I have just returned from the Netherlands Contact Lens Congress (NCC) where nearly 1,600 practitioners met to discuss the current state of affairs in the contact lens arena. The Congress was extremely broad with topics and debates ranging from contact lens materials to care solutions to contact lens dry eye, myopia control, and specialty lenses. I was reminded that practitioners in other parts of the world are just as, if not more, enthusiastic about the state of the contact lens industry in addition to learning new opportunities to care even more for their contact lens patients.
Jason J. Nichols, OD, MPH, PhD
Myolite’s Protective Lighting System Receives Its Second Patent
The U.S. Patent and Trademark Office has issued a second patent to Myolite, Inc., which aims to reduce the incidence of myopia and regulate the progression of myopia through the use of protective lighting systems.
The patent, titled Electromagnetic Radiation Refractive Therapy, was issued to inventor and vision scientist Jerome A. Legerton, OD. It claims that the intracellular signal transduction networks that regulate eye growth can be regulated by light sources when such light sources are controlled to deliver the proper chromaticity, amount, direction, and duration of light.
The two most recent Myolite patents teach the concept of electromagnetic radiation refractive therapy and describe how specific light sources with emission in the visible spectrum can be placed in spectacle lenses, contact lenses and spectacle frames. A third pending patent teaches a Protective Lighting System primarily intended for classroom use to mitigate the decrease in time spent outdoors by a significant number of young school-age children.
Myolite anticipates that the use of electromagnetic radiation refractive therapy, as described in the patents, will complement refractive error regulation by pharmaceutical intervention and peripheral defocus by way of corneal refractive therapy and multifocal contact lenses
Along with Dr. Legerton, other key members of the Myolite team include Glenn Moro, former global head of Marketing, Innovation and Myopia Control for Alcon Vision Care; and British-trained optometrist and vision scientist, Mark Bullimore, PhD, who was recently appointed as executive director of the World Council of Optometry.
CooperVision has launched a toric calculator to its OptiExpert app, the second major upgrade. The free app is available to download for iOS and Android devices and provides initial diagnostic contact lens suggestions from CooperVision’s product families—Avaira, Biofinity, Biomedics, Clariti and Proclear.
The new toric calculator offers an efficient way to calculate a suggested initial diagnostic toric contact lens for each patient. The practitioner simply inputs the patient’s most recent spectacles prescription and the app suggests the toric contact lenses that may result in fitting success. OptiExpert also takes into consideration back vertex distance adjustment and on-eye orientation, while supporting any refinement required, based on the practitioner’s observation of the toric axis location marker.
The latest addition to the app complements the existing multifocal calculator, which is used by practitioners seeking to transition their presbyopic patients to multifocal contact lenses. The app’s original functionality converts the Efron Grading Scales into a digital tool that is designed to be easier to use. It enables practitioners to grade patients against 16 sets of images and covers the key anterior ocular complications of contact lens wear.
The app also includes the ability to securely store images of the patient’s eye condition for easier comparison to other images on the scale. Practitioners are able to add their own comments following each patient evaluation, allowing a record to be compiled of each patient and any treatment prescribed.
OptiExpert is available in 14 languages and 33 countries. To download the app, practitioners should speak to their CooperVision business development manager to obtain a password and then visit the App Store or Google Play Store.
AccuLens Inc. Announces EasyFit HD Scleral Lenses for Healthy Eyes
AccuLens announced that high definition (HD) optics are now available in the EasyFit Scleral Lens for healthy eyes. According to the company, its proprietary HD algorithm on the front surface of the lens offers truer more accurate vision versus conventional lenses. It also boosts visual clarity in all visual conditions including low light situations. Objects will be sharper and more defined allowing patients better focus in all tasks. The introduction into HD optics reduces the common issue of spherical aberrations.
Dr. Jean-Louis Blanchard, co-founder of Blanchard Contact Lenses, passed away on February 18 at the age of 91. Dr. Blanchard was one of the pioneers of “contactology” in Quebec. According to the company, he traveled the world to learn and share his knowledge of contact lenses. Dr. Blanchard’s contributions to the contact lens manufacturing industry were recognized on many occasions with various awards, such as the American Academy of Optometry Founder Award. In addition, the Optometry School of University of Montreal considered him a founder of the profession of optometry. Memorial services were held on March 18 and 19.
Jack Hartstein, MD, passed away on March 12 at the age of 91. He has served as a clinical professor of ophthalmology at the Washington University School of Medicine in St. Louis and Medical Director of the Contact Lens department at Barnes Hospital. He is former chairman of the Department of Ophthalmology at St. Luke's Hospital. He has authored three textbooks on contact lenses for eye care professionals and was the former editor-in-chief of the Contact and Intraocular Lens Medical Journal. He was a member of the AMA, American Academy of Ophthalmology, Contact Lens Association of Ophthalmology, MD-OD Contact Lens Foundation of St. Louis, and an Advisory Board member of the GPLI.
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Corneal Transplantation in Disease Affecting Only One Eye: Does It Make a Difference to Habitual Binocular Viewing?
We need to remember that we do have two eyes that need to work together!
When unilateral corneal disease is present that requires performance of penetrating keratoplasty (PK), we typically measure functional success by outcomes of best corrected visual acuity either with spectacles and/or with contact lenses. Often, these monocular acuity outcomes fail to provide information pertaining to performance under binocular vision circumstances.
