One of the “great debates” in our community today relates to specialty contact lenses. While there are many benefits of scleral lens wear, particularly in diseased eyes, there are also some potential undesirable effects of scleral lens wear. For instance, scleral lenses are thick and have very little tear exchange associated with them. Likewise, scleral lenses are often fitted by vaulting the cornea, which can lead to post-lens tear films of up to a few hundred microns. There are also some concerns about intraocular pressure associated with scleral lens wear.
The questions are “should scleral lenses become the lens of first choice?” and “in what clinical situations?” For instance, should patient age and disease severity be factors associated with decisions to fit these lenses? Or, should we consider scleral lenses a first choice regardless of disease? More research on specialty lens choices is needed and will be discussed at the Global Forum for Specialty Lens Research (GFSLR) held just following the Global Specialty Lens Symposium on Jan. 27, 2019.
Jason J. Nichols, OD, MPH, PhD
SynergEyes and BHVI Join Forces for Specialty Contact Lens Development
SynergEyes announced a new partnership with the Brien Holden Vision Institute (BHVI) to deliver advanced, customized vision correction for myopes and presbyopes. The exclusive worldwide licensing agreement will enable the manufacturing of design technologies developed by Brien Holden Vision Institute, augmenting the SynergEyes presbyopic package by offering the latest designs on the hybrid contact lens platform.
BHVI has developed new optical designs that incorporate an extended depth of focus (EDOF) that provide a series of smooth, non-monotonic power variations across the optic zone to deliberately manipulate multiple higher-order aberrations. The idea is to achieve an extension in depth of focus that would facilitate a balanced visual performance designed to satisfy presbyopes who have low-, medium-, and high-add requirements.
PEN Presents Eyes of America Optometric Summer Seminar
Primary Eyecare Network (PEN), a division of ABB Optical Group, will present its Eyes of America Summer Seminar on Aug. 19 in Mason, OH. Participants will have the opportunity to hear from industry experts and to earn eight hours of optometric continuing education credits.
The morning session will cover how to increase the overall performance of a practice through profit margin analysis and practice metrics. The session also will cover dry eye disease management. The afternoon session will focus on lid margin disease management, treatments for dry eye disease, and the basics of fitting and implementing scleral lenses. Speakers include Mark Wright, OD; Paul Karpecki, OD; and Katie Greiner, OD, MS.
The morning session costs $230, and the afternoon session costs $200. The cost for participants who plan to attend the full day is $275. To register, visit primaryeye.net or call (800) 444-9230.
Sunil Shah Assumes BCLA Presidency
Professor Sunil Shah was installed as the new president of the British Contact Lens Association (BCLA) at the organization’s Annual General Meeting in London on June 10, which was held alongside the BCLA UK Conference and Exhibition. He takes over from outgoing president Keith Tempany.
Professor Shah is a consultant ophthalmic surgeon affiliated to Midland Eye in Birmingham and Solihull and is a full professor at Aston University. Professor Shah, whose clinical interests include complex corneal problems, refractive surgery, and dry eye, will now lead the organization through its next cycle of global events, including BCLA Asia, Visionaries, and next year’s BCLA Conference and Exhibition in Manchester.
Bausch + Lomb Introduces Two New Products
Bausch + Lomb (B+L) introduced Ocuvite Blue Light eye vitamins, a nutritional supplement formulated with lutein and zeaxanthin. This formulation of eye nutrients includes high levels of lutein and helps protect eyes from the blue light that reaches the macula, according to the company. Ocuvite Blue Light eye vitamins will be available for purchase at major retailers in the third quarter of 2018.
In other news, B+L introduced Soothe Xtra Protection (XP) Preservative Free lubricant eye drops. According to the company, Soothe XP eye drops use a combination of Restoryl mineral oils as active ingredients, which work to restore the lipid layer, seal in moisture, and protect against further irritation. Soothe XP Preservative Free eye drops will be available at many major retailers nationwide, including Walmart, Target, Walgreens, Rite Aid, and Meijer, by the end of June.
