Substantial numbers of our colleagues, their practices, and their patients are still significantly affected by COVID-19. Along these lines, in the Reader Commentary section below, we share a few more perspectives from colleagues around the globe to learn how the pandemic has impacted eye care in their locale.
Stay healthy, vigilant, and optimistic in these challenging times!
Jason J. Nichols, OD, MPH, PhD
From Eef van der Worp, BSc, PhD (The Netherlands)
Following (parts of) Asia, Europe currently seems to be the epicenter of COVID-19 infections. If North America is going to be the next hotspot, then, from a European experience, the only advice to give is to not take this lightly, but to take this as seriously as possible. In Europe, large differences exist between countries partly because of cultural differences, which may potentially be more universal in North America.
Contact lens appointments have been cancelled and replaced by telephone consultations where possible. Only urgent care is face-to-face. Most important is to make sure that eyecare practitioners are accessible/attainable--via mobile phone--for questions and concerns. Apart from all of the obvious health concerns and regulations in our practices, [this situation] also has had a huge effect on everyday life in terms of “home working” and “home schooling.” Although not our biggest problem, we don’t want [this to spur] myopia development in our kids. So, simple education about near work (not too long without breaks and not too close [at least 30cm for near work]) is indicated, as is an ample focus on outdoor time (although play with other kids is discouraged).
All European contact lens meetings for the coming months have been cancelled or postponed. Whether we like it or not, this may be here to stay for a while.
From Luis Alberto de Velasco (Mexico)
The news of COVID-19 started earlier this year and until today, with 310 cases and two confirmed deaths in Mexico (unreliable data due to lack of communication), the government has not taken real action; people seem to be divided into three groups: those who are taking the problem very seriously and taking action to stay home, those who believe that nothing will happen to them or that this is all a political move and continue their routine life as if there is no problem, and those who would like to take action but have no choice but to continue going to work because they cannot miss their jobs …due to lack of financial resources. Unfortunately, there are many people who...are more concerned with starvation than with coronavirus.
I have a private practice in the Mexico, and five people work with me. We made the decision to close the practice for nine days, although the news in Mexico wasn’t so alarming at that time. We believed that staying at home was the best thing for us, our families, and our patients. This has caused us several issues--we had to cancel all appointments and resolve the delivery of spectacles and contact lenses that were pending. We left an answering machine message informing patients of our temporary “until further notice” closure. We also asked that, in the event of an emergency, patients should send us an email. Some delivery problems and minor emergencies have arisen, but they have been resolved. We are now... able to meet the needs of patients and administrative staff thanks to new technology--almost everything can be resolved online.
The decision to close was made with the intention of being socially responsible, helping those who remain at home, and avoiding the chain of infection. Staying home has generated very positive effects as a family...this opportunity helps us value the things that we have and to remain truly united as a family.
Thinking as an optometrist...in a way, it is my responsibility to help society. So, I have focused on NOT LEAVING my home and not panicking. But, I will be close to virtual self-learning tools and will set up virtual educational classes. Our task is simple, and we must maintain the decision to stay at home and maintain the necessary hygiene and care measures to ensure that this ends as soon as possible. This is a great opportunity for us to be an example to our patients through social networks.
It is a shame to know that, in Mexico, the lack of information and education in different sociocultural sectors does not allow an efficient approach in important decisions. I do not doubt that, as always, we will get ahead of this problem and will return to the course for the improvement of public health.
From Pauline Cho, PhD (Hong Kong)
Suddenly, one day in January 2020, Hong Kong went into a panic, and people were rushing to stock up on food, masks, sanitizers, bleach, and then toilet paper. Who would have believed that we would ever get to the point when we would go “mask” shopping when we were on holidays in another country! It seems so surreal, even after so many days and weeks, to wake up every day and see new cases popping up all over the world. Well, the virus does not recognize race, and neither do fear and panic. Globally, I see finger pointing, which is hardly surprising, but I also see a lot of solidarity, which is what really matters now. We need to all stand together and fight this epidemic.
