Contact Lens Spectrum started publishing the annual dry eye issue of the journal 10 years ago next month. It is remarkable to look back through those dedicated issues to see where we have been and where we are headed. For example, while symptom assessment and tear breakup time still remain the preferred diagnostic methodology of our readers, it is noteworthy to see how expansive our diagnostic approaches have become with all of the new technologies that we have today compared to just 10 years ago. Look for this very special issue of Contact Lens Spectrum just around the corner.
Jason J. Nichols, OD, MPH, PhD
B+L to Host Multi-City Workshop
As part of its CLEAR (Customized Lens Education and Resources) initiative, Bausch + Lomb (B+L) announced that its Specialty Vision Products business will host a multi-city workshop to offer eyecare professionals hands-on training to support their patients who have challenging visual conditions using the Zenlens family of scleral lenses. During the workshops, attendees will learn about the features and benefits of the company’s Zenlens scleral lenses, including SmartCurve technology, Zenlens Multifocal lenses, and the Tangible Hydra-PEG (Tangible Science) coating, and will also be able to gain first-hand experience with the lenses.
The workshops will take place in select cities. Several workshops were held last week. The remaining workshops include:
• Tuesday, July 16, 2019 – West Conshohocken, PA, hosted by Shelley Cutler, OD • Wednesday, July 17, 2019 –Pearl River, NY, hosted by Shelley Cutler, OD • Tuesday, Aug. 6, 2019 – Schaumburg, IL, hosted by Jason Jedlicka, OD • Wednesday, Aug. 7, 2019 –Oakbrook, IL, hosted by Tiffany M. Andrzejewski, OD • Tuesday, Sept. 17, 2019 – Tarrytown, NY, hosted by Susan Resnick, OD
EyePoint Pharmaceuticals appointed Scott Jones as chief commercial officer and Said Saim, PhD, as chief technology officer. Mr. Jones will be responsible for the commercialization of Dexycu (dexamethasone intraocular suspension) 9% for the treatment of postoperative inflammation following cataract surgery and of Yutiq (fluocinolone acetonide intravitreal implant) 0.18mg for the treatment of chronic noninfectious uveitis affecting the posterior segment of the eye. Most recently, he was chief commercial officer and vice president, Business Development at Notal Vision. Dr. Saim will be responsible for advancing EyePoint’s pipeline products and technology for ocular treatments from formulation, preclinical research, up to clinical development as well as pharmaceutical sciences, manufacturing, and operations. Most recently, he was vice president, Pharmaceutical Development at Collegium Pharmaceutical.
Ocusoft Introduces Ocusoft Lid Scrub Allergy
Ocusoft Inc. announced the availability of new Ocusoft Lid Scrub Allergy Eyelid Cleanser for allergy conditions in pre-moistened pads. According to the company, Ocusoft Lid Scrub Allergy removes oil, debris, pollen, and other contaminants from the eyelids while utilizing green tea extract, tea tree oil, and PSG-2 (phytosphingosine) to effectively reduce redness, inflammation, and itching of allergy eyelids.
Ocusoft Lid Scrub Allergy is available at retail at CVS Pharmacies as well as directly from the company’s website www.ocusoft.com. Discounted pricing is available for practitioners’ offices.
NovaBay Pharmaceuticals Launches Avenova Direct on Amazon.com
NovaBay Pharmaceuticals Inc. announced that Avenova Direct is available without a prescription on Amazon.com through the company’s new direct-to-consumer online channel. Avenova, a lid and lash spray, is designed for the removal of bacteria and debris on and around the eyelid margin that contribute to bacterial eye infections, according to NovaBay Pharmaceuticals.
The launch of NovaBay’s direct-to-consumer channel is supported by Avenova’s existing brand awareness campaign. In addition, the company is conducting a comprehensive online promotional strategy that includes search engine optimization, Google Ads, and Amazon promotions using searchable keywords; Facebook lead ads and social media marketing targeting influencers; and email campaigns focused on ophthalmologists, optometrists, and current and former Avenova patients.
Lacrivera Introduces the Vera180 Synthetic Absorbable Lacrimal Plugs
Lacrivera, a division of Stephens Instruments, launched Vera180 Synthetic Absorbable Lacrimal Plugs. The Vera180 provides extended temporary occlusion lasting approximately 180 days and is ideal for treatment of post-surgical dry eye and for treating the dry eye components of various ocular surface diseases, including contact lens intolerance, according to the company. The Vera180 plugs are made of poly-p-dioxanone (PDO), are available in sizes of 0.2mm, 0.3mm, 0.4mm, and 0.5mm, and are packaged in single-pair and 10-pair boxes (20 plugs).
Tina Zhu, OD, Glendale, AZ
This image shows the eye of a 47-year-old male who presented with an active central corneal ulcer. The patient reported a history of a corneal ulcer with perforation that was formerly treated with glue. This optical coherence tomography (OCT) image shows an elevated lesion composed of possible glue and corneal epithelium adjacent to the active corneal ulcer.
