As noted by Dr. DeLoss in her column this week, myopia management is a huge topic in eyecare today, and the field is growing by leaps and bounds. That said, there are still many controversies and unanswered questions. For example, are myopia control-based practices a good model going forward? Do we need to measure axial length in myopia management of the patient? Does the optical profile of standard soft contact lenses contribute to increased myopia progression? What is the appropriate dose of atropine? And, do combination therapies (e.g., contact lens + atropine) have greater efficacy than single therapies alone?
These are but a few clinical questions that remain unanswered, and we ask you to add to our list by sending them to email@example.com. Note: we will be addressing many of these questions at the Global Specialty Lens Symposium (GSLS) in January 2020 in our “Clinical Controversies in Myopia Management” session. We look forward to hearing from the experts on these and other topics!
Jason J. Nichols, OD, MPH, PhD
B+L Ultra Multifocal for Astigmatism Lenses Available in the United States
Bausch + Lomb (B+L) announced the U.S. launch of Bausch + Lomb Ultra Multifocal for Astigmatism contact lenses, a multifocal toric lens available as a standard offering in a fit set. B+L says the new monthly silicone hydrogel lens was specifically designed to address the lifestyle and vision needs of patients who have both astigmatism and presbyopia. The lens combines the company’s 3-Zone Progressive multifocal design with the stability of its OpticAlign toric design as well as its MoistureSeal technology.
Bausch + Lomb Ultra Multifocal for Astigmatism contact lenses are made from samfilcon A material and have a 46% water content. The lenses are available with a base curve of 8.6mm and a 14.5mm diameter. Spherical powers are available from +4.00D to –6.00D in 0.25D steps (in 0.50D steps above –6.00D), in axes 10° to 180° (in 10° steps), add powers of +0.75D to +1.50D (Low) and +1.75D to +2.50D (High), and in cylinders of –0.75D, –1.25D, –1.75D, –2.25D, and –2.75D.
Alcon launched Dailies Colors contact lenses, a new collection of four colors that delivers color enhancement plus eye definition in one daily disposable lens, according to the company. The lenses are made of nelfilcon A material, which has a 69% water content and a Dk of 26. They are available in mystic blue, mystic gray, mystic green, and mystic hazel. Parameters include 8.6mm base curve, 13.8mm diameter, sphere powers of plano and –0.50D to –8.00D (0.50D steps above –6.00D), and center thickness of 0.10mm at –3.00D.
In unrelated news, Alcon announced the addition of Sean Clark and Dr. Kristin Anderson to its executive team. Mr. Clark was recently appointed general manager of US Vision Care from his most recent role as head of the Vision Care Business Unit for Alcon Japan. He has more than 10 years’ experience each in the vision care and consumer goods industries, and he started in the eyecare industry at Ciba Vision before the integration with Alcon in 2012. Dr. Anderson joined Alcon in the newly-created role of director of Professional Education – US Vision Care and Dry Eye. In this new role, she will lead professional education, training strategy, and tactics for Vision Care and Dry Eye, including the Alcon Experience Academy. In her most recent role, Dr. Anderson served as vice president for Institutional Advancement at Southern College of Optometry.
Webinar Gives BCLA Members Online Access to Expert Views on Dry Eye Disease
In its second “Evening Scientific Meeting,” members of the British Contact Lens Association (BCLA) will be able to watch a webinar on the diagnosis and management of dry eye disease for free at a time and place that is convenient for them.
The session, titled “Optometrist vs Ophthalmologist; Different perspectives on dry eye disease diagnostic and management strategies” will be hosted by Sarah Farrant and Indy Sian from 6.30 p.m. to 7.30 p.m. BST on June 26. This webinar will offer a general overview of the latest guidance on dry eye disease from the Tear Film & Ocular Surface Society Dry Eye WorkShop II (TFOS DEWS II) report and will set out how dry eye management differs between community and hospital settings. It will explain also how the two groups can work together to support patients who have a wide spectrum of dry eye disease. Several case studies highlighting different types of dry eye disease will be presented to highlight the differing approaches to investigation, diagnosis, and management of dry eye.
