As several reports have acknowledged, the primary reason why practitioners fit scleral contact lenses today is for the management of keratoconus. There is no doubt that these lens designs have had a significant impact in managing this disease. However, I think it is important to consider the potential impact of other technologies on this trend. For instance, we are concurrently seeing an increase in the use of corneal cross-linking in treating keratoconus. The abstract this week highlights a large multicenter clinical trial of the procedure for keratoconus, showing it to be both safe and efficacious.
Although the procedure is promising, we have managed keratoconus for many years both safely and efficaciously using contact lenses. What remains to be seen is the impact of procedures like this on the contact lens management of keratoconus and other related corneal irregularities. As Dr. Eiden notes in his column below, some surgical procedures can help in very complex contact lens fittings, while some might anticipate that some surgical procedures might reduce the need for complex contact lens fittings for the irregular cornea. Either way you look at it, the future appears bright in that we have many options for managing corneal irregularities going forward.
Jason J. Nichols, OD, MPH, PhD
Dr. Jonathan Talamo Joins Johnson & Johnson Vision as Chief Medical Officer
Johnson & Johnson Vision Care, Inc. recently announced Jonathan Talamo, MD, as its new chief medical officer (CMO) and worldwide vice president of Medical Affairs and Clinical Affairs for Johnson & Johnson Vision, which comprises both its Vision Care and Surgical businesses, starting in early July.
Dr. Talamo joins Johnson & Johnson Vision from Ocular Therapeutix, Inc., a public bio-pharma company, where he served as CMO. Prior to that, he owned a private medical practice for almost 20 years, specializing in refractive surgery, cataract surgery, and corneal transplantation.
Acuity Polymers Receives FDA Clearance for Two More GP Materials
Acuity Polymers, Inc. recently announced U.S. FDA clearance of the Acuity 58 (enflufocon B) GP contact lens and the Acuity 85 (oprifocon A) GP contact lens. Acuity 58 and Acuity 85 GP lenses will be available soon from custom contact lens laboratories in the United States and across the world.
The company hopes to have a fifth material cleared by the end of 2017. Most of the U.S. custom laboratories have qualified as alternate manufacturing sites for Acuity Polymers GP contact lenses. The company’s current offerings are Acuity 100, Acuity 85, Acuity 58, and Acuity 18.
Primary Eyecare Network (PEN), a division of ABB Optical Group, is presenting a myopia symposium on Aug. 6 from 7:30 a.m. to 2:30 p.m. at the San Ramon Marriot in San Ramon, CA.
The morning session will cover evidence-based management of progressive myopia, applying research to develop a myopia-control practice, and methods and potential pitfalls of corneal reshaping. The lunch session will cover wet lab training and certification and will provide practitioners with the instruction necessary to fit Paragon CRT Contact Lenses.
The symposium is pending approval for three hours of Council on Optometric Practitioner Education (COPE) credits.
Presenters include Yue Liu, OD, of the UC Berkeley School of Optometry; Dan Press, OD, of North Suburban Vision Consultants; and Craig Norman of the Vision Research Institute at Ferris State University's Michigan College of Optometry.
This free event is sponsored by ABB Optical Group and Paragon Vision Sciences. To register or for more information, visit PrimaryEye.net or e-mail firstname.lastname@example.org.
AAOF Announces 2017 Award of Excellence in Contact Lens Patient Care Recipients
The American Academy of Optometry Foundation (AAOF) announced the 2017 Johnson & Johnson Vision Award of Excellence in Contact Lens Patient Care program recipients. This award recognizes outstanding fourth-year student clinicians who have demonstrated excellent overall knowledge of the contact lens field plus skillful, considerate, and professional care of contact lens patients during their optometric education. Each winner receives a $500 educational award and a personalized plaque commemorating their accomplishment.
Jamie Blavat, Illinois College of Optometry Hailey Shaffer Williams, Indiana University at Bloomington School of Optometry Jessica Tu, Inter-American University of Puerto Rico School of Optometry Michael Belhumeur, Massachusetts College of Pharmacy and Health Sciences School of Optometry Austin Schipper, Michigan College of Optometry at Ferris State University Elizabeth Ledezma, Midwestern University Arizona College of Optometry Avani Dave, New England College of Optometry Jessica White, Northeastern State University Oklahoma College of Optometry Laura Jankiprasad, Nova Southeastern University College of Optometry Ashley N. Dues, The Ohio State University College of Optometry Paige Stephens, Pacific University College of Optometry Patrick O'Connor McManamon, Pennsylvania College of Optometry at Salus University Justine Gonzalez, Southern California College of Optometry at Marshall B. Ketchum University Rebecca Goad, Southern College of Optometry Azinda Morrow, State University of New York College of Optometry Kate Oliver, University of Alabama at Birmingham School of Optometry Andrew Vo, University of California Berkeley School of Optometry Allison Quirin, University of Houston College of Optometry Kelsey Haugen, University of Missouri-St. Louis College of Optometry Laurianne Trudeau, University of Montreal School of Optometry Tam Nguyen, University of the Incarnate Word Rosenberg School of Optometry Jonathan Ngoc Dinh, University of Waterloo School of Optometry and Vision Science Lilia Babakhan, Western University of Health Sciences College of Optometry
VisionPros.com Acquires LowestPriceContacts.com
VisionPros.com announced its acquisition of LowestPriceContacts.com. Lowest Price Contacts customers can now choose between the following brands of contact lenses: Alcon, Johnson & Johnson Vision, Bausch + Lomb, and CooperVision. In addition, VisionPros.com soon will be offering spectacles by Boss Orange, Tommy Hilfiger, Guess, and Diesel.