On a less pessimistic note, I also believe that we can achieve something positive from this bad situation. For years, I have been working with Dr. Maureen Boost, a microbiologist, and speaking wherever I can about noncompliance. I stressed the need for proper handwashing using soap and water and for hand drying, and I even have a video clip advising against the storage of contact lens accessories in the bathroom, where we can have millions of microbes (yes, including viruses) floating in the air after flushing the toilet and landing everywhere in the bathroom. Sadly, I believe [this information was] largely ignored.
NOW, I believe, is the time that our patients will be listening very carefully. NOW is the time for us to stress good compliance with correct procedures in contact lens practice and use, for both practitioners and patients. People do and will get complacent over time, so we need to remember and to remind ourselves and our patients, or else there is no lesson learned from this outbreak. We have practitioners now seeking help to install protective shields on their slit lamps, using alcohol pads to diligently wipe chin and head rests before every patient, and, no doubt, spending more time emphasizing the importance of handwashing and examining the eyes. Suddenly, we realize that a little bit of extra time spent with patients is important in our profession.
To combat COVID-19, you have been advised to wash hands and/or use hand sanitizers frequently. But, I’d add, not just your hands but your mobile phone as well, as many of us (including me) cannot seem to take our hands off of our phones for long.
So, take the time to self-reflect. Take courage, take precautions, and stay safe. It’s always darkest before the dawn. A big salute to the frontline medical workers fighting COVID-19.
Topcon Healthcare Announces a Series of Customer Initiatives to Combat COVID-19 Crisis
Topcon Healthcare has announced a series of initiatives and programs designed to support its customers. To start, the company is now offering all of its slit lamp customers a free breath shield that fits onto their instrument and provides a first line of defense for both healthcare providers and patients. To register to receive the Topcon Breath Shield, customers should visit: http://bit.ly/2x8aVlk.
Additionally, Topcon has developed several ways for customers to connect virtually in the absence of tradeshows and face-to-face communications. To address the tradeshow situation, Topcon Healthcare has announced an online Expo taking place at the end of March. TopconExpo will give customers a "virtual tradeshow" from the comfort of their home or office. The event will offer special sales incentives to customers while providing live sales support, with clinical experts ready to answer any questions they might have.
IACLE Makes Resources Available to Contact Lens Educators
The International Association of Contact Lens Educators (IACLE) is offering all educators access to online resources for remote teaching during the global COVID-19 outbreak. The IACLE Case Reports Series is now in the “Free Resources” area of the IACLE website at www.iacle.org. It provides 23 illustrated, interactive case reports with multiple-choice questions. This resource is available in English, Spanish, Portuguese, Korean, and simplified Chinese.
The 2013 version of the IACLE Contact Lens Course (ICLC) comprises 10 modules in 55 parts in PowerPoint format and is also available under “Free Resources” as a student aid. The latest version of the course – ICLC2020 – will be launched in April. The IACLE Education Team is currently developing a series of narrated lectures as additional support for its members worldwide.
FDA Issues Emergency Use Authorization for Point-of-Care Diagnostic
The U.S. Food and Drug Administration (FDA) issued an emergency use authorization for a point-of-care COVID-19 diagnostic for the Cepheid Xpert Xpress SARS-CoV-2 test. The FDA issued an emergency use authorization to Cepheid for the Xpert Xpress SARS-CoV-2 test for use in high- and moderate-complexity Clinical Laboratory Improvement Amendments (CLIA)-certified laboratories as well as in certain patient care settings. The company intends to roll-out availability of its point-of-care testing by March 30.
Everlywell announced an at-home collection kit with telehealth diagnosis for COVID-19. The test can be requested online by consumers experiencing COVID-19 symptoms. The company’s COVID-19 lab partners are operating under the Emergency Use Authorization guidelines issued by the FDA.