Mr. Sian is a consultant eye surgeon at Taunton and Somerset NHS Foundation Trust, and Ms. Farrant is joint director of an independent practice as well as a specialist practice within a general practice surgery, both in Somerset.
Members need to register via the BCLA website for exclusive access to the webinar. For more details and to book your place, visit www.bcla.org.uk.
EyePromise Introduces Screen Shield Pro Eye Vitamin
EyePromise introduced Screen Shield Pro to its premium eye vitamin line. According to the company, Screen Shield Pro is designed to protect and relieve the associated symptoms of digital eye strain of adults (ages 18 and up) who spend 8+ hours staring at digital screens while working, gaming, or just binge watching their favorite shows.
EyePromise Screen Shield Pro is GMO-, gluten-, and lactose-free and is NSF Certified for Sport for safety and efficacy. It is manufactured in U.S. Food & Drug Administration Current Good Manufacturing Practices (cGMP) facilities. The company also says that the product is designed to complement a daily multivitamin.
NovaBay Pharmaceuticals Appoints Executives
NovaBay Pharmaceuticals Inc. announced the appointments of Justin Hall as president and CEO and of Jason Raleigh as CFO.
Mr. Hall has served as interim president and CEO since March 2019. He has been with NovaBay for six years in a variety of roles including as corporate counsel and has been actively involved in a number of operating functions including the sales organization and manufacturing.
Mr. Raleigh has served as interim CFO also since March 2019. He has been with NovaBay for more than three years and has nearly 20 years of financial experience.
Optometry Students Honored with 2019 GP Clinical Excellence Awards
The Contact Lens Manufacturers Association (CLMA) and the GP Lens Institute (GPLI) bestowed the 2019 GP Clinical Excellence awards. The following 4th year optometry students were selected by the contact lens faculty at their respective schools for exemplary performance in GP contact lens fitting during the course of their education.
Along with an engraved plaque, the students received GP diagnostic/fitting sets that include materials supplied by Acuity Polymers Inc., Contamac Inc., InnoVision Inc., The LifeStyle Company Inc., Menicon America Inc., and Stellar Contact Lens Inc.
Amanda Gerson, OD, Illinois College of Optometry, Sponsored by Art Optical Contact Lens Company Inc.
Theodore Chow, OD, Indiana University School of Optometry, Sponsored by Art Optical Contact Lens Company Inc.
Jennifer Chan, OD, Inter-American University of Puerto Rico, Sponsored by TruForm Optics Inc.
Kellen Plomski, OD, Massachusetts College of Pharmacy and Health Sciences School of Optometry, Sponsored by TruForm Optics Inc.
Justin Ullrey, OD, Michigan College of Optometry, Ferris State University, Sponsored by Art Optical Contact Lens Company Inc.
Nha Cao, OD, Midwestern University Arizona College of Optometry, Sponsored by Visionary Inc. (California)
Lauren Nicholas, OD, New England College of Optometry, Sponsored by Art Optical Contact Lens Company Inc.
Kathleen Nelson, NSU Oklahoma College of Optometry, Sponsored by TruForm Optics Inc.
Joshua Walek, OD, NOVA Southeastern University College of Optometry, Sponsored by Advanced Vision Technologies Inc. (AVT)
Ryan Rutschilling, OD, The Ohio State University College of Optometry, Sponsored by Art Optical Contact Lens Company Inc.
Kennedy Antoniuk, OD, Pacific University College of Optometry, Sponsored by Visionary Optics, LLC (Virginia)
Roxanne Chalifoux, OD, Salus University Pennsylvania College of Optometry, Sponsored by Conforma Contact Lenses Inc.
