Do you have a burning question related to contact lenses, yet you haven’t really gotten a definitive answer nor known who to ask? How about your peers? Send us your burning questions (and potential responses), and we will select from them and publish your question as an upcoming Quick Poll (with credit, of course). Please send your nominations to firstname.lastname@example.org.
Jason J. Nichols, OD, MPH, PhD
CDC Promotes Healthy Contact Lens Wear and Care During Spring Break
The Centers for Disease Control and Prevention has put together a marketing program targeted at college-age contact lens wearers that promotes healthy contact lens wear and care behaviors around spring break. The outreach efforts will go out on various social media outlets during the week of March 4 through March 8, 2019 to coincide with many universities’ spring breaks.
Key messages will include the following: take out your contact lenses before going to sleep; bring enough contact lens supplies and a spare pair of glasses with you in case you need to use them while traveling; never swim or shower while wearing contact lenses; never "top off" solution (add new solution to old solution) in the case to store contact lenses; and do not wear contact lenses without a prescription from an eyecare provider.
Alcon Debuts Multifocal Contact Lens Fitting Process in a New Virtual Reality Experience
Alcon launched a new Multifocal Virtual Reality training module in partnership with Microsoft and Elara Systems. The virtual reality experience gives eyecare practitioners (ECPs), fellows, and students a three-dimensional view into actual multifocal contact lens fittings.
The Multifocal Virtual Reality training module was developed at Microsoft’s Mixed Reality Capture Studio, where Elara Systems was able to bring a real patient experience to life within a digital practitioner’s office. This training module is part of the Alcon Experience Academy, which offers face-to-face and virtual training and educational resources.
B+L Announces FDA Approval of Lotemax SM
Bausch + Lomb (B+L) announced that the U.S. Food and Drug Administration (FDA) has approved Lotemax SM (loteprednol etabonate ophthalmic gel) 0.38%, a new gel formulation for the treatment of postoperative inflammation and pain following ocular surgery. Compared to Lotemax Gel (loteprednol etabonate ophthalmic gel) 0.5%, Lotemax SM delivers a submicron particle size for faster drug dissolution in tears, according to the company.
IACLE Holds First Fellowship Exam Based on New Programs
The International Association of Contact Lens Educators (IACLE) will hold its Fellowship Exam on Nov. 16, 2019. This year will be the first administration for which the New Distance Learning Program (DLP) is available to candidates to prepare for the exam.
The New DLP—an online self-study program—was launched in September 2018 to align with the fully revised and updated New IACLE Contact Lens Course.
All IACLE members are eligible to sit the exam. Candidates who achieve a successful outcome and have been members for at least 12 months can apply for Fellow of IACLE status. Those who meet the Fellowship criteria can use the FIACLE title. Existing FIACLEs can also re-sit the Fellowship Exam as many times as they wish—free of charge—to refresh their knowledge and keep abreast of the latest developments.
The deadline for applications is June 30, 2019. The next Fellowship Exam will be in 2021.
Eaglet Eye Announces Eye Surface Profiler Upgrade
Eaglet Eye b.v. announced a major upgrade to its Eye Surface Profiler (ESP) software. In addition to bringing the total number of designs embedded to more than 35, the software can now calculate four quadrant peripheries, bitoric sclerals, and toric haptics. According to the company, the most significant upgrade is SmartMerge, which allows practitioners to combine up to five full images. This allows full functionality (optimal coverage) should one image not have sufficient data.
The software upgrade is expected to be released after thorough testing within the next two weeks. The ESP upgrade is available to users worldwide.
Oyster Point Raises $93 Million to Support the Clinical Development of Dry Eye Treatment
Oyster Point Pharma, Inc., a privately held clinical-stage pharmaceutical company with an initial focus on developing novel therapies to treat dry eye disease, announced a $93 million Series B financing. The round was co-led by Invus Opportunities and Flying L Partners in collaboration with Falcon Vision. Existing investors New Enterprise Associates (NEA) and Versant Ventures, as well as new investor Vida Ventures, participated significantly in the round.
Oyster Point will use the proceeds to support the development of OC-01 and OC-02, which are delivered via an ocular surface-sparing nasal spray designed to stimulate the trigeminal parasympathetic pathway to promote natural tear film production.
Rayner Launches New Eye Drop Formulations for Dry Eye
Rayner has introduced Aeon, a family of pre- and post-surgery eye drops to help patients who have dry eye manage their condition and improve their visual outcomes. The new Aeon range is intended to relieve the symptoms of dry eye to help surgeons achieve more accurate postoperative visual acuity and to improve satisfaction for patients, according to the company.
Aeon Protect Plus has a cross-linked sodium hyaluronate (HA) formulation to provide an artificial tear for relief of moderate to severe dry eye. Aeon Repair is designed for use in the weeks after surgery and combines HA with vitamins A and E to lubricate, soothe, and aid the repair of the eye surface. Both Aeon Repair and Aeon Protect Plus are free of phosphates and are stored in multidose dropper devices, which allow the solutions to stay sterile without the need of preservatives, according to Rayner.
In which city would you prefer to attend the Global Specialty Lens Symposium (GSLS)?
Your Interesting Case Photo Here in the Next Issue
Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in Contact Lenses Today in the coming weeks!
