Spring is here, and the allergies that go along with the season are fast approaching. It is a good time to remember how important it is to evert the eyelids of all of your patients, especially your contact lens wearers. Observations of the palpebral conjunctiva can lead to earlier diagnoses rather than waiting for symptoms to show up, which allows for a proactive management strategy. This can help alleviate or reduce some otherwise bothersome symptoms during this season and can lead to safer and more comfortable continued contact lens wear.
Jason J. Nichols, OD, MPH, PhD
Nicox Signs Agreement for Zerviate in China
Nicox SA and Ocumension Therapeutics have entered into an exclusive license agreement for the development and commercialization of Nicox’s product Zerviate (cetirizine ophthalmic solution), 0.24% for the treatment of allergic conjunctivitis for a territory comprising mainland China, Hong Kong, Macau, and Taiwan. Nicox and Ocumension recently also entered into a collaboration for the development and commercialization in the same territory of NCX 470 for patients who have glaucoma or ocular hypertension. Ocumension Therapeutics is an ophthalmology company funded by 6 Dimensions Capital, which was formed by the merger of Wuxi Healthcare Ventures and Frontline BioVentures.
Ocumension is expected to have to conduct additional clinical studies for the regulatory approval of Zerviate in the Chinese market. All development activities will be overseen by a Joint Development Committee comprising representatives of both companies, with Ocumension responsible for undertaking all of the activities at its own cost.
Avedro, Inc. Announces Appointment of Patrick B. Jacques as Vice President of Sales
Avedro, Inc. appointed Patrick B. Jacques as vice president of sales, effective immediately. Reporting to James Schuermann, Avedro’s chief business officer, Mr. Jacques will be responsible for directing Avedro’s U.S. sales strategy, building relationships with clinicians and other key partners, and contributing to Avedro’s marketing programs.
Mr. Jacques brings more than 20 years of sales and leadership experience across various segments in ophthalmology and optometry to Avedro. He began his career with SPS Medical Supply and held roles of increasing responsibility with Briot/Buchman and Advanced Medical Optics.
Alcon Announces Acquisition of PowerVision, Inc.
Alcon has acquired PowerVision, Inc., a privately held, U.S.-based medical device development company focused on creating fluid-based intraocular lens implants. Commercial availability of PowerVision’s IOL technology will be determined following significant additional development and clinical trials of the intraocular lens.
According to PowerVision, its lens design utilizes the eye’s natural accommodating response to transport fluid in the intraocular lens, which is implanted in the eye’s capsular bag. While most presbyopia-correcting intraocular lenses use a multifocal design that distributes light between different focal points, PowerVision’s fluid-based design creates a continuously variable monofocal lens, utilizing the natural contraction of the eye’s muscles, according to the company.
BHVIF Receives Donation
The Brien Holden Vision Institute Foundation (BHVIF) announced that it has received a donation of $225,000—the largest single donation in the history of the foundation. The donation will be used to fund scholarships to train Aboriginal optometrists and providers of vision care services within regional areas of Australia. The donor, who wishes to remain anonymous, has released the funds for use over the next three years.
The first scholarship will be dedicated to the late Professor Brien Holden in recognition of his work in building eye care services for Indigenous Australians. It is the donor’s wish that the second scholarship be dedicated to Yvonne Holden, a tireless advocate for the Aboriginal community.
American Academy of Optometry Announces Peter Scott as New Executive Director
The American Academy of Optometry announced that Peter Scott, MBA, will assume the position of executive director in mid-April 2019. The Academy’s outgoing executive director, Lois Schoenbrun, will retire from her position at the end of April. Ms. Schoenbrun has been executive director of the American Academy of Optometry and the American Academy of Optometry Foundation since 1996. Mr. Scott most recently served as the COO for the North American Veterinary Community in Orlando, FL.
GSLS Seeks Award of Excellence Nominations
The Global Specialty Lens Symposium (GSLS) Program Committee is honored to accept letters of nomination of individuals for the GSLS Award of Excellence. The award is given to distinguished clinicians, scholars, and/or scientists to recognize their lifelong achievements in the field of contact lenses, including development, practice, translation of knowledge and education, and scholarly activity, all of which move the field of contact lenses forward in seminal ways. To make a nomination (including a self-nomination) for the 2020 GSLS Award of Excellence, please send a letter of nomination to firstname.lastname@example.org. All nominations must be received by April 15, 2019.
Vakishan Nadarajah, OD, Berkeley, CA
A 22-year-old Hispanic male came in to the office because he had keratoconus. He was referred by his older brother (who had milder keratoconus) to get specialty contact lenses. Pentacam imagery revealed that his right eye had mild keratoconus; his left eye turned out to be 95D and had a pachymetry reading of ~210μm for the thinnest point. The stromal scarring looks like a snowflake pattern that I have never seen before. Let it snow, let it snow. He was referred for corneal cross-linking in his right eye and will be fit into scleral lenses after the procedure.
We thank Dr. Nadarajah 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.
