Advances in technology are often simply amazing and perhaps taken for granted far too frequently. This holds true for advances in contact lens technology as well. As noted in our abstract this week, major technological advances in personalizing the contact lens care regimen are described by a “lab on a chip” device, which could have significant impact on our patients’ ability to monitor their contact lens care. Perhaps, one day, the technology will remind the patient to also discard their contact lenses after the lenses have been worn for the prescribed number of days as well.
Jason J. Nichols, OD, MPH, PhD
Bausch + Lomb Educates 400+ ECPs During B+Lieve Innovation Summit
Bausch + Lomb (B+L) continued its educational and training initiative for eye care professionals (ECPs), offering them the opportunity to experience and learn about the latest innovations in contact lens technology. The B+Lieve Innovation Summit took place from March 4-5, 2016, in Orlando, FL, introducing more than 400 ECPs to B+L’s Ultra for Presbyopia contact lenses, a monthly replacement silicone hydrogel lens that will begin distribution this month.
At the event, ECPs learned about the 3-Zone Progressive design; heard from other ECPs who have successfully incorporated B+L’s MoistureSeal technology and 3-Zone Progressive design in their practices; participated in training sessions to learn how to fit the Ultra for Presbyopia lenses in accordance with the simplified fitting guide; and experienced the lenses themselves.
The event also featured keynote speakers: Paul Karpecki, OD, FAAO, an eye care professional from Koffler Vision Group in Lexington, KY; Mile Brujic, OD, an eye care professional from Premier Vision Group in Bowling Green, OH; and Mark Wright, OD, an eye care professional from the Solution Center in Westerville, OH.
FDA Allows Marketing of Contact Lens that Measures IOP
The U.S. Food and Drug Administration (FDA) allowed marketing of a one-time use contact lens that may help practitioners identify the best time of day to measure a patient’s intraocular pressure (IOP). Elevated IOP is often associated with the optic nerve damage that is characteristic of glaucoma.
The Triggerfish, which is manufactured by Sensimed AG, has a sensor embedded in a soft silicone contact lens that detects tiny changes or fluctuations in an eye’s volume. The device is worn for a maximum of 24 hours, transmitting data wirelessly from the sensor to an adhesive antenna worn around the eye. A portable data recorder worn by the patient receives information from the antenna and can transfer the data via Bluetooth to the clinician’s computer, which shows the range of time during the day the pressure of the eye may be increasing. The device does not actually measure IOP, is not intended to be a diagnostic tool, and is not used to correct vision.
The Triggerfish is indicated for use in adults age 22 and older under the direction and supervision of a health care professional. Clinical data supporting the marketing authorization of the Triggerfish included several studies of the safety and tolerability of the contact lenses and the effectiveness of the device measurement. The effectiveness of the device was demonstrated by showing an association between the Triggerfish device output and IOP fluctuation. The most common temporary side effects were pressure marks from the contact lens, ocular hyperemia (red eyes) and punctate keratitis (irritation of the cornea).
The FDA reviewed the data for the Triggerfish through the de novo premarket review pathway, a regulatory pathway for some low- to moderate-risk medical devices that are not substantially equivalent to an already legally marketed device.
X-Cel Announces Daily Disposable Lens in Three Diameter Options
X-Cel Specialty Contacts announced the expansion of its product line with a new lens: Extreme H2O Daily, a one-day disposable contact lens available in three diameter options (13.6mm, 14.2mm, and 14.8mm). According to X-Cel, the 13.6mm lens is a solution for patients with smaller corneas or lid apertures, and the 14.8mm lens should be a go-to lens for patients with active lifestyles.
Extreme H2O Daily is made with hioxiflcon A, a non-ionic ultra-hydrating material that retains 99% of its water content throughout the wearing time. The lens comes in three diameter options 13.6mm (8.2 base curve [BC]), 14.2mm (8.5 BC), and 14.8mm (8.7 BC). Available parameters in all diameters are: +0.50 to +6.00 and –0.50 to –10.00 (.50D steps after –6.00).
Anyone who tells us that multifocal contact lenses are “there” is delirious. Folks, we have issues. But, in the same way, anyone who tells you that progressive addition lenses are perfect is a person who doesn’t keep an eye on the progressive market. In fact, all the manufacturers are introducing new progressive addition designs on a yearly basis. How much improvement does each iteration bring over the prior years? Marginal at best. However, if we could improve our multifocal designs yearly by as much as 3% to 5%, imagine where we would be.
Alas, the contact lens developers are not innovating as quickly, which leads us to settle with what we have. Are they really that bad? Are they really that good? It would have been really easy for the Egyptians to have thought “man, these pyramids would be a lot easier to build if we only had an automated crane and dump trucks to move these giant stones.” But, they made due with what they had.
Like many of you, we are not waiting for perfect; we are crushing it with multifocals now more than ever. We are finding the right patients that fit into the designs and using our knowledge of the optics to maximize our patients’ vision. Sure we have the complainers and patients who wish things could be better, but we have to bring things back to reality and emphasis the benefits. If you’re a naysayer who says that they are not good enough yet, let me promise you that we will always have struggles. Builders today are wishing that artificial intelligence operators could climb to the top of skyscrapers instead of themselves. But, fortunately, they build on anyway. And, lucky us, we get the outcomes we have today. What outcomes are you creating today?
CARE SOLUTION CORNER Andrew D. Pucker, OD, MS, FAAO
An Intrinsic Hazard of Hydrogen Peroxide Solutions
I have found hydrogen peroxide solutions to be effective contact lens cleaning agents, yet these popular cleaners should always be used with some caution since they can pose an ocular hazard until they are neutralized. This fact is especially concerning for the uninformed patient or for the tired patient who mistakes one care solution for another. While in clinic, I have had multiple patients indicate to me that they have accidently applied unneutralized hydrogen peroxide to their eyes. In general, they have told me that it hurt, but it was a limited event.
With that said, one case in particular stands out. I had a keratoconus patient present for an emergency visit. He was currently wearing piggyback contact lenses; he was cleaning his GP contact lenses with a hydrogen peroxide solution and his soft contact lenses with a multipurpose solution. On the day of his visit, he had switched the bottles and applied soft contact lenses with unneutralized hydrogen peroxide to his eyes. Needless to say, this caused him extreme pain. And, this action resulted in significant corneal damage, which prevented him from wearing contact lens for about two weeks.
While this severe situation is uncommon, we need to help our patients avoid such circumstances. When possible, remind your patients of the dangers of the products that you prescribe to them and keep their treatments as simple as possible. This is highlighted by the situation above, which may have been avoided if my patient were using one type of contact lens solution for both types of contact lenses.
A Contact-Lens-on-a-Chip Companion Diagnostic Tool for Personalized Medicine.
The authors presented a novel, microfluidic platform that integrates human tears (1μL) with commercial contact lens materials to provide personalized assessment of lens care solution performance. This device enabled the detection of significant differences in cleaning and disinfection outcomes between subjects and between biofilms vs. planktonic bacteria.
The research team used the device to demonstrate how tears impact both lens selection and care solutions. In the future, it may be adapted for use for point-of-care testing in eye clinics.
Guan A. Wang Y. Phillips KS, Li Z. A Contact-Lens-on-a-Chip Companion Diagnostic Tool for Personalized Medicine. Lab Chip. 2016 Feb 29. [Epub Ahead of print]