What is your protocol when a patient says “I tried everything and nothing works”? Or, when you are unsure how to treat a complicated contact lens fit? Or you see a rare disease that you have not seen prior?
Ever have one of those nagging questions that you can’t seem to figure out? Yup, me too. We ponder them for a few minutes and, more often than not, give up without finding an answer. Now, Contact Lenses Today and Contact Lens Spectrum can help.
In the oh-so-wise words of Dr. Seuss “Sometimes the questions are complicated and the answers are simple.” So, simply send your questions to email@example.com and we’ll put our expert columnists on the trail toward the explanation. You’ll find the answers in a column titled “You Asked for It,” which will appear periodically to help resolve these challenging scenarios.
Jason J. Nichols, OD, MPH, PhD
IACLE to Hold 2017 Congress on Contact Lens Education
“Translating Knowledge into Increasing Contact Lens Penetration” will be the theme for the 2017 International Association of Contact Lens Educators (IACLE) Congress on Contact Lens Education, taking place in Hyderabad, India from Sept. 9-10, 2017. The Congress is timed to precede the World Council of Optometry’s 2nd World Congress of Optometry, also In Hyderabad (being held on Sept. 11-13), where IACLE will also be providing the contact lens content. Supporters of the event include Alcon, CooperVision, and Johnson & Johnson Vision.
The IACLE Congress is being held at L V Prasad Eye Institute (LVPEI), a comprehensive eye health facility with its main campus located in Hyderabad. The program will cover: addressing contact lens dropouts; the importance of a contact lens work-up protocol, lens care, and follow up; IACLE resources and assessment of students; and contact lenses in the management of presbyopia.
To help cover the cost of attending this meeting, IACLE members are eligible to apply for bursaries up to a maximum value of $500 (Indian members up to $250), subject to terms and conditions. Applications will be considered on a first come, first served basis and decided based on their active participation in IACLE programs, and their reach and impact on contact lens education at their institution as well as at local and regional levels. Completed applications must be submitted online no later than Mar. 31, 2017.
TearLab Announces CE Marking for Next-Generation System
TearLab Corporation announced that its next-generation in-vitro diagnostics testing platform is in conformity with all the applicable provisions of In Vitro Diagnostic Medical Devices Directive 98/79 EC enabling CE Marking of the device. CE Marking provides clearance in the European Union (EU) and European Free Trade Association (EFTA) member countries.
This CE Marking provides regulatory clearance for both the device and the initial next-generation test card, capable of measuring both osmolarity and an inflammation biomarker, which together will help identify patients expected to respond to dry eye disease (DED) therapies.
The company also announced it will seek CE Marking for a second protein biomarker that will, when combined with osmolarity and the first inflammation biomarker, comprise the initial commercial multiplex test card on the new platform. TearLab then plans to build a robust clinical data package and secure valuable feedback from global key opinion leaders in support of a 510(k) submission to the U.S. Food and Drug Administration, which is expected in the third quarter of 2017.
Art Optical Adds New GP Materials from Acuity Polymers
Art Optical has entered into a vendor partnership with Acuity Polymers. Acuity 18 (enflufocon A) and Acuity 100 (hexafocon A) lens materials are now available across the range of specialty GP lens designs offered by Art Optical.
Acuity 18 is a fluorosilicone-acrylate material with a low Dk (21) that delivers excellent stability, wettability, and optics and is good choice for thin lens designs, according to the company. The high-Dk (111) Acuity 100 material offers fitters and patients the oxygen delivery required with today’s advanced corneal and scleral lens designs. Both Acuity 18 and Acuity 100 are FDA cleared and are available in a number of handling tints.
VTI Uses IPO to Raise Funds for U.S. Expansion
Visioneering Technologies, Inc. (VTI) has raised A$33.3 million (Australian dollars) following the close of its fully underwritten initial public offering (IPO), which the company says was strongly supported by institutional and sophisticated investors in Australia and Asia.
The IPO proceeds will provide capital as VTI broadens and accelerates the U.S. launch of its NaturalVue Multifocal daily disposable contact lenses for adults who have presbyopia and for children who have myopia (currently an off-label treatment). The company will also launch additional contact lens products.
The funds raised in the IPO are intended to further build out the U.S. sales force to approximately 45 direct sales representatives over the 12 months following listing and to build inventory that will support the expanded sales effort.
VTI offered for issue approximately 79.4 million CHESS Depositary Interests, each representing an interest in one share of VTI’s Class A common stock. The offer was priced at A$0.42/CDI, with an indicative market capitalization of approximately A$88.2 million (on a fully-diluted basis). The CDIs will be quoted on the Australian Securities Exchange following the IPO. The IPO was fully underwritten by Cannacord Genuity.
Britney Kitamata-Wong, OD, Anaheim, CA
A 36-year old Caucasian male presented with a chief complaint of frequent deposits on his scleral contact lens. A soft contact lens is worn in the fellow eye. He reported sleeping in his contact lenses most nights and that he cleaned them once a week with a peroxide cleaner without digital rubbing. His history was significant for having keratoconus in both eyes and daily marijuana smoking. The image shows a combination of protein (grey) and pigment (brown) deposits on the front and back surfaces of the lens. Deposits are concentrated along the flat meridian of the toric haptics and are easily removed with a sodium hypocholorite/potassium bromide cleaner.
We thank Britney Kitamata-Wong 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.
CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
Pets, Allergies, and Contact Lenses
Pets can be a wonderful addition to one’s home or workspace. In fact, owning or working with a pet can increase one’s physical activity, improve heart health, reduce one’s stress levels, and result in a better quality of life.1 While many people benefit from pets, others find them to be a source of allergens that negate these benefits.
