Contact lenses are medical devices. And, as such, they are regulated by most medical regulatory bodies around the world such as the U.S. Food and Drug Administration (FDA). There is no doubt that verification of contact lens prescriptions has been a thorny issue and often a challenge when balancing consumer rights and patient safety. As noted in the abstract this week, passive verification of contact lens prescriptions is riddled with problems and inaccuracies. With such a flawed approach, it is clear that medical decisions are being placed in contact lens sellers’ hands, which is probably not in the best interest of the patients.
Jason J. Nichols, OD, MPH, PhD
COPE Extends Rules Modification for Interactive Online CE
Due to continued state restrictions and Centers for Disease Control and Prevention (CDC) guidelines related to COVID-19, the Council on Optometric Practitioner Education (COPE) has made the decision to extend the temporary rules modification to allow COPE administrators and providers to present continuing education (CE) activities through an Interactive Online format and give Live COPE CE credit through Dec. 31, 2020. COPE previously announced a temporary modification to the rules through June 30, 2020.
COPE is modifying its rules to give Live credit for CE courses that are presented in an Interactive Distance Learning format. To be considered interactive, attendees must be able to have immediate interaction with the instructor (i.e., live webinar or videoconference). The activity can only be presented at one specified time, and once it has taken place the learners may no longer participate in that activity. COPE administrators and accredited providers must have a way to confirm the learners’ attendance for every course before issuing certificates of attendance. Post-course tests will not be required for this modified type of activity.
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.
Bausch + Lomb Ultra Silicone Hydrogel Lenses Receive Approval In China
Bausch + Lomb announced that Bausch + Lomb Ultra monthly silicone hydrogel contact lenses have received approval from the National Medical Products Administration in China.
ABB Optical Group (ABB), in conjunction with Paragon Vision Sciences, announced that it is accepting abstract submissions for the sixth annual Optometry Student Challenge. The Optometry Student Challenge will award travel grants of $1,500 each to three third- or fourth-year optometry students to attend the 2021 Global Specialty Lens Symposium (GSLS), to be held on Jan. 20 to 23, 2021 in Las Vegas, and to present a scientific poster on a topic, of the students’ choice, related to contact lenses.
In November, ABB and Paragon Vision Sciences will hold a live webinar in which the top six student challenge finalists will present their posters virtually. Attendees will have the opportunity to vote on their favorite poster presentation. Scores will be incorporated in the overall judging of the winners.
CooperVision Names Simon Seshadri to Lead Global Marketing
CooperVision has named Simon Seshadri as senior vice president, Global Marketing, effective immediately. He is responsible for executive leadership and management for the company’s Global Marketing organization, including driving product pipeline innovation and advancing standards for inbound and outbound marketing functions.
Mr. Seshadri was most recently vice president of Marketing, North America, in which he also led commercial activation across key customer groups. He joined the company in 2014 as senior director, Global Brand Marketing for frequent replacement products. Prior to that, he served in international marketing roles with GE Healthcare and Bausch & Lomb as well as working for Philips Consumer Lifestyle in Japan and North America and for Boots Healthcare in the United Kingdom and Japan.
He succeeds Guy Whittaker, who earlier this year was promoted to the position of senior vice president, Global Strategy and Lifecycle Management.
New Scleral Lens Book Available
Dougmar Publishing Group announced a new book by Daddi Fadel, DOptom, titled Scleral Lens Issues and Complications: Their Recognition, Etiology, and Management. This book discusses all issues and complications that may occur during scleral lens fitting and provides guidelines on their management.
The book defines scleral lens issues and differentiates between issues and complications related to scleral lens wear. It also describes all of the issues and complications that can ensue from fitting scleral lenses. The 350-page book is also illustrated with more than 370 images. Additionally, there is a “quick find” index that includes all issues and complications, their symptoms, clinical signs, etiology, management, and observation.
IMI Launches Global Search for Country Representatives
The International Myopia Institute (IMI) consensus group announced a search for leading eyecare practitioners to help disseminate the evidence from its published white papers to every part of the world. Appointed country representatives will help to identify gaps and unmet needs in myopia education, research, and training as well as support the dissemination of the evidence through their professional networks. Those who are interested should send their CVs and a statement about their professional experience and how they would be able to support the mission of advancing myopia research, education, and advocacy in their country to Dr. Monica Jong at firstname.lastname@example.org.