SPECIALTY LENS SPACE
Karen DeLoss, OD
Lifting the Mask on Keratoconus Patients
I don’t know about you, but I really have a strong disdain for toric intraocular lenses in the setting of specialty contact lens fits. Toric intraocular lenses are safe and effective for treating more than 1D to 1.5D of astigmatism.1 Furthermore, a few studies have reported on the use of toric intraocular lenses for correction of astigmatism in keratoconus.2,3 But while frequency has increased, complications can include increased aberrations and impairment of visual acuity.4
For eye care, this type of patient can be a "masquerader" if past surgical history is not known. Patients will usually present with poor visual acuity and a poor endpoint on refraction. For some, underlying corneal conditions such as keratoconus may lead you to attribute the poor vision to the corneal limitations. However, a quick look at or question about past surgical history can help. From there, I find that using a spherical GP or scleral lens is my next step, and a slow sphero-cylindrical over-refraction helps determine vision potential.
After that, options include a front-surface toric or bitoric (if the corneal lens is stable and won’t rotate). Use a front-surface toric stabilized by a toric peripheral curve for sclerals. Worst case, put the residual prescription in a pair of glasses to wear in conjunction with the contact lens. I certainly will continue to try to persuade my surgeons to forego the toric implant.
1. Lee, YC. Astigmatism considerations in cataract surgery. Tzu Chi Medical Journal. 2013 Mar;25:19-22.
2. Zvornicanin J, Cabric E, Jusufovic V, Musanovic Z, Zvornicanin E. Use of the Toric Intraocular Lens for Keratoconus Treatment. Acta Inform Med. 2014 Apr;22:139-141.
3. Allard K, Zetterberg M. Implantation of toric intraocular lenses in patients with cataract and keratoconus: a case series. Int Med Case Rep J. 2018 Aug 28;11:185-191.
4. Hayashi K, Kondo H, Yoshida M, Manabe S, Hirata A. Higher-order aberrations and visual function in pseudophakic eyes with a toric intraocular lens. J Cataract Refract Surg. 2012 Jul;38:1156-1165.
MATERIALS & DESIGNS
David L. Kading, OD
Has the World of GP Lenses Gone Away?
It certainly has not, and it won’t be going away for a long time. Although we have many patients who have moved over to scleral lenses, there seems to be a shift recently in which patients who have been in them long enough are requesting to try corneal GP lenses again. This may be because of some hyperemia, the hassle of lens handling, or cost. Regardless of the reason, practitioners need to make sure that they are equipped to handle these patients when they want to come back to corneal lenses.
To start, make sure that you are willing to listen and to work with them. If patients want to move on from scleral lenses, but you think that they are the best thing since batteries, you may attempt to talk them out of it without listening to their reasoning. Certainly, patients need to be aware of their options. However, if they really want to go back to corneal lenses and you are not willing to help them, they may seek that care elsewhere. Next, talk to your laboratory and see whether there is anything new that they have developed in the corneal lens space that may make the transition back easier. From coatings to materials to designs, there may be something that you have not tried that might surprise you.
Keep your patients happy, whether it is by fixing their scleral lens issues or by taking a chance to see whether it is worth it. Your laboratory should be able to guide you through the process.
Atomic Force Microscopy Analysis of the Effect of Plasma Treatment on Gas Permeable Contact Lens Surface Topography
This study used atomic force microscopy (AFM) to investigate anterior surface topography (AST) in worn and unworn plasma surface-treated (PST) and untreated (UT) GP lenses and to investigate the influence of surface topography on in vivo comfort.
The GP lens AST was evaluated with AFM in tapping mode, using an uncoated, 40nm symmetric tip (sampling frequency: 300kHz), at five randomized locations over a 100μm2 area to produce mean average roughness (Ra) and root mean square (RMS) values for each sample. Four unworn lenses (two PST, two UT) were examined (Quasar/Boston EO material). Twenty worn lenses (10 PST, 10 UT) of the same design and material as the unworn lenses were collected after three months of lens wear. General wearing comfort was also reported by visual analogue scale (VAS) at the three-month visit. For sample preparation, two worn UT GP lenses were divided into four segments; each segment underwent a different lens rinse and drying method.
The unworn UT lenses had significantly higher mean RMS and Ra values compared to unworn PST lenses (Mann-Whitney, p < 0.05). The worn UT lens median RMS values were significantly higher compared to the worn PST lenses (Mann-Whitney, p < 0.05). No correlation was found between general comfort and RMS or Ra scores. The Method 4 (purified, distilled water rinse/nitrogen gas dry) preparation method produced optimum median RMS and Ra values.
The researchers concluded that unworn PST GP lenses had lower Ra and RMS values compared with unworn UT GP lenses. After three months of wear, PST lenses had smoother surface topographies than UT lenses did. No relationship was found between surface topography and lens wear comfort. They also determined that sample preparation protocol directly impacts AFM results.
Gill FR, Purslow C, Murphy PJ. Atomic force microscopy analysis of the effect of plasma treatment on gas permeable contact lens surface topography. Cont Lens Anterior Eye. 2019 Feb 23. [Epub ahead of print]