There has been an explosion of insights into dry eye disease over the last 10 years, much of it relating to new diagnostic techniques and therapeutic approaches. We have also come a very long way in our understanding of importance of managing the multifactorial nature of the disease and the various etiologies that present in practice. Because of its frequency in practice and impact on our patients’ ability to successfully wear contact lenses, our July issue of Contact Lens Spectrum each year is completely devoted to dry eye disease. We hope you enjoy this focused issue of the journal; please be on the lookout for it as it becomes available soon.
Jason J. Nichols, OD, MPH, PhD
Quadrant Specific Control Technology Now Available in Ampleye Scleral
The latest capability in customizing Ampleye, the new 16.5mm scleral lens from Art Optical, is the availability of Quadrant Specific Control Technology. A proper scleral fit is essential to successful wear for patients, however; when dealing with inherent scleral toricity, asymmetry, and other scleral irregularity, finite control of each lens segment is required to achieve an optimal scleral landing.
With Quadrant Specific Control Technology, practitioners can independently manage up to four quadrants of the scleral landing (SLZ) area. Each quadrant can be adjusted up to 375μm higher or lower from a zero position. Using the Quad Control feature, Ampleye can be customized to compensate for scleral asymmetry as well as vaulting pterygiums, pingueculae and limbal scars. Art Optical's fitting consultants are well versed on Quadrant Control Technology and can provide detailed assistance at your request.
Designed to fully vault the cornea and limbus and land gently on the sclera with 360° of alignment, Ampleye ensures no corneal involvement, so irregular cornea fitting is simplified and patient comfort is maximized, according to the company. Ampleye also includes an inherent toric haptic to more precisely match the true shape of the human sclera for more predictable diagnostic fitting.
Ampleye is fit diagnostically by corneal condition and sagittal depth with the aid of an efficient and affordable 9-lens trial set that can accommodate prolate and oblate corneas. Ampleye lenses are featured in Optimum Extra material by Contamac.
Ampleye lenses are competitively priced, backed by Art Optical’s comprehensive warranty programs, and manufactured and shipped within 24 hours of order. For additional information on Ampleye, visit the company website, www.artoptical.com/ampleye, or contact Art Optical at 1-800-253-9364.
Jedlicka Joins B+L Specialty Vision Products as Consultant
Jason Jedlicka, OD, FAAO, FSLS, FCLSA, clinical associate professor at Indiana University School of Optometry and director of the Cornea and Contact Lens Service, has joined the Bausch + Lomb Specialty Vision Products business as an independent consultant.
Dr. Jedlicka brings more than 20 years of extensive academic and private practice experience in customized contact lenses, and has also co-designed the Zenlens scleral lens. In this new role, Dr. Jedlicka will be responsible for working with the B+L marketing and R&D teams to develop novel customized contact lens designs to further enhance the company’s specialty lens product line. He will also provide support to eye care professionals through lecturing and fitting instruction during educational events, in partnership with Lynette Johns, OD, a global expert in scleral lenses, on the Bausch + Lomb Specialty Vision Products team.
Dr. Jedlicka is a diplomate in the American Academy of Optometry’s Cornea, Contact Lens, and Refractive Technologies section, a past president of the Scleral Lens Education Society, and a fellow and board member of the Contact Lens Society of America. Dr. Jedlicka has also lectured internationally and written many articles and book chapters on contact lenses and anterior segment disease.
The Educational Program Committee of the Global Specialty Lens Symposium invites the submission of abstracts for the Free Paper Section and the Scientific Poster Competition. Papers and posters related to presbyopia, keratoconus, corneal topography, post penetrating keratoplasty or related irregular corneal surface, myopia control, orthokeratology and lens care topics are welcome.
The GSLS will be held January 19-22, 2017 at The Rio Hotel in Las Vegas, Nevada. Visit www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2016.
Nicox S.A. announced that the U.S. Food and Drug Administration (FDA) has accepted the Company's New Drug Application (NDA) for AC-170, a novel, proprietary, cetirizine eye drop formulation, for the treatment of ocular itching associated with allergic conjunctivitis. The FDA also granted Priority Review and has assigned a Prescription Drug User Fee Act (PDUFA) goal date of October 18, 2016. Such date is indicative and contingent upon the information (including data) to be eventually provided by Nicox in the review period.
AC-170 is a novel formulation of cetirizine, which has been developed for the first time for topical application in the eye for the treatment of ocular itching associated with allergic conjunctivitis. Cetirizine is a second generation antihistamine and mast cell stabilizer that binds competitively to histamine receptor sites to reduce swelling, itching and vasodilation. Cetirizine, as an approved oral drug, has a well-characterized systemic safety and efficacy profile with worldwide exposure. AC-170 is covered by two granted U.S. patents expiring in 2030 and 2032.
Approval of the AC-170 NDA prior to 1st December 2016 will trigger a milestone payment of $35 million in Nicox shares to ex-Aciex shareholders or $10 million in Nicox shares if approval of the NDA is received after this date. AC-170 was developed by Aciex Therapeutics, Inc., which became a wholly-owned subsidiary of Nicox in October 2014 and was subsequently renamed Nicox Ophthalmics, Inc.