IACLE Launches TLC Initiative
The International Association of Contact Lens Educators (IACLE) has launched a new initiative to support educators, students, and industry and to help reduce the impact of the COVID-19 pandemic on global contact lens education. Teach. Learn. Connect (TLC) is a new online education program and communications campaign that began this month and will supplement IACLE’s existing educational activities as the recovery from the pandemic continues.
The TLC Initiative will include a full program of live and recorded webinars on a global, regional, and national basis to help educators and students adapt to new ways of teaching and learning; a half-day virtual conference in September that will examine the way forward for education, practice, and for the contact lens industry; a new teaching online platform—IACLETOP—which will become IACLE’s central point to access all of IACLE’s online resources and teaching materials; opportunities for industry to connect with educators and students worldwide; and communications providing new information to support all sectors during the pandemic recovery, including IACLE’s first social media campaign.
BCLA to Offer Myopia Management Certificate
A newly launched certificate in myopia management from the British Contact Lens Association (BCLA) will allow eyecare professionals to translate the latest global myopia research findings to their clinical practice. 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 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.
GMAC Says "Game Over, Myopia" by Bringing its Message to Gamers
The Global Myopia Awareness Coalition (GMAC) is working with influential online gamers and with parents to raise awareness about myopia in children by encouraging them to discuss the importance of getting away from screens and playing outside.
GMAC found that since the COVID-19 outbreak, 44% of parents surveyed say that their children are spending four or more hours per day on electronic devices, watching television, using handheld devices, and even completing schoolwork remotely. Given that many of these children are also gaming, the coalition is bringing its message to them directly via online video game streams and to parents who are encouraged to re-create their children's favorite digital games.
To follow along with the campaign, search #GameOverMyopia on social media.
Many meetings that we attend have been adapted to a virtual environment. Do you feel that some meetings should continue with a virtual format after the pandemic?
Stacy Zubkousky, OD, Nova Southeastern University, Fort Lauderdale, FL
This photo shows a free-form scleral lens designed using corneal-scleral profilometry data. It was designed for a patient who was post-radial keratotomy and who has advanced ectasia and more than an 800-micron difference in corneal elevation.
We thank Dr. Zubkousky 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
Down Syndrome, Keratoconus, and Corneal Density
The association of keratoconus (KCN) with Down syndrome is well known. The fact that corneas of Down syndrome individuals tend to be steeper and thinner has resulted in reports of keratoconus prevalence in the Down syndrome population to be high (as high as greater than 70% in some reports). However, these may be overestimates, and differentiating criteria may be helpful in guiding eyecare practitioners toward appropriate application of treatments such as corneal cross-linking. One such measure is the corneal density, which can discriminate between KCN and normal eyes; however, its normal range has not been determined in Down syndrome individuals. Corneal density is an indicator of corneal transparency, and densitometry readings provide useful information about corneal clarity. We currently have the ability to measure corneal densitometry with commercially available Scheimpflug-based tomography instruments.
A recent study was published that assessed corneal density in three groups (Down syndrome patients who did [Down-KCN, 24 eyes] and did not [Down-nonKCN, 204 eyes] have KCN and a normal age- and gender-matched comparison group [184 eyes]) and compared results to determine the individual effects of these conditions.1 The parameters studied were the corneal density measured with Pentacam HR (Oculus) in five concentric zones and annuli (0mm to 2mm, 2mm to 6mm, 6mm to 10mm, 10mm to 12mm, and 0mm to 12mm) in four different depth layers (anterior 120µm, posterior 60µm, middle layer, and the full thickness of the cornea) and the 10mm zone corneal volume.
