The results from this month’s Quick Poll are in, and they are interesting! Nearly 45% of practitioners state that at least one-quarter of their contact lens-wearing patients leave their offices in a different soft contact lens. I find this quite noteworthy, and much higher than I would have predicted. Among other interpretations, this could suggest that eyecare practitioners are actively embracing and using new contact lens technologies to help provide the best lens-wearing experience for their patients.
Jason J. Nichols, OD, MPH, PhD
CooperVision Announces Availability of New MyDay Toric in Plus Powers
CooperVision, Inc. announced the addition of plus powers to its MyDay toric daily disposable contact lens family. The expanded parameters, which include +0.50DS to +6.00DS in 0.50D steps, will be available on April 2. CooperVision’s MyDay toric lenses were first introduced in January 2018.
BostonSight Announces New Chief Medical Officer
BostonSight appointed Daniel C. Brocks, MD, as the full-time chief medical officer. Dr. Brocks will oversee delivery of BostonSight treatment solutions to patients suffering from diseases of the ocular surface.
Dr. Brocks is a board-certified ophthalmologist with a specialization in the medical and surgical treatment of the cornea. He specializes in the treatment of dry eye disease and is the founder of The Dry Eye Center at Hudson Valley Eye Surgeons in Fishkill, NY. His interest is in the treatment of dry eye related to various autoimmune issues including Sjögren’s syndrome. He also specializes in the management of corneal disorders with a specific interest in the management of infectious keratitis, corneal ectasia, and rheumatologic associated with corneal and anterior segment disorders.
He is a member of the American Academy of Ophthalmology, the International Society of Refractive Surgery, The Corneal Society, The Sjögren’s Syndrome Foundation, the American Association for Physician Leadership, the American Telemedicine Association, the Refractive Surgery Alliance, the Scleral Lens Education Society, ARVO, and the Contact Lens Association of Ophthalmologists.
What percentage of patients coming into your office wearing a specific soft contact lens go home wearing a different soft contact lens?
Professor Sergey Cusato Jr., São Paulo, Brazil
This 4-year-old patient, who has keratoconjunctivitis, was seen in our dry eye department and fitted with a scleral lens.
We thank Professor Cusato 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.
S. Barry Eiden, OD
According to reports mentioned in a previously published article,1 nearly 1 million U.S. healthcare visits for keratitis or contact lens complications occur annually, at a cost of $175 million. The largest single risk factor for microbial keratitis is contact lens wear. This article pointed to a variety of patient behaviors that increase the risk for contact lens complications.
The goal of this investigation was to ultimately guide prevention efforts against contact lens-related eye infections and complications. The investigators utilized a population-based survey to estimate the number of contact lens wearers aged ≥ 18 years in the United States. A separate online survey of contact lens wearers assessed the prevalence of contact lens hygiene-related risk behaviors.
Approximately 99% of wearers reported at least one contact lens hygiene risk behavior. Nearly one-third of contact lens wearers reported having experienced a previous contact lens-related red or painful eye requiring a visit to an eyecare practitioner. According to the authors, an estimated 40.9 million U.S. adults wear contact lenses, and many could be at risk for serious eye infections because of poor contact lens wear and care behaviors. The authors stated that these findings have resulted in the creation of targeted prevention messages aimed at contact lens wearers—such as keeping all water away from contact lenses, discarding used disinfecting solution from the case and cleaning with fresh solution each day, and replacing contact lens cases every three months.
Some of the high-risk behaviors included sleeping overnight in contact lenses (50.2%), napping in contact lenses (87.1%), topping off disinfecting solution (i.e., adding new solution to existing solution in the contact lens case instead of emptying and cleaning the case before adding new solution; 55.1%), extending the recommended replacement frequency of lenses (49.9%) or cases (82.3%), and showering (84.9%) or swimming (61.0%) in contact lenses. In addition, 35.5% of contact lens wearers reported rinsing their lenses in tap water, and 16.8% reported storing their lenses in tap water.