We thank Dr. Zhu 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
Evidence-Based Clinical Trials and Corneal Ring Segments for Keratoconus
The comprehensive management of keratoconus involves early diagnosis, control of progression, and restoration of vision. The primary role of corneal ring segment implantation for keratoconus is to restore a relatively more regular anterior surface with corneal flattening and centralization of the apex. The desired outcome is to achieve some improvement in vision and potentially to make the cornea more receptive to contact lenses in cases in which tolerance to contact lens wear has been negatively impacted by the disease. The opinions regarding the value of corneal ring segments for keratoconus vary greatly in the eyecare community. Some practitioners have had good results in achieving desired outcomes, while many others find limited value and, in many cases, creation of problems that did not exist prior to the surgical procedure. Surely there is no consensus regarding the value of corneal ring segments for the management of keratoconus. One of the greatest challenges is the apparent lack of specific and agreed-upon surgical protocols as well as of properly conducted clinical research based upon accepted scientific methods. In fact, the nomograms of implantation are typically currently based on empirical data and on the subjective analysis by the surgeon.
A recent paper was published, the objective of which was to evaluate the effectiveness and safety of intrastromal corneal ring segments as a treatment for keratoconus.1 The authors searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register, 2018, Issue 1; Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The researchers did not implement any date or language restrictions in the electronic search for trials. The last search of the electronic databases was on Jan. 25, 2018. Two review authors independently assessed records from the electronic searches to identify randomized controlled trials (RCTs). Disagreements were resolved by discussion.
The authors found no RCTs comparing intrastromal corneal ring segments with spectacles or contact lenses. In the absence of eligible RCTs to review, the authors stated that no conclusions can be drawn with regard to the effectiveness and safety of intrastromal corneal ring segments as a treatment for keratoconus.
Although other study forms such as cohort reports and case studies are important in the development of clinical research, the cornerstone of established and accepted clinical methods is based upon randomized clinical controlled trials. As it relates to corneal ring segments in the management of keratoconus, it appears that more work is needed.
1. Zadnik K, Money S, Lindsley K. Intrastromal corneal ring segments for treating keratoconus. Cochrane Database Syst Rev. 2019 May 14;5:CD011150.
OCULAR SURFACE UPDATE
Paul Mostoff, PT, DPT, OCS, COMT, and Katherine Mastrota, MS, OD
Let’s revisit my last “Ocular Surface Update” installment regarding “neck hygiene” for digital device users (https://www.clspectrum.com/newsletters/contact-lenses-today/june-2,-2019). In this week’s installment, physical therapist, Dr. Paul Mostoff, director of Physical Therapy, New York Hotel Trades Council & Hotel Association of New York Employee Benefit Funds in New York, recommends some simple, yet effective, active patient exercises based on the McKenzie Technique. These exercises can help patients improve forward head posture (FHP), which is a common neck concern associated with prolonged digital device use and is a contributor to headaches.
The McKenzie Method, also known as Mechanical Diagnosis and Therapy (MDT), is a system for analyzing patients and treating them through exercises for the spine and extremities by using a self-treatment program. When successful, these exercise programs result in pain reduction, improved posture, and increased range of motion.
During a typical McKenzie exercise, joints are repetitively placed in whichever position the therapist believes will provide a positive change in a patient’s pain quality or distribution of symptoms or overall motion. This strategy then becomes the basis for a patient’s home exercise program that can be repeated multiple times per day—allowing the patient to receive “multiple doses” of the treatment throughout the day.
There are many different variants of McKenzie exercises that are administered based on patient response; one of the most commonly prescribed exercises for FHP (common in slit lamp users) is the repeated cervical retraction. In this exercise, a patient is seated upright and then pulls his or her chin straight back in the posterior direction toward the throat. The neck should not flex or extend (see image below). This movement should be repeated 10 times and held for three to five seconds at end-range. The exercise is then performed every three hours during the day.
Studies have shown that consistent application of these types of exercises can decrease FHP over time. A consultation with a physical therapist can help determine which is the safest and most effective for our patients based on their personal mechanical assessment. Consider recommending a physical therapy consultation for your patients who suffer from discomfort, headaches, or postural changes induced by modern-day work and smartphone-induced “fallout.” One final thought: Can correction of FHP alleviate symptoms we inappropriately attribute to dry eye?
Eyeglasses-Based Tear Biosensing System: Non-Invasive Detection of Alcohol, Vitamins and Glucose
In this study, the researchers examined a wearable tear bioelectronic platform that integrated a microfluidic electrochemical detector into an eyeglasses nose-bridge pad for non-invasive monitoring of key tear biomarkers. The alcohol-oxidase (AOx) biosensing fluidic system allowed real-time tear collection and direct alcohol measurements in stimulated tears, leading to a wearable platform for tear alcohol monitoring.
Placed outside of the eye region, the researchers noted that the fully wearable tear-sensing platform addressed drawbacks of sensor systems involving direct contact with the eye such as a contact lenses platform. They also noted that integrating the wireless electronic circuitry into the eyeglasses frame yields a fully portable, convenient-to-use fashionable sensing device.
The tear alcohol sensing concept was demonstrated for monitoring of alcohol intake in human subjects over multiple drinking courses, and it displayed good correlation to parallel blood alcohol concentration (BAC) measurements. The researchers also demonstrated the ability to monitor tear glucose outside of the eye and the utility of wearable devices for monitoring vitamin nutrients in connection with enzymatic flow detection and rapid voltammetric scanning, respectively. The authors concluded that these developments will pave the way to build an effective eyeglasses system capable of chemical tear analysis.
Sempionatto JR, Brazaca LC, García-Carmona L. Eyeglasses-based tear biosensing system: Non-invasive detection of alcohol, vitamins and glucose. Biosens Bioelectron. 2019 Jul 15;137:161-170.