Allergic rhinitis is a common condition that affects about one-third of the population, and about half of these people experience concurrent ocular symptoms (e.g., itching, watering, redness, and/or swollen eyes); these symptoms are often under-diagnosed and under-treated.2 Allergy symptoms can have a negative impact on one’s daily activities, and they could also lead to contact lens discomfort.2,3
While pollen and dust mites are the most common causes of allergic rhinitis, pets are also frequent instigators, and questions related to all of these topics should be raised when investigating a potential case of allergic rhinitis.2 This is especially true when it inhibits a patient’s daily life, such as the wearing of contact lenses.
Regularly caring for ocular allergies with topical anti-allergy medications or preventing work-related allergies with occupational safety devices (such as protective clothing or respirators) can help your patients avoid animal-related allergy symptoms while at the same time allowing them to maintain their normal work duties and continue wearing contact lenses.4,5 Likewise, I find that emphasizing contact lens care regimens and increasing replacement frequency can also help reduce lens deposition associated with allergies.
1. Matchock RL. Pet ownership and physical health. Curr Opin Psychiatry. 2015 Sep;28:386-392.
2. Klossek JM, Annesi-Maesano I, Pribil C, Didier A. The burden associated with ocular symptoms in allergic rhinitis. Int Arch Allergy Immunol. 2012;158(4):411-417.
3. Dumbleton K, Caffery B, Dogru M, Hickson-Curran S, Kern J, Kojima T, Morgan PB, Robertson DM, Nelson JD; members of the TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: report of the subcommittee on epidemiology. Invest Ophthalmol Vis Sci. 2013 Oct;54:TFOS20-TFOS36.
4. Renström A, Olsson M, Hedren M, Johansson SG, van Hage M. Pet shop workers: exposure, sensitization, and work-related symptoms. Allergy. 2011 Aug;66:1081-1087.
5. Ehlers JP, Shah CP, Wills Eye Hospital (Philadelphia Pa.). The Wills Eye Manual : Office and Emergency Room Diagnosis and Treatment of Eye Disease. 5th Ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
MATERIALS & DESIGNS
David Kading, OD
Mix and Match on Dry Eye
I naturally tend to find a solution to a problem and stick to that solution. It is our tendency as human beings to have buckets to which we regularly go.
Bucket 1: These are my treatments for dry eye.
Bucket 2: These are my treatments for spherical patients.
Bucket 3: These are my treatments for conjunctivitis patients.
Of course, we have many more buckets for other conditions as well. However, rarely do we look to mix our buckets across several different conditions, but there are certainly times in which overlap can really benefit a patient.
Once such area is the use of scleral lenses for dry eye patients. Over the last four years, my dry eye practice has grown into a regional referral center. My knowledge has grown with this patient base. One thing that I discovered is how cautious we need to be in recommending contact lenses to patients who have dry eye. Lenses tend to further progress some patients’ dry eye issues and, as such, need to be prescribed with caution. Scleral lenses are no exception; however, they do offer one thing that other lenses do not—a fluid reservoir.
The fluid reservoir that is created between a patient’s lens and cornea can act as a protective chamber for advanced dry eye patients. We have found that scleral lenses are usually best used in advanced cases in which the meibomian glands are severely atrophied and patients are no longer capable of creating their own tears in a quality way. If the patients have any hope of creating their own quality tears again—either after adding heat and pressure to the inner eyelid or using a T cell mediated drop—then we will not use scleral lenses yet.
But if they are beyond this, then we will use scleral lenses as a barrier to the harmful dry environment to which the cornea, limbus, and surrounding conjunctiva are susceptible. The surface of the lens may require regular artificial tear use to maintain a wet, slippery surface so as to not create additional symptom issues; in these cases, the patients are not able to readily wet the surface through their own diminished tear film.
If you haven’t comingled your dry eye and keratoconus buckets, I encourage you to consider using scleral lenses on your patients who have severe dry eye. You may find that “mixing and matching” brings about a big win for everyone involved.
Patient Comfort and Visual Outcomes of Mini-Scleral Contact Lenses
The objective of this retrospective case series was to evaluate short-term visual outcome, patient acceptance, and tolerance of mini-scleral contact lenses in the management of various corneal pathologies.
During the single-center retrospective case series, conducted between Feb. 2010 and Jan. 2013, 32 patients (40 eyes), who had a mean age of 41 ± 16 years and various corneal pathologies, were offered either AccuLens’ Maxim 5R, Maxim 7, or Maxim 7 × 11 mini-sclerals for nonsurgical optimization of visual correction. Patients had follow-up exams at one and three months for assessment of best-corrected visual acuity (BCVA), comfort, length of daily wear, and complications.
The report noted that 18 patients had previously undergone surgery such as penetrating keratoplasty, deep anterior lamellar keratoplasty, and intraocular lens implantation. The median BCVA improved from 0.3 logMAR (range 0-1.3) before mini-sclerals to 0.05 logMAR (range 0-1) with mini-sclerals (p < 0.0001). At the one-month follow up, the median length of wear was 10 hours per day (range 1.5 to 15 hours). At the three-month follow up, the median length of wear was 12 hours per day (range two to 15 hours). All eyes were comfortable at initial use of mini-scleral lenses and 91% were comfortable at the three-month follow up.
The authors concluded that mini-scleral lenses may be a comfortable management option for patients who have keratoconus and other corneal pathologies who are unable to achieve adequate visual outcome with traditional spectacles or GP contact lenses.
Yan P, Kapasi M, Conlon R, Teichman JC, Yeung S, Yang Y, Ziai S, Baig K. Patient comfort and visual outcomes of mini-scleral contact lenses. Can J Ophthalmol. 2017 Feb;52:69-73.