The COVID-19 test will be shipped to customers with everything needed to collect a sample at home and safely ship that sample to a CLIA-certified laboratory partner with overnight delivery. Secure digital results will be available online within 48 hours of the lab receiving the sample, and free telehealth consultations with an independent, board-certified physician will be available for those who have positive results.
To access a COVID-19 test, consumers can go to www.everlywell.com, where they will be asked to complete a screening questionnaire provided by an independent telehealth partner and based on guidelines from the Centers for Disease Control & Prevention (CDC). The test will be available for $135 at no profit to Everlywell and will be covered by participating HSA and FSA providers. Everlywell has reached out to government officials and public health departments to see whether the test can be made available for free.
ImprimisRx Announces Agreement with Doxy.me to Provide Telemedicine Services
Harrow Health, Inc. and ImprimisRx, a wholly-owned subsidiary of Harrow, announced that they have entered into an exclusive agreement with Doxy.me, a full-service telemedicine solution. This agreement will provide all ImprimisRx ophthalmology, optometry, and wellness practices with the Clinic level Doxy.me telemedicine solution at no charge.
Through the agreement, ImprimisRx prescribers and their patients get access to a user-friendly platform using a computer, tablet, or mobile phone. Patients can “see” their practitioner from anywhere by clicking a web link that takes them directly to their practitioner’s “virtual waiting room”; telemedicine is generally covered by insurance; patients may also elect to pay out of pocket using built-in credit card payment options; Doxy.me is HIPAA compliant – no patient data is stored, and video sessions are encrypted; remote file sharing is easy between patient and healthcare provider; image capturing feature aids in diagnosis; prescriptions can still be delivered to patients from ImprimisRx’s mail-order pharmacy, limiting the need for in-person interaction for at-risk patients; recent changes to healthcare regulations now allow for telemedicine services to cross state lines; and practitioners can treat patients in need, regardless of their state of residence (note: rapidly expanding parity laws require that insurance companies reimburse providers for telemedicine visits at the same rate as an in-office visit).
ImprimisRx customers will receive the Clinic level Doxy.me service free of charge. Existing ImprimisRx customers can request their telemedicine account by visiting https://www.imprimisrx.com/telemed.
Low Risk of Coronavirus Spreading Through Tears
While researchers are certain that coronavirus spreads through mucus and droplets expelled by coughing or sneezing, it is unclear whether the virus is spread through other bodily fluids, such as tears. A recently published study offers evidence that it is unlikely that infected patients are shedding the virus through their tears, with one important caveat: none of the patients in the study had conjunctivitis, also known as pink eye. However, health officials believe that pink eye develops in just 1% to 3% of people who have coronavirus. The study’s authors conclude that their findings, coupled with the low incidence of pink eye among infected patients, suggests that the risk of virus transmission through tears is low. Their study was published online in Ophthalmology, the journal of the American Academy of Ophthalmology.
For the most up-to-date COVID-19 news and tips for eyecare providers, visit bit.ly/2WxiFbA.
CooperVision Announces 2020 Best Practices Honorees
CooperVision unveiled its 2020 Best Practices honorees. They are: Advanced EyeCare, Durango, CO; Advanced Family Eye Care, Denver, NC; Associates in Eyecare – Optometrists, Ashburn, VA; Better Vision Optometric Center, P.A., Fayetteville, NC; Draisin Vision Group, Charleston, SC; Eye Center of Houston, Houston; Kapperman, White and McGarvey, Chattanooga, TN; Miamisburg Vision Care, Miamisburg, OH; Phoenix Eye Care, Phoenix; and Valencia Eyecare Optometry, Valencia, CA.
All U.S. optometry practices currently fitting contact lenses were eligible for consideration in Fall 2019. Candidates were evaluated and honorees selected by a panel of judges including past Best Practices honorees and industry experts. The 2020 Best Practices honorees are invited to participate in a specially designed educational meeting hosted by CooperVision. To learn more about this year’s honorees, visit www.eyecarebestpractices.com.