Connie Minah Woo, OD, Southern California College of Optometry at Ketchum University, Sponsored by Visionary Inc. (California)
Jacqueline Benoit, OD, State University of New York College of Optometry, Sponsored by X-Cel Specialty Contacts Inc.
Charlotte Wang, OD, University of California, Berkeley School of Optometry, Sponsored by ABB Optical Group
Alexandra Gada, OD, University of Missouri-St. Louis College of Optometry, Sponsored by X-Cel Specialty Contacts Inc.
Sadie Steinbeisser, OD, University of Houston College of Optometry, Sponsored by Essilor Custom Contact Lens Specialists Inc.
Simon-Pier Falardeau, OD, Universite De Montreal Ecole d’Optometrie, Sponsored by TruForm Optics Inc.
Nicole Malone, OD, University of Waterloo School of Optometry & Vision Science, Sponsored by Art Optical Contact Lens Company Inc.
IDOC to Provide All Members with IDOC Insider Advanced Analytics
IDOC will now offer unlimited access to business analytics and reporting as a complimentary benefit to members who have GPN Technologies-compatible practice management systems. This month, IDOC will add a customized Report Card feature to the Insider benefit package, which will provide data-driven practice performance feedback in an easy-to-read dashboard format.
Launched in January of this year, IDOC Insider is powered by EdgePro by GPN Technologies. IDOC Insider Report Card will display clinical and optical revenue, sales volume by product type, performance benchmarks compared to participating IDOC member averages, and other key performance indicators. Those key performance indicators are then interpreted by IDOC practice management experts, who provide actionable “next steps” to help members identify and act on valuable market opportunities, according to the company.
CORE Develops “Five Minute Overviews” of International Myopia Institute Papers
The Centre for Ocular Research & Education (CORE) has published “five minute overviews” of each International Myopia Institute (IMI) paper ahead of the official release. In conjunction with Dr. Kate Gifford, CORE has also created a downloadable set of practical tips on how to implement the clinical management guidelines in practice. The summaries, reference guide, and additional myopia management insights can be accessed for free at https://contactlensupdate.com/category/issues/myopia-matters/ .
The summaries and clinical insights fact sheet are part of a special edition of Contact Lens Update, which receives support from the educational arms of Alcon and Johnson & Johnson Vision.
Are measures of axial length required for practicing myopia control in your practice?
Nicholas Rumney, MSCOptom, FCOptom, DipTp(IP), ProfCertMedRet, Hereford, UK
This 73-year-old patient underwent monovision intraocular lens (IOL) implantation following cataract extraction in July 2016, with YAG capsulotomy in September of that same year. Corrected visual acuity was 20/20 OD and OS. The patient’s subsequent refractive outcome was deemed overly myopic (–1.75D), and the final outcome was adjusted by laser-assisted subepithelial keratomileusis (LASEK) in February 2017. At an office visit in December 2018, the patient complained of reduced vision OS (20/30 and disability glare). Both the slit lamp and optical coherence tomography (OCT) images show epithelial haze that did not respond to topical steroid. Now stable, we are considering a phototherapeutic keratectomy (PTK).
We thank Nicholas Rumney for these images 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
How High Should You Go?
Myopia control is a hot topic these days, and many practitioners use a multitude of methods to prevent myopia progression. Methods can include bifocal spectacles, multifocal contact lenses, and orthokeratology, and, in some cases, atropine has been prescribed for children to prevent progression. It is no surprise that worldwide, myopia can have a significant economic burden.1 One method that almost all eyecare providers have readily available is soft multifocal contact lenses. However, what is the best combination or lens modality to use for these patients?
Although center-near designs are available, only center-distance soft multifocal lens designs have been studied to date. These studies provide the most widely accepted evidence-based medicine to support the use of distance-center multifocal designs in clinical practice and, on average, these contact lenses slow progression by 46%.2-4 With respect to add power, in general, +2.00D tends to be a popular starting point. This allows patients to receive the benefit of reduced accommodative demands, without significantly impacting distance vision. In general, many patients (or parents) may be willing to tolerate some level of visual compromise to reduce the risks of myopia progression.5 As always, educating patients and their parents on outcomes can lead to increased compliance.
