhD.
Sonja Krösser, PhD, vice president of preclinical and clinical development, will continue to lead Novaliq’s dry eye developments and remains responsible for the preclinical and clinical team.
Our Children’s Vision Hosts Major League Baseball Event
Our Children’s Vision, a global initiative upscaling, accelerating, and expanding eye health services to more children around the world, hosted a free vision event in collaboration with Major League Baseball Players Trust, KaBOOM, and Room2Bloom!. The event took place in Opa-Locka, Miami on July 8 as part of a playground build for the community. Our Children’s Vision teamed with Brien Holden Vision Institute, VSP Global Eyes of Hope, Essilor Vision Foundation, Florida’s Vision Quest, Nova Southeastern University College of Optometry, and The Optical Foundation to provide children of the community with free vision assessments while they play.
Do you ask your scleral lens wearers to remove and reapply their contact lenses midday, each day?
Summer in Cyprus, room temperature 82.4º F/28º C. This patient needed a vault of 350µm, but due to the toric periphery, we tried a 400µm vault with a toric scleral haptic zone. Before I realized what was going on, I got this pretty picture. The image shows small bubbles in the saline, which were formed when the patient’s warm body temperature interacted with the cool saline.
We thank Kyriakos Telamitsi 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, PhD
Parental Permission for Contact Lenses
I have met many patients who have told me that their practitioner told them that they could not wear contact lenses. After closer examination, however, I have found that a large portion of these patients just had low levels of astigmatism, presbyopia, or they were children—all of whom can be relatively easily treated with contact lenses. This failure to offer all of the available treatment options to our patients is a disservice to them and to the eyecare community.
One of my most recent endeavors related to this topic is opening the Myopia Control Clinic at UAB Eye Care at the University of Alabama at Birmingham School of Optometry. A primary aim of this clinic is to offer progressing myopes the option to be fitted with multifocal or orthokeratology contact lenses, or treated with atropine.1-3 While all three of these treatments involve educating my patients and usually their parents about the potential benefits of electing to start myopia control (which remains an off-label use), I have found that some parents are particularly concerned about allowing their children to wear contact lenses, a hurdle that must be overcome before I can initiate treatment.
A study by Zeri et al highlights the negative sentiment held by some parents regarding their children wearing contact lenses.4 Specifically, the study found that only 62% of parents supported their child wearing contact lenses even though 77.5% of children were interested in wearing contact lenses.4
Zeri and colleagues also found that parents think that contact lenses are significantly less safe for children than for the general population.4 While it is true that contact lenses are not a good option for all children, there is evidence indicating that contact lenses are not only safe for children, but that certain contact lenses can reduce their myopia development by about 50% while also improving their self-esteem.1, 2, 5, 6 I believe that it is our charge to educate not only our patients but also their parents (when applicable) about the benefits of contact lenses. Ultimately, parents will likely be the deciding voice as to whether their child starts wearing contact lenses.7
1. Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Curr Eye Res. 2005 Jan;30:71-80.
2. Walline JJ, Greiner KL, McVey ME, Jones-Jordan LA. Multifocal contact lens myopia control. Optom Vis Sci. 2013 Nov;90:1207-1214.
3. Chia A, Chua WH, Cheung YB, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012 Feb;119:347-354.
4. Zeri F, Durban JJ, Hidalgo F, Gispets J; Contact Lens Evolution Study Group. Attitudes towards contact lenses: a comparative study of teenagers and their parents. Cont Lens Anterior Eye. 2010 Jun;33:119-123.
5. Walline JJ, Lorenz KO, Nichols JJ. Long-term contact lens wear of children and teens. Eye Contact Lens. 2013 Jul;39:283-289.
6. Walline JJ, Gaume A, Jones LA, et al. Benefits of contact lens wear for children and teens. Eye Contact Lens. 2007 Nov;33:317-321.
7. Li L, Moody K, Tan DT, Yew KC, Ming PY, Long QB. Contact lenses in pediatrics study in Singapore. Eye Contact Lens. 2009 Jul;35:188-195.
MATERIALS & DESIGNS
David L. Kading, OD
Every Day Is a New Toric Day
Five years ago, I noted that my daily disposable lens usage was low. I came up with all kinds of excuses. Among the biggest was that daily disposable lenses didn’t have many power options. Nevertheless, we concluded as an office that we were going to move as many people as we could to the modality. After one year of making that commitment, we shot up to 69% daily disposable usage.
The following year, a surge of toric and multifocal daily disposable lenses entered into the marketplace. With our commitment to move as many people over to daily disposable lenses as possible, we are proud to report that our prescribing frequency is now at 92%.
Your number one excuse may still be cost—and you can read other columns from me on why I think that this is a poor excuse—but we can really no longer blame parameters. Many manufacturers have come out with premier multifocal lenses in the daily disposable modality. Further, with new introductions this past spring for astigmatism, we now have more toric options.
If you have not moved your patients who wear torics and multifocal lenses into a daily disposable, may I urge you to start working to advance your practice with newer modalities?
Imaging Approaches for Contact Lens Deposition
Deposition on contact lenses (CLs) starts quickly after their application to the ocular surface. Deposits may be composed of tear film components or other extraneous substances. These deposits have been related to various adverse conditions of the eye, leading to reduced biocompatibility between the CLs and the ocular surface. Analysis of these deposits is essential to better elucidate the relationship between these deposits and their adverse reactions so that better methods of increasing biocompatibility can be developed.
Although methods such as enzymatic assays are available for quantitative analysis, they do not provide a complete picture of the deposition (e.g., lack of morphological details); therefore, the use of imaging methods that can provide both qualitative and quantitative information about the deposits may be more preferable. A search of the peer-reviewed literature that focused on imaging methods in the analysis of deposits on CLs was conducted and various methods of imaging deposits in-vitro, in-vivo, or ex-vivo were described along with the associated results.
Imaging methods using fluorescence-based techniques and scanning electron microscopy appear to be the more frequently used methods. Some of the described methods not only provided morphologies but also identified the types of various deposits that were attached to the CLs. Various CL materials possessed different deposition morphologies and different quantities of the attached deposits.
The authors recommend that further imaging studies be performed in conjunction with other methods that could identify and quantify the deposits at a molecular level.