NovaBay Pharmaceuticals Unveils Refreshed Consumer Branding for Online Sales of Avenova
NovaBay Pharmaceuticals, Inc. unveiled a rebrand for non-prescription Avenova, its antimicrobial lid and lash solution. The refresh reinforces the company’s strategy of reaching a broader audience through Avenova.com and Amazon.com. Avenova is a patented, FDA-cleared formula that uses pure hypochlorous acid to treat issues such as bacterial dry eye, blepharitis, and contact lens intolerance.
New Online Learning Resource for Eyecare Professionals
A transatlantic partnership between Waterford Institute of Technology in Ireland and Salus University Pennsylvania College of Optometry in Pennsylvania has created a new online learning resource allowing eyecare practitioners and technicians to complete certified training about the importance of nutrition to eye health at their desk or using a mobile device. Those who complete each session will be tested with a short online questionnaire before receiving an online certificate as proof of successful completion.
MacuLearn.com is the brainchild of Professor John Nolan, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, and Dr. James Stringham, Visual Performance Laboratory, Duke University Medical School, North Carolina. The www.maculearn.com site is now live. Additional learning modules are scheduled to be added through the rest of 2020 and beyond.
AbbVie and Allergan Sign Consent Decree Agreement with the FTC
AbbVie and Allergan plc announced that they have entered into a consent decree agreement with staff of the U.S. Federal Trade Commission (FTC) regarding AbbVie's pending acquisition of Allergan. Under the terms of the consent decree, the companies have agreed to divest brazikumab, an investigational IL-23 inhibitor in development for autoimmune diseases, to AstraZeneca and to divest Zenpep, a treatment for exocrine pancreatic insufficiency due to cystic fibrosis and other conditions, to Nestle. Nestle also will be acquiring Viokace, another pancreatic enzyme preparation, as part of the same transaction.
The consent decree, including the proposed purchasers, remains subject to further review and approval by the Commissioners of the FTC. The parties anticipate closing in May 2020.
Call for CE Abstracts
The Global Specialty Lens Symposium (GSLS) Program Committee invites you to submit one-hour continuing education courses for consideration for the GSLS 2021, which will take place in Las Vegas from Jan. 20 to 23, 2021. The submission window will close at 5:00 p.m. ET on April 15, 2020. Submit all materials at www.gslsymposium.com. The committee seeks the submission of new and innovative courses on all aspects of contact lenses (such as materials, designs, lens care) in addition to related topics such as corneal and ocular surface disease, diagnosis and treatment approaches, and practice management.
How significant an obstacle to successful scleral lens wear is difficulty with handling of the lenses?
The patient was a 74-year-old man who had suffered a penetrating injury to his right eye. At first, he had sutures to close to wound and save the eye. Then, he underwent a penetrating keratoplasty (PK), which failed. That was followed by a second PK that also failed. After nearly a year with a light perception (LP) scar, the decision was made to try the Boston Keratoprosthesis (KPro), which worked well. Best-corrected vision was 20/30. He wore a +1.00D daily disposable contact lens to protect the lid from the sutures.
We thank Dr. Benoit 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
Scleral Lens Discomfort?
Corneal GP lenses have been notoriously linked to contact lens discomfort and intolerance. The general thought is that scleral lenses would be, and quite frankly are, a great alternative for those patients who cannot tolerate corneal lenses. Is it possible that a patient can suffer from scleral lens discomfort or intolerance too? If so, do we troubleshoot or abandon the lens design altogether?
Some patients who have scleral lens discomfort will complain of a dull ache, difficulty with removal, dryness, and burning, to mention a few. Even though the lens may appear to be fitting well, if there is suction, a patient will complain of discomfort. This is easy to remedy with a slight peripheral curve modification (i.e., flatten the periphery).