CMS Issues Preliminary Decision on Unique J Code for Avedro Photrexa
Avedro, Inc. announced that the Centers for Medicare and Medicaid Services (CMS) has issued a preliminary decision to establish a product specific Healthcare Common Procedure Coding System (HCPCS) J code for Photrexa drug formulations. Claims submitted with a product specific J code are generally processed more efficiently than are claims using a miscellaneous code (J3490), which requires manual review.
These Photrexa formulations are the only drugs approved by the U.S. Food and Drug Administration (FDA) for use in conjunction with the KXL System in corneal collagen cross-linking to treat progressive keratoconus and corneal ectasia following refractive surgery.
CMS’ preliminary decision was announced at its public meeting held on May 15, 2018 and is expected to be finalized and announced in Nov. 2018, with new or revised codes becoming effective on Jan. 1, 2019.
CORE Enhances ContactLensManagement.com Guide
Now under the direction of the Centre for Ocular Research & Education (CORE), with significant enhancements and new content, the Clinical Contact Lens Management Guide (ContactLensManagement.com) will serve as a resource for established and new practitioners as well as for students.
The free, fully searchable database lists conditions in four sections: cornea, limbus, conjunctiva, and lid. Each entry is also cross-referenced by contact lens, signs, symptoms, and biomicroscope categories. Clicking through, each item presents a detailed description of the condition, its signs, symptoms, prevalence, differential diagnosis, and management along with photos and videos to aid in diagnosis and resolution. Later this year, CORE will update sections on Demodex along with incorporation of information from the recent Tear Film & Ocular Surface Society Dry Eye Workshop II dry eye report.
First conceived in 1993, the Clinical Contact Lens Management Guide is hosted by CORE and supported by an independent medical education grant from Alcon.
Illinois College of Optometry Appoints New President
The Illinois College of Optometry (ICO) Board of Trustees announced the appointment of Dr. Mark Colip as the sixth president of ICO. He will succeed Dr. Arol Augsburger, who retires after 16 years as president. Dr. Colip will take office on Aug. 6, 2018.
ICO says that this appointment marks the culmination of an extensive national search process that yielded a strong pool of talented candidates. As the president of the college, Dr. Colip will lead the efforts to advance the mission of ICO as it charts the course to its upcoming 150th Anniversary in 2022.
Dr. Colip is a graduate of ICO and brings experience from private practice and from serving as a member of the faculty and ultimately as a part of the College’s Senior Administration for the past 15 years. He has chaired the Admissions Committee since 1993, was appointed as the vice president for Student Affairs in 2004, and took on an expanded role as the vice president for Student, Alumni and College Development in 2009. In this position, Dr. Colip has worked to steward contributions and support surpassing the $4 million mark in 2012 and 2014.
In addition to his work at ICO, Dr. Colip has been a volunteer consultant for the Accreditation Council on Optometric Education (ACOE), serving as a site team member for professional accreditation of Doctor of Optometry education programs. He has also served with ASCO’s Student Affairs and Development Officer’s Special Interest Groups (SIGs) and participated in international medical mission work.
Have online channels for contact lens prescriptions or sales impacted the contact lens portion of your practice?
Share in New Soft Contact Lens Products and Growth
As reported a few weeks ago, Contact Lens Spectrum forged a partnership with the ABB Optical Group to periodically report insights on trends from their unique perspective on the contact lens market. In the current analysis, more than 11,000 practices were included, all of which have been regular customers of ABB Optical for the last two years. For this installment, the relation between usage of a higher share of new soft contact lenses in their portfolio and soft lens practice growth was assessed. As seen in the figure, practices with a higher share of use of new soft contact lenses were associated with faster growth of that portion of their practice (and are outpacing market growth). These data are encouraging and point toward continued adoption of new soft lens technologies, not only for patients, but also for the practice.
CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
Office Dispensing of Contact Lens Care Products
Selecting eyecare products (e.g., over-the-counter) can be confusing to patients, and the differences between them are often unclear.1 It is important for eyecare professionals (ECPs) to understand the various products that they are prescribing and to educate patients on their decisions.2,3 Nevertheless, the choices at the mega mart can be overwhelming, and the store may not even have the exact product that is being recommended, which could lead to further confusion.3
One potential solution to this problem is for the office to stock a finite line of products.3 Practitioners may specifically want to stock their favorite contact lens care systems, in addition to eyelid hygiene products; and hard-to-find products, such as specialty contact lens application and removal devices.3 It is recommended to start simple with a line of products and to make them visible (e.g., a display near patient checkout). In addition, ECPs should educate the staff to help champion the effort.3 Overall, making products easily available could result in decreased patient confusion and better overall compliance, while at the same time making the practice more profitable, which benefits everyone involved in the process.3
1. Pucker AD, Ng SM, Nichols JJ. Over the counter (OTC) artificial tear drops for dry eye syndrome. Cochrane Database Syst Rev. 2016 Feb 23;2:CD009729.
2. Wu Y, Carnt N, Willcox M, Stapleton F. Contact lens and lens storage case cleaning instructions: whose advice should we follow? Eye Contact Lens. 2010 Mar;36:68-72.
3. Farris PK. Office dispensing: a responsible approach. Semin Cutan Med Surg. 2000 Sep;19:195-200.
MATERIALS & DESIGNS
David L. Kading, OD
Ortho-K That’s Bent Out of Shape
There are some fantastic orthokeratology lenses available. One lens was shown in a study to be successful with empirical fitting more than 80% of the time with the first trial lens using only keratometry readings, a prescription, and horizontal visible iris diameter (HVID). That is amazing.
For most patients, that will work well. But what about that pesky orthokeratology patient whom practitioners keep seeing?
A key measure to evaluate in depth is corneal toricity. When looking at topography, does the patient have central corneal astigmatism or does it extend limbus to limbus? When evaluating the elevation map, is there greater than 30 microns of difference between the horizontal and vertical meridians? If there is, this could explain why the lens never centers.
Practitioners should take those measurements and speak to the orthokeratology laboratory. The lab is able to help design a lens that has toric peripheral curves that will better fit the corneal shape and account for the elevation difference. This will create a better treatment zone and reduce the amount of decentration.
Sometimes, a little time at the topographer can save hours of visits on the back end.
Management of Digital Eye Strain
Digital eye strain, an emerging public health issue, is a condition characterized by visual disturbance and/or ocular discomfort related to the use of digital devices and resulting from a range of stresses on the ocular environment. This review aimed to provide an overview of the extensive literature on digital eye strain research with particular reference to the clinical management of symptoms.
As many as 90% of digital device users experience symptoms of digital eye strain. Many studies suggest that the following factors are associated with digital eye strain: uncorrected refractive error (including presbyopia), accommodative and vergence anomalies, altered blinking pattern (reduced rate and incomplete blinking), excessive exposure to intense light, closer working distance, and smaller font size. Because a symptom may be caused by one or more factors, a holistic approach should be adopted.
The following management strategies have been suggested: 1) appropriate correction of refractive error, including astigmatism and presbyopia; 2) management of vergence anomalies, with the aim of inducing or leaving a small amount of heterophoria (~1.5Δ Exo); 3) blinking exercise/training to maintain normal blinking pattern; 4) use of lubricating eye drops (artificial tears) to help alleviate dry eye-related symptoms; 5) contact lenses with enhanced comfort, particularly at end-of-day and in challenging environments; 6) prescription of color filters in all vision correction options, especially blue light-absorbing filters; and 7) management of accommodative anomalies.
The authors concluded that prevention is the main strategy for management of digital eye strain, which involves ensuring an ergonomic work environment and practice (through patient education and the implementation of ergonomic workplace policies) as well as visual examination and eye care to treat visual disorders. Special consideration is needed for people who are at a high risk of digital eyestrain, such as computer workers and contact lens wearers.
Coles-Brennan C, Sulley A, Young G. Management of digital eye strain. Clin Exp Optom. 2018 May 23. [Epub ahead of print]