CARE SOLUTION CORNER Andrew D. Pucker, OD, PhD, FAAO
Giant Papillary Conjunctivitis and Care Systems
Giant papillary conjunctivitis (GPC), which is primarily associated with contact lens use, is a papillary reaction that affects the upper tarsal conjunctiva. This reaction is associated with symptoms such as ocular irritation, redness, itching, contact lens intolerance, and excessive contact lens movement.1 GPC is more common in soft contact lens wearers than gas permeable contact lens wearers.1 Furthermore, patients with GPC often have difficulties keeping their contact lenses clean because these patients tend to develop coatings over their contact lenses.1 These coatings have been hypothesized to contain antigens that may be inducing the inflammatory reaction seen with GPC, yet the true etiology of GPC is still unknown.1
My general GPC treatment approach is to temporarily stop contact lens use and to prescribe a topical soft steroid until the condition is under control.1 I then taper the steroid, and if possible, I refit my patients into daily disposable contact lenses to reduce potential harmful deposits.1 While there is evidence that my treatment plan is effective, recent research suggests that altering the patient’s contact lens care system may also be beneifical.1, 2 Specifically, Lievens et al. enrolled symptomatic GPC subjects who habitually used biguanide-preserved multipurpose solutions (BMPS) and randomized them to either continue using their BMPS or switch to a hydrogen peroxide solution.2 Lievens et al. found that subjects in the hydrogen peroxide group had significantly better papillae scores and improved comfort (e.g., irritation, itchiness, dryness) at 30, 60, and 90 days compared to the BMPS group, which provides some evidence that solution choice has an impact on GPC.2
Hydrogen peroxide solutions may reduce GPC signs and symptoms by cleaning contact lenses better, by neutralizing to water, or by some other unknown factor.1, 2 While changing solutions may be beneficial, this action is unlikely to be enough to treat advanced cases, and you will still likely need to implement additional measures.1 Nevertheless, Lievens et al’s work highlights yet another reason why one should consider contact lens care systems in a patient’s overall treatment plan.2
1. Donshik PC, Ehlers WH, Ballow M. Giant papillary conjunctivitis. Immunol Allergy Clin North Am. 2008;28:83-103, vi.
2. Lievens CW, Kannarr S, Zoota L, Lemp J. Lid Papillae Improvement With Hydrogen Peroxide Lens Care Solution Use. Optom Vis Sci. 2016 May 26. [Epub ahead of print]
Not to make light of the gruesomeness of the historically inaccurate movie Braveheart, I love the heart-tugging cry for freedom that he makes at the end of the movie. (https://www.youtube.com/watch?v=lLCEUpIg8rE) I think patients are screaming with the same intensity for the freedom that, they perceive, LASIK will give them from contact lens wear.
What we know that they do not, is that LASIK may make dry eye worse. If a patient truly has “dry eye” they are certainly not a great candidate for LASIK. If I have said it once, I have said it a thousand times, if a patient has dry eye disease, no change in contact lens or solution is going to solve their problem. Rather, we as a profession need to embrace the solutions that we can provide dry eye patients by treating their dry eye.
However, when a patient has got to the point of giving up, even if we have stabilized their dry eye problems, we may have a couple options left. One that is often ignored is Ortho-K.
Orthokeratology has been around a long time. If we look at the expansive evidence in the literature, we can say with certainty that Ortho-K is a safe and effective method of wearing contact lenses. It gives the patient freedom from daily-wear contact lenses while providing exceptional vision.
So if you have that uncomfortable dry eye patient whom you have treated properly and they still want contact lenses, perhaps you should provide them with the freedom from contact lenses that they seek. Perhaps that was what Mel Gibson was screaming about in the movie.
Quantitative Assessment of Central and Limbal Epithelium After Long-Term Wear of Soft Contact Lenses and In Patients with Dry Eyes: A Pilot Study
The researchers wanted to analyze the microstructural alterations of corneal and limbal epithelial cells in healthy human corneas and in other ocular conditions.
Unilateral eyes of three groups of subjects including healthy volunteers (G1, n=5), contact lens wearers (G2, n=5), and patients with dry eyes (G3, n=5) were studied. Imaging of basal (BC) and intermediate (IC) epithelial cells from central cornea (CC), corneal limbus (CL) and scleral limbus (SL) was obtained by in vivo confocal microscopy (IVCM). An appropriate image analysis algorithm was used to quantify morphometric parameters including mean cell area, compactness, solidity, major and minor diameter, and maximum boundary distance.
The morphometric parameters of BC and IC demonstrated no significant differences (P>0.05) between groups. Comparison between three corneal locations (CC, CL, and SL) within the groups showed significant differences (P<0.05) with mean values of cell area, compactness, solidity, and major and minor diameter of BC that increase from CC to limbus. The BC were round and regular in the central cornea (P<0.05) compared with CL and SL.
The authors concluded that VCM enables high-quality confocal images from central corneal and limbal epithelium. This quantitative study demonstrated morphological differences in the basal and intermediate epithelium between limbus and central cornea, and found no differences between contact lens wearers, dry eyes, and normal subjects.
Prakasam RK, Kowtharapu BS, Falke K, Winter K, Diedrich D, Glass A, Jünemann A, Guthoff RF, Stachs O. Quantitative assessment of central and limbal epithelium after long-term wear of soft contact lenses and in patients with dry eyes: a pilot study. Eye (Lond). 2016 Apr 22. doi: 10.1038/eye.2016.58. [Epub ahead of print]