Our management of dry eye disease, including contact lens dry eye, has developed by leaps and bounds over the last several years. In fact, it seems as though care of dry eye patients is almost considered part of primary eye care today.
We have new, commonly accepted diagnostic approaches using innovative technologies based on scientific findings. In addition, we have new therapeutic options that are leading to a reduction in both signs and symptoms in our patients.
In anticipation of this, please look forward to our annual Dry Eye Issue of Contact Lens Spectrum featured next month. We aim to bring you the latest and greatest clinical perspective from the current thought leaders in the field. It is an issue you don’t want to miss.
Jason J. Nichols, OD, MPH, PhD
Blanchard Contact Lenses Adds Sym-Toric to Onefit Scleral Lens Platform
Blanchard Contact Lenses announced that it has added another lens design to its Onefit Scleral Lens Platform. According to the company, Sym-Toric is an advanced proprietary front toric scleral lens design that enhances patient comfort and consistency of vision performance and greatly simplifies the practitioner fitting experience for scleral astigmatic patients utilizing the existing Onefit Scleral Lens Platform diagnostic lens set.
Onefit Sym-Toric does not rely on the prism ballast or toricity in the haptic as is typically used to stabilize axis orientation. While keeping the same edge elevation 360º, the Onefit Sym-Toric posterior surface aligns to the different radii values of the cornea and sclera. Utilizing a thin lens design, Sym-Toric is stable, comfortable, and promotes optimum oxygenation of the cornea and limbal stem cells, according to the company.
Teva Announces Exclusive Launch of Generic Pataday in the United States
Teva Pharmaceutical Industries Ltd. recently launched generic Pataday (olopatadine hydrochloride ophthalmic solution) 0.2% in the United States. Olopatadine hydrochloride ophthalmic solution 0.2% is a mast cell stabilizer indicated for the treatment of ocular itching associated with allergic conjunctivitis.
The Mentholatum Company Introduces Rohto Dry-Aid Lubricant Eye Drops
The Mentholatum Company, a global health and wellness company, launched Rohto Dry-Aid, a new over-the-counter (OTC) lubricant eye drop designed for patients who need an advanced artificial tear option to help relieve their dry eye symptoms.
Rohto Dry-Aid Lubricant Eye Drops are available in a single 10mL multidose bottle and can be found at various retail locations where OTC eye drops are sold, with nationwide distribution in July. Patients can download discount coupons at http://bit.ly/2qBaYlv.
If you haven’t voted yet in this month’s poll...
Do you think that if your patients don’t see well in their contact lenses, they can still be comfortable in their lenses?
Your Interesting Case Photo Here in the Next Issue
Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in Contact Lenses Today in the coming weeks!
We 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
Cleaning Scleral Contact Lenses
All daily wear contact lenses require a cleaning regimen; scleral contact lenses are no different.1 Another similarity between scleral lenses and other contact lenses is that there are a number of products available for cleaning both. Relatedly, cleaning regimen options have evolved over the years, much like scleral lens material technologies,2 a trend that was recently highlighted by the results of a reader poll in the May 21 issue of Contact Lenses Today (http://www.clspectrum.com/newsletters/contact-lenses-today/may-21,-2017).
Over the past few years, many prescribers have switched their primary scleral lens care recommendation from traditional GP cleaners to hydrogen peroxide-based cleaners. The data from the Contact Lenses Today reader poll showing that 52% of practitioners recommend hydrogen peroxide for scleral lenses is corroborated by a recent publication from the SCOPE Study group, which found that at least 61% of prescribers were recommending hydrogen peroxide-based care systems to their patients.2 One possible reason for the surge in hydrogen peroxide care system prescribing could be that such systems neutralize to nonpreserved water within hours of lens soaking.1
While hydrogen peroxide-based systems have gained scleral lens market share, traditional GP cleaners are still commonly prescribed;2 they are likely to continue to be prescribed because very-large-diameter sclerals are too big for most standard hydrogen peroxide cases, although some larger cases can be found online. Also, because hydrogen peroxide care systems must be neutralized to prevent hydrogen peroxide burns, this prevents these systems from being used as a midday cleaning system, which is often a necessary step for combating midday scleral lens fogging.3,4 Thus, if prescribers do plan to prescribe a hydrogen peroxide care system, it would also be wise to also prescribe a traditional GP cleaner.
