There is ever-growing interest from both our profession and our patients in safe and effective treatments that slow the progression of myopia. Options for treating myopia progression include both optical and pharmaceutical means (although not all have regulatory approvals with specific indications). This week’s abstract shows, in the context of the study design used, that orthokeratology seems to do better compared to 0.02% atropine in slowing axial elongation. We look forward to seeing more data as it relates to the various treatments being used alone as well as in combination with one another.
Jason J. Nichols, OD, MPH, PhD
Haag-Streit and SimulEye Create Lenstar Shield
SimulEye has joined forces with Haag-Streit to create the Lenstar Shield, which is made for Haag-Streit’s Lenstar biometer. The shield is made from thick-gauge and durable materials that can be easily sanitized, according to the companies. Additionally, it uses a proprietary magnet system that facilitates installation, removal, and cleaning.
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.
GSLS 2020 Encore Introduced
Were you unable to attend the Global Specialty Lens Symposium (GSLS) live in 2020? Or, perhaps you were in Las Vegas but missed out on attending a few breakout sessions? GSLS is introducing GSLS 2020 Encore!
On June 22, Gloria Chiu, OD, and Alan Kwok, OD, will lead an encore presentation of their GSLS 2020 CE Breakout: "Do No Harm: When is a scleral lens more detrimental than beneficial?" The session will take place at 8:00 p.m. EST. This session is COPE approved for one hour of live CE. This activity is supported by an unrestricted educational grant from BostonSight and Contamac. To register, visit https://bit.ly/gslsencore62220.
Next IMI Consensus Reports Will Be Published in Early 2021
The International Myopia Institute (IMI) has re-focused its efforts to ensure that it can deliver planned consensus reports in early 2021.The IMI consensus group of key clinical researchers, scientists, and eyecare practitioners continues its efforts to advance myopia research, education, and advocacy. The International Myopia Institute had a recent online meeting to plan for the publication of new white papers. These new white papers, which continue from the initial papers published in 2019 in Investigative Ophthalmology and Visual Science (IOVS), serve to bring consensus to areas not previously addressed. Taskforces have been set up for the following areas: impact of myopia, pediatric high myopia, high myopia in adults and its associated complications, preferred practice patterns (PPPs), environmental risk factors in myopia, accommodation and binocular vision in myopia, and yearly digest 2020.
AI Improves Eye Exam Accuracy
Researchers have developed an online vision test—fueled by artificial intelligence (AI)—that produces much more accurate diagnoses compared to the Snellen chart. If perfected, they predict that the test could also help patients who have eye diseases track their vision at home.
Chris Piech, a computer scientist at Stanford University, wanted to find a way to remove the inherent human error from the Snellen exam while improving the exam’s accuracy. So, he and his colleagues developed an online test. After calibrating their screen, users enter their distance from the screen. The test then displays an “E” in one of four orientations. Based on the answer, the algorithm then uses statistics to make a prediction for a vision score. As the test progresses, the algorithm is able to make a more accurate prediction about the score. The test asks 20 questions per eye and takes several minutes to complete. Results from a recent study of the AI system—known as the Stanford Acuity test (StAT)—appear in the Proceedings of the AAAI Conference on Artificial Intelligence. To try StAT, visit https://myeyes.ai.
Myopia Management Certificate Launched by BCLA
A newly launched certificate in myopia management from the British Contact Lens Association (BCLA) will allow eyecare professionals to translate the latest global research findings to their clinical practice as part of a drive to boost awareness of myopia. The online course will feature six recorded lectures and will include the latest evidence-based research presented in an easily accessible format. The lectures are delivered by a panel of renowned myopia management experts from around the world, including Gillian Bruce, Professor Pauline Cho, Professor Ian Flitcroft, Dr. Nicola Logan, and Professor Kathryn Saunders. This program is open to all BCLA members.
The BCLA Principles of Myopia Management certificate will be issued on successful completion of the course and one relevant myopia or myopia management workshop or peer review and after passing a final Viva Voce style examination. This certificate, which is inclusive of BCLA membership, gives access to all course materials and additional resources and will need to be renewed every four years.
AAOF Announces the 2020 Joe and Janet Barr Early Career Cornea and Contact Lens Research Award Recipient
The American Academy of Optometry Foundation (AAOF) announced the recipient of the Joe and Janet Barr Early Career Cornea and Contact Lens Research Award. Sidra Sarwat is a first-year PhD candidate at the School of Optometry and Vision Science, University of New South Wales. Her research project, titled “In Vivo Labelling and Bioimaging of the Tear Film Using Silicon Quantum Dots,” was chosen out of the six applicants who applied for the award. The award provides a first- or second-year MS or PhD vision science or physiological optics student with a $2,000 research project seed fund in the area of cornea/ocular surface or contact lenses.
Acuvue RevitaLens Multi-Purpose Disinfecting Solution Available in Canada
Johnson & Johnson Vision unveiled the first-ever extension of the Acuvue brand name beyond contact lenses with the launch in Canada of its Acuvue RevitaLens Multi-Purpose Disinfecting Solution, which is now available at major retailers nationwide.