1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 May;123:1036-1042.
2. Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology. 2011 Jun;118:1152-1161.
3. Lam CS, Tang WC, Tse DY, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014 Jan;98:40-45.
4. Walline JJ, Greiner KL, McVey ME, Jones-Jordan LA. Multifocal contact lens myopia control. Optom Vis Sci. 2013 Nov;90:1207-1214.
5. Sha J, Tilia D, Diec J, et al. Visual performance of myopia control soft contact lenses in non-presbyopic myopes. Clin Optom (Auckl). 2018 Jul 25;10:75-86.
MATERIALS & DESIGNS
David L. Kading, OD
Multifocal Mission Possible
Remember when multifocal lenses were impossible? Fortunately, the industry took (and is still taking) practitioners’ suggestions to make improved lenses that provide better comfort and better vision. We have incredible options for multifocals today. Patients who are presbyopic tend to make up a smaller percentage of contact lens wearers, as many have dropped out by the age of presbyopia onset due to dryness and discomfort.
Naturally, I believe that daily disposable lenses are the direction in which we should go for all of our patients. And, with the added benefit of a daily disposable lens, these patients will likely experience less dryness. Additionally, these patients oftentimes have come to a realization regarding what “compromised” vision is; they have worn progressive lenses and experienced the compromise of the head point. Or, they may have worn monovision and experienced the decrease in depth perception. With multifocals, we never promise perfect vision. Instead, we balance a patient’s ideal vision situation with the tools that we have. Low, medium, high…regardless of the amount of presbyopia, we have tools.
If you are struggling with multifocals, realize that there are millions of patients who are successful. The tools are sound. In my experience, my “failures” with multifocals are usually due to improper expectations that I set. Have a reasonable discussion about vision with regard to what multifocal lenses can and can’t provide, then find your preferred tool and go to work.
The Outcome of Scleral Lens Fitting for Keratoconus with Resolved Corneal Hydrops
The purpose of this study was to investigate the success and failure of scleral lens fitting in patients who had keratoconus with resolved hydrops.
The study included a retrospective case series of patients who had keratoconus and who attended the ophthalmology department at Antwerp University Hospital, Belgium, and who developed acute hydrops between Jan. 1, 2015, and June 30, 2018. The exclusion criteria included amblyopia, mental retardation, and insufficient follow up.
Of the 25 patients who had keratoconus with acute hydrops, 14 patients (16 eyes) were included in this study. Median age was 31 years (range 19 to 52 years). Before hydrops, the median maximum keratometry value of affected eyes was 81.3D (range 66.3D to 108.3D). Acute hydrops was managed medically in five eyes (31.3%), by observation in five eyes (31.3%), by application of a bandage contact lens in one eye (6.3%), and by compression corneal sutures in five eyes (31.3%). Contact lens fitting after hydrops was not necessary for two patients (two eyes; 12.5%) because of excellent vision in the fellow eye. Of the remaining patients, 11 (68.8%) were successfully fitted with mini-scleral lenses, with a median visual acuity of 0.7 (0.5 to 0.9; decimal Snellen). Three patients (three eyes; 18.8%) proceeded to graft surgery because of limited visual acuity with scleral lenses (n = 2) or persistent edema (n = 1).
The authors concluded that scleral lenses are effective for providing satisfactory visual acuity after corneal hydrops in keratoconus. A scleral lens trial is advised before listing patients for graft surgery.
Kreps EO, Claerhout I, Koppen C. The Outcome of Scleral Lens Fitting for Keratoconus with Resolved Corneal Hydrops. Cornea. 2019 Jul;38(7):855-858.