The same holds true for patients who have difficulty with lens removal at the end of the day. The lens may be slowly tightening down, which thus renders it difficult to remove. Again, peripheral curve adjustment should help. Another consideration would be to switch to a different diameter. I have found clinically that some patients who have scleral lens discomfort benefit tremendously from simply changing to a larger-diameter lens or, conversely, going smaller if they are wearing a larger-diameter lens.
While I realize that I may have oversimplified lens discomfort, it’s worth a try to make some small modifications that could lead to huge benefits for patients.
Materials & Designs
David L. Kading, OD
Stay Connected While Distant
As most of our practices are currently shut down, many of us are looking for avenues to still stay connected to our patients. If not through social media, then through email, text, or even phone calls. While all of this can be challenging, thank goodness for modern technology. Our contact lens suppliers have positioned us for such a time as this. Additionally, so have our GP lens manufacturers. Here are five things you can do to stay connected with your contact lens patients and, potentially, still generate a little working capital.
1. Reach out to your patients (social media, text, email) with some thoughts on contact lens wear while in quarantine. Let them know about safety and that they can contact you (call, text, etc.) if they have any issues.
2. Update your website to link to your distributor’s site for ordering contact lenses. My distributor has my practice logo on my page, so my patients think that it is my own site.
3. Connect with patients who have not ordered a year's supply and have seen you in the last six months. Mention to these patients that it is a good time to consider ordering more contact lenses so that they do not overwear their lenses. Link them to your website, and offer a promotion on shipping. Most of the big distributors are offering free shipping, and I suggest that you pass those savings on to your patients.
4. Connect with patients who are contact lens wearers and are due to see you in the next month or two. Mention to them that you are willing (if you are willing) to extend their prescriptions and will authorize them to buy extra contact lenses to get them through the current state of things.
5. Reach out to patients who have not been in for a GP fitting in the last six months and are scheduled for a visit in the next two months. Discuss with them that you would be happy to order them another pair of lenses to get them by if they need it. Let them know that you are able to extend the warranty on lenses if changes need to be made until we are all back online (if your GP lab isn't doing this, it should be, mine is).
While we can all rest in our sweatpants during this time, it is now that we can work through all of our to-do lists. It is now that we can stay socially connected to our patients. Try not to distance yourself from them and their contact lens wear. It is now that they need you as much as ever.
Evaluation of Tear Film and the Morphological Changes of Meibomian Glands in Young Asian Soft Contact Lens Wearers and Non-Wearers
The aim of this study was to explore the differences in terms of tear film and meibomian glands (MGs) between young Asian soft contact lens (CL) wearers and non-wearers.
A prospective, cross-sectional observational study was conducted using 148 subjects (63 non-wearers and 85 soft CL wearers who had been wearing CLs for more than one year) recruited from a clinic in Tianjin, China. All subjects first responded to an Ocular Surface Disease Index (OSDI) questionnaire and then underwent a standardized dry eye examination, which included measuring tear meniscus height (TMH), non-invasive tear breakup time (NIBUT), and corneal fluorescein staining (CFS). The MGs were evaluated via ImageJ; distorted MG count and the MG dropout were recorded.
Compared to the control group (non-wearers), the CL group recorded higher OSDI and CFS scores, lower TMH and NITBUT values, a larger distorted MG count, and larger MG dropout (all P < 0.05). Pearson correlation analysis found a correlation between MG dropout and the duration of CL use (r = 0.44, P < 0.001), OSDI (r = 0.30, P = 0.006), and CFS scores (r = 0.44, P < 0.001).
The researchers determined that CL wearers showed higher MG dropout and reduced TMH and NITBUT, which likely contributes to severe CL-related dry eye symptoms. CL use may lead to a higher MG dropout rate, and the extent of the MG dropout presumably influences the tear film status in CL wearers.
Gu T, Zhao L, Liu Z, Zhao S, Nian H, Wei R. Evaluation of tear film and the morphological changes of meibomian glands in young Asian soft contact lens wearers and non-wearers. BMC Ophthalmol. 2020 Mar 4;20:84.