Study results indicated that in Down-KCN, Down-nonKCN, and control groups, respectively, mean full-thickness density in the 0mm to 12mm zone was 19.35 ± 2.92, 17.85 ± 2.55, and 15.78 ± 2.67 grayscale units (GSUs), and mean corneal volume was 57.45 ± 4.37mm3, 56.99 ± 3.46mm3, and 61.43 ± 3.42mm3. All density readings were significantly different among the three studied groups (all P < 0.01) except for full thickness density in 0mm to 2mm and 2mm to 6mm (P > 0.05) and corneal volume (P = 0.519) between Down-KCN and Down-nonKCN groups; these inter-group densitometry differences within the 6mm zone were only in the middle layer and not in the anterior or posterior thickness layers (all P > 0.05). Corneal density increased with age and corneal thickness, but there was no significant relationship with gender.
The researchers concluded that overall, Down syndrome is associated with increased density and light scatter in all corneal layers up to the 12mm diameter. In Down patients who had KCN, the increased light scatter and density in the 6mm zone is only in the middle thickness layer. Corneal volume is reduced in Down syndrome irrespective of the presence or absence of KCN. Further, they stated that in Down syndrome patients, increased corneal density is a characteristic of Down syndrome; however, a middle-layer corneal density > 17.5 GSU in the 0mm to 2mm zone and > 15.5 GSU in the 2mm to 6mm zone can be indicative of KCN.
These results can help clinicians distinguish KCN in Down syndrome patients and avoid misdiagnoses and overestimations. Further studies are needed to understand when such changes occur compared to other signs and symptoms of KCN and to determine the value of densitometry indices in identifying KCN cases.
Technological advances in assessment of keratoconic eyes continue to develop. These advances have significant impact on the differential diagnosis, early detection, detection of disease progression, and even on the definition of the disease. As such, this can have dramatic impact on our therapeutic approaches.
1. Asgari S, Aghamirsalim M, Mehravaran S, Hashem H. Effect of Down syndrome and keratoconus on corneal density and volume: a triple comparative study. Sci Rep. 2020 Jun 4;10:9098.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Dry Eye: Inside Out
Whole-body dehydration is suspected to contribute to a “dry eye.” Tear osmolarity is used as a measure of severity in dry eye disease and has been proposed as an index of body hydration (blood plasma osmolarity).1
Human health and performance can be reduced when the body is dehydrated. In fact, no gold standard for hydration assessment exists. Dehydration is a result of excess total body water loss and is often accompanied by abnormalities in electrolyte balance.2 Therefore, a reasonable conclusion is that by enhancing body hydration and electrolyte balance, dry eye symptoms (and perhaps its underlying pathophysiology) can be ameliorated.
Hence has been born a potable dry eye therapy proposed to bolster serum hydration and that of the ocular surface (think energy drink). Not only does the beverage contain essential electrolytes, but these electrolytes are delivered via a nanosome technology platform.3 Scant data is available to support the dry eye drink. However, practitioners should consider and investigate all options that may contribute to our patients’ well-being and quality of life. I look forward to more research on the topic.
Passive Verification: A Flawed System Putting Patients' Sight at Risk
The purpose of this study was to assess the rate of erroneous or expired (invalid) contact lens prescriptions submitted for passive verification at two practice sites in Cleveland.
Passive verification facsimile (FAX) requests were collected from the office staff at a county hospital (MetroHealth [MH]) and at a private ophthalmology group office (University Ophthalmology Associates [UOA]) in Cleveland from January 2013 to January 2018.
A total of 415 verification requests were evaluated (339 MH, 75 UOA); 28.2% (104 MH, 13 UOA) were expired, 11.8% (48 MH, one UOA) were not under the care of the practitioners to whom the request was directed, 8.9% (32 MH, 5 UOA) were incorrect, and 3.9% (16 MH, 0 UOA) did not complete fitting. The total rate of invalid prescriptions was 52.8% (200 MH, 19 UOA).
The authors concluded that there is a high rate of invalid prescriptions presented for passive verification. Although the majority of prescriptions are simply expired, there is a fraction of prescriptions that contain incorrect specification of lens parameters or no record of prescription by that practitioner. The current mechanism of passive verification, with the burden on the provider for denial within a short time window, makes it likely that such prescriptions would be filled, potentially putting patient comfort and safety at risk.
Yupari RJ, Steinemann TL. Passive Verification: A Flawed System Putting Patients’ Sight at Risk. Eye Contact Lens. 2020 May 14. [Online ahead of print]