1. Lievens CW, Kannarr S, Zoota L, Lemp J. Lid Papillae Improvement With Hydrogen Peroxide Lens Care Solution Use. Optom Vis Sci. 2016 Aug;93:933-942.
2. Harthan J, Nau CB, Barr J, Nau A, Shorter E, Chimato NT, Hodge DO, Schornack MM. Scleral Lens Prescription and Management Practices: The SCOPE Study. Eye Contact Lens. 2017 Apr 6. [Epub ahead of print]
3. U.S. Food and Drug Administration. Contact Lens Solutions With Hydrogen Peroxide: To Avoid Injury, Follow All Instructions. 2017 May 24. Available at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm487420.htm. Accessed on June 12, 2017.
4. Walker MK, Bergmanson JP, Miller WL, Marsack JD, Johnson LA. Complications and fitting challenges associated with scleral contact lenses: A review. Cont Lens Anterior Eye. 2016;39:88-96.
MATERIALS & DESIGNS
David L. Kading, OD
Dropouts Are Dropping Out All Around Me
Contact lens dropout rates have remained stable for the last 10 to 20 years. Yet, we have great contact lenses, great patients, and great practitioners with a multitude of options to potentially help with comfort. The fact remains that putting a contact lens on the eye in a challenging environmental can be tough on the ocular surface. Wearing that contact lens throughout the day may further diminish the number of times that patients blink, beyond the decreased blink rate than is induced by their digital devices.
I’m struck by how infrequently I consider orthokeratology lenses for my dry eye patients. What could be better? Wearing a lens at night when the eyes are closed and then having as natural of an ocular surface as possible during the day.
During my fellowship process for the American Academy of Optometry, I presented a case on a contact lens-intolerant patient whom I switched to orthokeratology and was struck by her improved comfort. Since then (over the past 11 years), I am continually impressed by this fantastic option for our patients who desire reduced or complete freedom from glasses.
Consider giving your patients a break from daily lens wear with the use of overnight lens wear for glasses- and contact lens-free vision all day long.
Visual Performance and Optical Quality of Standardized Asymmetric Soft Contact Lenses in Patients With Keratoconus
The purpose of this study was to evaluate the visual performance and optical quality of a standardized asymmetric soft contact lens (SCL) used for correction of higher-order aberrations (HOAs) in eyes with keratoconus.
The authors included 30 eyes (26 patients) with keratoconus (average K: 45.7D ± 2.3D). The patients were subjected to corneal tomography, aberrometry, measurements of manifest refraction and visual acuity (VA), and visual analog scale (VAS) assessments. The study contact lenses were made using a molding method and consisted of six standardized types; an asymmetric power distribution of approximately 2.0D to 12.0D (in 2.0D steps) was used to correct HOAs. The contact lens type suitable for each eye was selected based on the corneal tomography and aberrometry data. The on-eye performance of the contact lenses was evaluated using aberrometry (4mm pupil), over-refraction, VA, and VAS.
The standardized asymmetric SCL improved the best spectacle-corrected VA from –0.07 ± 0.09 logMAR to –0.11 ± 0.08 logMAR (P < 0.05) and the mean VAS score from 66.2 ± 21.8 to 75.4 ± 20.5 (P < 0.05). Vertical coma also decreased significantly (–0.50μm ± 0.36μm without SCL; –0.36μm ± 0.34μm with SCL; P < 0.01). In subgroup analyses, subjects in the high VAS group (score ≥ 75) accounted for 70% of all subjects, and this was the group in which the vertical coma decreased significantly from the level without the SCL.
The authors concluded that a standardized asymmetric SCL can reduce HOAs and improve vision quality when compared with spectacles in patients who have keratoconus and who wear GP lenses.
Suzaki A, Maeda N, Fuchihata M, Koh S, Nishida K, Fujikado T. Visual Performance and Optical Quality of Standardized Asymmetric Soft Contact Lenses in Patients With Keratoconus. Invest Ophthalmol Vis Sci. 2017 Jun 1;58:2899-2905.