A recent study was published that prospectively quantified the contribution of the transplanted eye toward habitual binocular viewing in 25 cases with unilateral corneal transplants [40 years (32 to 42 years) and 25 age-matched controls [30 years (25 to 37 years)]1. The authors stated that in unilateral corneal disease, the transplanted eye may remain functionally inactive during binocular viewing due to its suboptimal visual acuity and poor image quality, vis-à-vis the healthy fellow eye. Binocular functions, including visual field extent, high-contrast logMAR acuity, suppression threshold and stereoacuity, were assessed using standard psychophysical paradigms. Optical quality of all eyes was determined from wavefront aberrometry measurements.
Binocular visual field expanded by a median 21% (IQR: 18-29%) compared to the monocular field of cases and controls (p = 0.63). Binocular logMAR acuity [0.0 (0.0-0.0)] almost always followed the fellow eye’s acuity [0.00 (0.00-0.02)] (r = 0.82), independent of the transplanted eye’s acuity [0.34 (0.2-0.5)] (r = 0.04). Suppression threshold and stereoacuity were poorer in cases [30.1% (13.5-44.3%); 620.8arc sec (370.3-988.2arc sec)] than in controls [79% (63.5-100%); 16.3arc sec (10.6-25.5arc sec)] (p<0.001). Higher-order wavefront aberrations of the transplanted eye [0.34μ (0.21-0.51μ)] were higher than the fellow eye [0.07μ (0.05-0.11μ)] (p<0.001) and their reduction with RGP contact lenses [0.09μ (0.08-0.12μ)] significantly improved the suppression threshold [65% (50-72%)] and stereoacuity [56.6arc sec (47.7-181.6arc sec)] (p<0.001).
The authors concluded that in unilateral corneal disease, the transplanted eye does participate in gross binocular viewing, but offers limited support to fine levels of binocularity. Improvement in the transplanted eye’s optics enhances its participation in binocular viewing. Current metrics of this treatment success can expand to include measures of binocularity to assess the functional benefit of the transplantation process in unilateral corneal disease.
The results of this study further support the benefit of rigid contact lens treatment following PK via their influence on reduction of high order aberrations and secondary improvement in binocular functioning as evidenced by improved stereoacuity and suppression threshold. So, although it is important to evaluate success of PK based on monocular visual performance, we need to keep in mind that most of our patients are binocular individuals and that in order to determine the true functional improvement following surgery, we need to measure binocular performance.
1. Bandela PK, Satgunam P, Garg P, Bharadwaj SR. Corneal Transplantation in Disease Affecting Only One Eye: Does It Make a Difference to Habitual Binocular Viewing? PLoS One. 2016 Mar 3;11(3):e0150118.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Be a Crusader
I can list dozens of references that demonstrate smoking to be deleterious to the health of the eye, including the ocular surface. A patient’s smoking history is so important, that it is a core measure in reporting EMR Meaningful Use. It is a top query in a dry eye evaluation. My father, who was a smoker, died from lung cancer. My brother battled nicotine addiction for decades. I am a crusader for smoking cessation and my patients know it.
Tobacco smoke contains more than 7,000 chemicals, including more than 70 carcinogens. Cigarette smoking is responsible for more than 480,000 deaths each year in the United States, nearly one in five deaths1.
A powerful advertising campaign is currently running (at least in New York) that brings into sharp, brutal, and uncensored focus the multiple cancers associated with smoking. Cigarette smoking (and information is coming in from e-cigarettes) is associated with 16 types of cancers: nasal cavity and the sinuses, mouth, larynx, throat, esophagus, lung, liver, pancreas, stomach, urethra, bowel, kidney, cervical, ovarian, bone marrow, and bladder.
An In Vivo Confocal Microscopic Study of Corneal Nerve Morphology in Unilateral Keratoconus
In this prospective cross-sectional study, the authors examined corneal nerve morphology and its importance in unilateral keratoconus. In the study, 33 eyes of 33 patients with keratoconus in one eye (Group 3) were compared with the other normal eye of the same patients (Group 2) and 30 eyes of healthy patients (Group 1). All patients underwent detailed ophthalmic examination followed by topography with Pentacam HR and in vivo confocal microscopy (IVCM). Five images obtained with IVCM were analyzed using an automated CCmetrics software version 1.0 for changes in subbasal plexus of nerves.
An intergroup comparison showed statistically significant reduction in corneal nerve fiber density (CNFD) and length (CNFL) in Group 3 as compared to Group 1 (p < 0.001 and p = 0.001, resp.) and Group 2 (p = 0.01 and p = 0.02, respectively). Though corneal nerve fiber length, diameter, area, width, corneal nerve branch density, and corneal total branch density were found to be higher in decentered cones, only the corneal nerve branch density (CNBD) was found to be statistically significant (p < 0.01) as compared to centered cones.
The authors concluded that quantitative changes in the corneal nerve morphology can be used as an imaging marker for the early diagnosis of keratoconus before the onset of refractive or topography changes.
Pahuja NK, Shetty R, Nuijts RM, Agrawal A, Ghosh A, Jayadev C, Nagaraja H. An In Vivo Confocal Microscopic Study of Corneal Nerve Morphology in Unilateral Keratoconus. Biomed Res Int. 2016;2016:5067853.