We all realize how beneficial contact lens wear is for our patients and that it is an amazingly safe modality of vision correction for tens of millions of patients in our country. By following some relatively simple and sensible behavior patterns, we can further reduce the risk of contact lens-related infections and complications to a significant degree. We as practitioners have to take the responsibility to properly educate our contact lens patients in this regard. This is not a one-time effort per patient, but an educational effort that needs to be regularly reinforced during ongoing care.
1. Cope JR, Collier SA, Rao MM, et al. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections--United States, 2014. MMWR Morb Mortal Wkly Rep. 2015 Aug 21;64:865-870.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
We often discuss pathologic causes of eyelash loss or eyelashes that are exhibiting reduced length and/or thickness. However, we must be aware of the opposite effect as well. Eyelash trichomegaly is defined as an increase in length (12mm or more), curling, pigmentation, or thickness of eyelashes. Although trichomegaly tends to have a benign course, it can lead to psychological disturbances. It also can result in corneal insult and visual disturbance if trichiasis occurs.
Lash trichomegaly is associated with systemic lupus erythematosus, atopic dermatitis, HIV infection, hypothyroidism, and metastatic malignancies, among other conditions.1
We know that topical prostaglandin analogues can lead to eyelash growth and thickness. Other drug classes can also induce eyelash changes. Epidermal growth factor receptor inhibitors, used to treat a variety of solid tumors such as bladder, breast, colorectal, head, and neck; ovarian cancers; lung cancer; and even gastrointestinal malignancies such as pancreatic cancer, are known to cause trichomegaly.2 The cutaneous adverse effects of these agents have been grouped into a condition known as PRIDE (papulopustules and/or paronychia, regulatory abnormalities of hair growth, itching, and dryness due to epidermal growth factor receptor inhibitors) syndrome.3 I urge you to evaluate a patient’s eyelashes as part of your examination, as changes in their growth pattern can be a subtle clue to something more.
1. Kaur S, Mahajan BB. Eyelash Trichomegaly. Indian J Dermatol. 2015 Jul-Aug; 60:378-380.
2. Agrawal CR, Goyal P, Doval DC, Dutta K, Domadia K, Kothiwal S. Eyelashes Trichomegaly: An Unusual Side Effect of Gefitinib Therapy. Int J Trichology. 2018 Jan-Feb;10:44-46.
3. Lacouture ME, Lai SE. The PRIDE (Papulopustules and/or paronychia, Regulatory abnormalities of hair growth, Itching, and Dryness due to Epidermal growth factor receptor inhibitors) syndrome. Br J Dermatol. 2006 Oct;155:852-854.
The Influence of Limbal and Scleral Shape on Scleral Lens Design
The purpose of this review study was to summarize the research findings on the ocular surface profile, to provide a definition and classification of the corneoscleral shape, and to offer guidelines in selecting scleral lens design.
A better understanding of the scleral contact lens comportment on the eye and the introduction of new diagnostic instruments to measure the anterior ocular surface have led to improved comprehension of corneoscleral contour and new scleral lens designs. The scleral lens landing zone is influenced by corneoscleral profile, which may be rotationally symmetric and rotationally asymmetric. To prevent and manage fitting problems, practitioners should take the following into consideration: corneal sagittal height; limbal shape; corneoscleral junction profile; corneal, limbal, and conjunctival angles; and scleral shape. Fitting problems could include air bubble formation, midday fogging, localized blanching, impingement, conjunctival prolapse, lens decentration, lens flexure, and decreased comfort, wearing time, overall satisfaction, and visual quality.
Corneoscleral shape may be considered rotationally symmetric, including spherical, aspherical, and toric profiles, and rotationally asymmetric, including regular and irregular quadrants profiles. Each ocular surface contour requires a different landing zone design for an optimal fitting, for vaulting properly over the cornea and limbus, and for ideal alignment on the sclera. The author further stated that additional studies are still necessary to clarify many aspects of scleral lenses, which are yet little known.
Fadel D. The influence of limbal and scleral shape on scleral lens design. Cont Lens Anterior Eye. 2018 Feb 26. [Epub ahead of print]