We welcome photo submissions from our 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
Bulbar Conjunctival Blood Flow and Contact Lens Wear: A New Area to Evaluate
With the dramatic increase in the use of contact lenses that interact with the bulbar conjunctival surface, it seems logical to look at the physiological influence of these lenses. Blood flow seems like a good place to start. A recent publication looked at the changes of microcirculation of the bulbar conjunctiva after wearing the contact lens and the relationship between contact lens discomfort and bulbar conjunctival microcirculation.1
The subjects wore soft contact lenses, and the right eye was selected as the experimental eye. The Ocular Surface Disease Index (OSDI) questionnaire as well as the Schirmer I and tear breakup time tests were completed before and after wearing the contact lens, and the conjunctival blood flow velocity and microvascular network density were also assessed by using functional slit lamp biomicroscopy. The changes of the indicators after wearing the contact lens were observed, and the correlation between the subjective feelings of the wearers and the microcirculation parameters of the bulbar conjunctiva as well as the main factors affecting the subjective feelings of the wearers were analyzed.
Outcomes from the investigation indicated that the conjunctival blood flow velocity was 0.534mm/s ± 0.132mm/s before wearing the contact lens and was 0.587mm/s ± 0.134mm/s after wearing the contact lens. The comparison was statistically significant before and after wearing the lens (t = –2.076, P = 0.048). OSDI was positively correlated with blood flow velocity at one month after wearing the contact lens (correlation coefficient r = 0.383, P = 0.048). The test results of the independent variables in the generalized estimating equation model showed that time and blood flow velocity were statistically significant (P < 0.05). The authors of the study concluded that blood flow velocity of the bulbar conjunctiva was increased after wearing the contact lens, and the contact lens discomfort of the wearers was positively correlated with the blood flow velocity of the bulbar conjunctiva.
Soft contact lenses, scleral lenses, and hybrid lenses all have direct contact with the bulbar conjunctival surface. Blood flow to this tissue seems to be a potential parameter to measure in contact lens wear. Making this clinically feasible would be the next challenge. We are beginning to look at angio-analytics of the anterior segment utilizing optical coherence tomography (OCT) technology at our practice. This is a potentially exciting area to explore. We shall see!
1. Hu L, Shu XP, Xu YY, et al. Clinical study on microcirculation changes of bulbar conjunctiva after contact lens wear. Zhonghua Yan Ke Za Zhi. 2019 Feb 11;55:98-104.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
OAB = DED
Overactive bladder (OAB) affects up to 17% of the U.S. population.1 OAB causes a sudden urge to urinate; that urge may be difficult to stop, and OAB may lead to the involuntary loss of urine (urge incontinence). OAB occurs because the muscles of the bladder start to contract involuntarily, even when the volume of urine in the bladder is low. This involuntary contraction creates the urgent need to urinate. OAB can significantly negatively impact the quality of life. Hence, commonly prescribed medications for OAB include tolterodine, oxybutynin, oxybutynin as a skin patch, oxybutynin gel, trospium, solifenacin, darifenacin, mirabegron, and fesoterodine. And, these medications can cause significant dry eye.
Be frank with your patient. Ask them to consider/discuss/investigate non-drug management to help them reduce/discontinue OAB medications. Suggestions include maintaining a healthy weight; regular, daily physical activity and exercise; limited consumption of caffeine and alcohol; smoking cessation; managing chronic conditions, such as diabetes, that might contribute to OAB symptoms; pelvic floor muscle strengthening exercises; and bladder training techniques.
The impact of OAB drugs cannot be underestimated, especially in combination with other medications. Do not overlook this in your dry eye history.
1. Powell LC, Szabo SM, Walker D, Gooch K. The economic burden of overactive bladder in the United States: A systematic literature review. Neurourol Urodyn. 2018 Apr;37:1241-1249.
Water Exposure and the Risk of Contact Lens-Related Disease
The purpose of this study was to describe the association of water exposure with contact lens (CL)-related disease and to explore the guidelines regarding water exposure to CL wearers as provided by CL manufacturing industry, global public health, and CL-related professional associations.
A review of the literature was conducted by searching PubMed, MEDLINE, and Web of Science databases up to September 2017 for articles published or translated in English using the keywords contact lens* and tap water or swimming or showering or water exposure and microbial keratitis or Acanthamoeba keratitis or corneal infiltrate* or ocular adverse event*. References in all relevant publications were also reviewed.
Water exposure during CL wear is associated with complications ranging from sterile corneal infiltrative events to sight-threatening infections. Despite the documented risks due to water exposure, water-related habits are common among CL wearers. This suggests a lack of awareness and understanding regarding the risks among CL wearers and potentially among CL practitioners. Discrepancies exist in guidelines for CL hygiene and compliance provided by the CL manufacturing industry, global public health, and CL-related professional associations. There is also widespread use of water imagery within CL marketing and packaging materials. These factors may give rise to confusion among wearers and may contribute to risk-taking behaviors.
The authors determined that consensus among stakeholders about water and CL care is needed. Guidelines should unequivocally advocate for the avoidance of any water exposure, including handling CLs with wet hands, rinsing CLs or storage cases in tap water, showering while wearing CLs, and swimming with CLs without wearing goggles.
Arshad M, Carnt N, Tan J, Ekkeshis I, Stapleton F. Water Exposure and the Risk of Contact Lens-Related Disease. Cornea. 2019 Feb 14. [Epub ahead of print]