Leah Johnson Appointed Director of Clinical Services at Paragon Vision Sciences
Paragon Vision Sciences appointed Leah Johnson, OD, to the role of director, Clinical Services. In this role, Dr. Johnson will be responsible for clinical and professional development programs supporting current and future eyecare practitioners across the United States and abroad. She will report directly to Richard Jeffries, president, Paragon Vision Sciences.
Dr. Johnson brings practice-based clinical optometric experience in the area of specialty contact lenses to her new position. Prior to joining Paragon Vision Sciences, she was in private practice at Vision Optique in Houston. She is a graduate of the University of Houston College of Optometry, where she also completed her post-doctorate work in Cornea and Contact Lenses. Dr. Johnson’s published work includes research in specialty contact lenses.
GPLI and ODwire.org Partner on GPLIwire2017
ODwire.org, a social network for eyecare practitioners with more than 20,000 OD members, and the GP Lens Institute (GPLI) have collaborated to create GPLIwire2017, an online continuing education (CE) event focused exclusively on specialty contact lens education.
Participants can earn up to 32 COPE CE credits focused on specialty contact lenses from leading global eyecare experts with all-new lectures and live wet labs from the comfort of their own homes. The event will be hosted live online on Sept. 23 and 24, 2017.
For those who cannot attend live, the courses will also be offered on-demand following the live event until Dec. 1, 2017. Participants can log in from any broadband-connected computer or mobile device to take courses and receive credit.
2nd International Conference & Expo on Optometry and Vision Science
Conference Series LLC announced the 2nd International Conference & Expo on Optometry and Vision Science, being held Sept. 11 to 12, 2017 in Paris. The theme this year is “Advances in Diagnosis & Treatment of Vision: Vision for Life.”
The conference is being offered in accordance with the requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of PeerPoint Medical Education Institute and Conference Series, LLC.
Topics covered will include cornea and refractive surgery, imaging techniques, contact lenses, optometric diagnosis and management, optometric vision therapy, innovations in optometry, the top five innovations in eye education, vision insurance and vision plans, vision screening, and more.
A 39-year-old Hispanic male presented for a contact lens fitting. His history is significant for a penetrating trauma of the right eye at age 10, resulting in cataract extraction, scleral suture intraocular lens, and vitrectomy. The horizontal corneal scar resulted in flattening of the cornea and a with-the-rule toric corneal topography. The patient was successfully fit with a bitoric GP lens and piggyback soft lens. Vision improved from 20/300 in spectacles to 20/50 with the contact lens.
We thank Dr. Kitamata-Wong 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
Synergy of Scleral Lens Management and Oculoplastic Services in Eyecare Practice
The past decade has shown a great increase in the use of scleral contact lenses for the management of irregular cornea conditions, ocular surface disease, and other ophthalmic conditions and diseases. Much closer relationships have been established between those eyecare practitioners who provide advanced scleral contact lens services and subspecialties within ophthalmology such as cornea and anterior segment disease specialists. Attention should also be given to the potential for synergy between scleral lens specialists and oculoplastic specialists. Numerous conditions exist in which these two subspecialties can work together for the benefit of our patients.
A recent article reviewed such a relationship between the contact lens service and oculoplastic service at the University of Iowa.1 The intent of this study was to describe the role and efficacy of scleral contact lenses (SCLs) in the treatment of progressive keratopathy in patients who have undergone periocular surgical procedures; to investigate the financial impact of these surgical interventions; and to demonstrate the role of oculoplastic surgery in improving scleral contact lens fit. A retrospective medical record review was performed to identify patients who both received SCLs and were examined by the oculoplastics service. The indication for SCL use, as well as clinical outcomes of prior oculoplastic treatments and SCL therapy, were recorded for each patient.