Sara Yost Appointed to GPLI Board of Directors
BostonSight announced that President and CEO Sara Yost, MBA, has been appointed to the board of directors of the GP Lens Institute (GPLI). Ms. Yost joined the BostonSight staff in July 2002, holding several positions in administration, operations, and finance, including three years as CFO managing the financial well-being of BostonSight.
Lensabl Offers Contact Lenses for Home Delivery
Lensabl is now selling contact lenses in its online store. According to the company, the offering includes all major contact lens brands. This move into contact lenses has been in the works for over a year, according to Lensabl. The company also offers an online vision test that allows customers to renew and extend their expired contact lens and spectacle prescriptions through their computer or smartphone.
Janice Chau, Philadelphia, PA
This image shows staining from dimple veiling after one night of orthokeratology lens wear.
We thank Janice Chau 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.
SPECIALTY LENS SPACE
Karen DeLoss, OD
Air bubbles with specialty lenses can cause many problems. With GP lenses, these bubbles usually indicate a fitting relationship issue, commonly too steep.1 However, with both scleral and hybrid lenses, it’s not always that simple. The first thing that a practitioner needs to decipher is whether it is user error or a fitting issue. User error means that either the patient or staff who are involved with the application have created the bubble through improper technique. For staff, or even practitioners who are new to specialty lenses, this can be resolved through observation and feedback; this can be as simple as a more user-friendly application position. For patients, I find that it is best to observe them or even to have them revisit the application and removal education. This provides an opportunity to see whether patients are filling the bowl of the lens completely or holding lids properly, among other issues.
With respect to fitting issues with hybrids or sclerals, it comes down to a careful inspection of the fitting relationship of the cornea and the conjunctiva. While hybrids are usually steeper compared to average keratometry readings, large bubbles within the center mean revisiting the fit and likely ordering a flatter center. For bubbles within the skirt, if consistent, an adjustment to a flatter skirt will resolve the issues.
For sclerals, more times than not, there is edge lift on the sclera. Lifting the lids and having the patient look in different directions will help elucidate the area of bubble intrusion. When examining the area, a large shadow will appear on the conjunctiva when using the slit lamp. Or, if you press on the conjunctiva past the edge of the lens but near the area of suspicion, you will likely burp a bubble under the lens. Alternatively, you can use sodium fluorescein and a Wratten filter to look for areas of air intrusion.
Ultimately, the main take home point is to figure out whether it’s operator error or fitting/anatomical error.
1. Ramdass S. Not All Bubbles Are Created Equal. Contact Lens Spectrum. 2020 Jun;35:14.
MATERIALS & DESIGNS
David L. Kading, OD
Bring It Together
How many times do we let those 0.75D to 1.00D astigmats slide? Too often, we use spherical equivalents for these patients; it works, and everyone is satisfied. Did you ever stop and think: I wonder whether these patients would be better if I showed them a correction with cylinder? Even though patients can read the eye chart and might not complain of the decreased clarity, there is a chance that things could be better for them.
For patients who have this small amount of cylinder, we always attempt a daily disposable toric lens and see what the outcome is. Within about five minutes, we usually know whether patients are going to appreciate the difference. If they notice variability to their vision, the lens is out. If they notice more halos and glare, then the lens is likely rotated.
The option takes a moment to try, and many patients can benefit and would be really appreciative. It’s worth the shot.
Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control
The purpose this study was to compare the efficacies of 0.02% atropine eye drops and orthokeratology to control axial length (AL) elongation in children who have myopia.
In this historical control study, 247 children were enrolled. The participants had myopia and had been administered 0.02% atropine (n = 142) or had undergone orthokeratology from an earlier study (n = 105, control group). Data on AL and other parameters were recorded at baseline and after one and two years of treatment.
The mean changes in AL in the first and second years of treatment were 0.30mm ± 0.21mm and 0.28mm ± 0.20mm, respectively, in the 0.02% atropine group and were 0.16mm ± 0.20mm and 0.20mm ±0.16mm, respectively, in the orthokeratology group. Axial length elongations after two years of treatment were 0.58mm ± 0.35mm and 0.36mm ± 0.30mm (P = 0.007) in the 0.02% atropine and orthokeratology groups, respectively. Multivariate regression analyses showed that the AL elongation was significantly faster in the 0.02% atropine group than in the orthokeratology group (β = 0.18, P = 0.009). In multivariate regression analyses, younger age and shorter baseline AL were associated with a rapid AL elongation in the 0.02% atropine group (βage = –0.04, P = 0.01; βAL = –0.17, P = 0.03), while younger age, lower baseline spherical equivalent refractive error (SER), and shorter baseline AL were associated with a greater increase in AL in the orthokeratology group (βage = –0.03, P = 0.04; βSER = 0.06, P = 0.03; βAL = –0.11, P = 0.009). Faster AL elongation was found in the 0.02% atropine group compared with the orthokeratology group at higher baseline SER (P = 0.04, interaction test).
Within the limits of this study design, the authors determined that orthokeratology seems to be a better method for controlling AL elongation compared with administration of 0.02% atropine in children who had higher myopia over a treatment period of two years.
Lyu Y, Ji N, Fu AC, et al. Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control. Eye Contact Lens. 2020 May 14. [Online ahead of print]