During the 25-year study period, 659 patients were fitted with SCLs at the authors’ institution; 43 of those patients were examined by the oculoplastics service for reasons related to their SCL, and 27 of those had surgery. Patients who were fit with SCLs before or after evaluation in the oculoplastics clinic presented with a variety of corneal and periocular pathology. Indications for oculoplastic clinic evaluation in current scleral lens patients included lagophthalmos, trichiasis, epiphora, cicatricial changes in the eyelids or fornices, and eyelid or eyebrow malposition affecting SCL centration. In all of the 27 patients mentioned above, surgical intervention resulted in improved SCL centration. Procedures performed before referral for SCLs included tarsorrhaphies, gold weights, ectropion repair with lateral tarsal strip, retraction repair with spacer grafts, full-thickness skin grafts, cheek lifts, and punctal occlusion.
The authors concluded that scleral contact lenses may offer a useful alternative to stabilize the ocular surface, improve vision, and minimize the financial impact and morbidity of multiple periocular procedures in select patients who have progressive keratopathy of varying etiologies. The therapeutic indications and utilization of SCLs are likely to increase in oculoplastic practices with optometric support, particularly in academic settings. Surgical correction of eyelid and eyebrow malposition, as well as epiphora, may also be useful adjunctive procedures to optimize SCL fit.
I can tell you from my personal experience of having an oculoplastic surgeon join our practice almost three years ago that the impact on our scleral lens service has been remarkable. Our oculoplastic surgeon has referred patients to our associates who fit our scleral lenses to address a number of ophthalmic conditions; respectively, our scleral lens specialists have referred to our oculoplastic surgeon for a variety of surgical procedures. Of special note has been the success of conjunctival chalasis surgery on affected patients in addition to the impact of lid positioning on the fitting of scleral lenses. I urge those of you who are involved in scleral lens management to establish a mutually beneficial relationship with an oculoplastic surgeon. You will be pleasantly surprised with how well such a relationship can work.
1. Chahal HS, Estrada M, Sindt CW, Boehme JA, Greiner MA, Nerad JA, Carter KD, Allen RC, Shriver EM. Scleral Contact Lenses in an Academic Oculoplastics Clinic: Epidemiology and Emerging Considerations. Ophthal Plast Reconstr Surg. 2017 May 22. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Two week’s time seems to roll around pretty quickly for me these days. I was reminded that I missed my biweekly Contact Lenses Today submission deadline and quickly needed a topic for my contribution. Looking back on my postings, I recognized that I think a lot about eyelashes. We’ve discussed mascara, mascara application, mascara removal, lash growth with lid hygiene, oily lashes, and dry eye blepharitis syndrome (DEBS).
Yet, there is still much to consider regarding all of the “stuff” patients apply to their eyelashes of which we are not aware. This, thereby, forces the question of the impact of these “products” to the eyelashes, lids, and ocular surface.
A walk through the cosmetic counters at any fine department store or health food store will demonstrate the myriad of eye makeup removers available. These products have oils, botanicals, fragrances, and coloring. Solutions/suspensions may be bi-phasic, oily or non-oily, and opaque-looking or clear. Your patient could be using baby oil, coconut oil, olive oil, or petroleum jelly on their lashes. Soaps, creams, lotions, gels, etc.…the list goes on detailing the creative ways that patients (both men and women) clean their lashes (or not).
Please ask what your patients are using for lash hygiene. Let’s create our CLT list to see how many products we can collect.
United States Multicenter Clinical Trial of Corneal Collagen Crosslinking for Keratoconus Treatment
The purpose of this prospective, randomized, multicenter, controlled clinical trial was to evaluate the safety and efficacy of corneal collagen cross-linking (CXL) for the treatment of progressive keratoconus. Study participants included patients who have progressive keratoconus (n = 205). The treatment group underwent standard CXL, and the sham control group received riboflavin alone without removal of the epithelium.
The primary efficacy criterion was the change over one year of topography-derived maximum keratometry value, comparing treatment with control group. Secondary outcomes evaluated were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent, endothelial cell count, and adverse events.
In the CXL treatment group, the maximum keratometry value decreased by 1.6D from baseline to one year, whereas keratoconus continued to progress in the control group. In the treatment group, the maximum keratometry value decreased by 2.0D or more in 28 eyes (31.4%) and increased by 2.0D or more in five eyes (5.6%). The CDVA improved by an average of 5.7 logMAR units. Twenty-three eyes (27.7%) gained and five eyes (6.0%) lost 10 logMAR units or more. The UDVA improved 4.4 logMAR units. Corneal haze was the most frequently reported CXL-related adverse finding. There were no significant changes in endothelial cell count one year after treatment.
The authors concluded that CXL was effective in improving the maximum keratometry value, CDVA, and UCVA in eyes with progressive keratoconus one year after treatment, with an excellent safety profile. CXL affords keratoconus patients an important new option to decrease progression of this ectatic corneal process.
Hersh PS, Stulting RD, Muller D, Durrie DS, Rajpal RK; United States Crosslinking Study Group. United States Multicenter Clinical Trial of Corneal Collagen Crosslinking for Keratoconus Treatment. Ophthalmology. 2017 May 7 [Epub ahead of print]