For many years, the contact lens field was focused on contact lens material oxygen permeability as the “holy grail” of successful contact lens wear. While there are admitted benefits to improved oxygen permeability, it seems as though these improvements in materials did not lead us down the path that we thought they would.
For example, in 2013, participants of the Tear Film and Ocular Surface Society (TFOS) International Workshop on Contact Lens Discomfort’s Contact Lens Materials, Design, and Care subcommittee considered evidence for and against material characteristics that relate to discomfort. This consensus-based panel of experts concluded: “In summary, there have been no Level I evidence studies that can provide an answer to question of whether oxygen levels influence comfort.” (http://iovs.arvojournals.org/article.aspx?articleid=2203206).
I think it is important that we consider these issues when prescribing contact lens materials, rather than prescribe based on one or two parameters. While we often are keen to adopt new technologies, it is also important to remember the following words from Nobel Prize Winner Christian Lous Lange: “Technology is a useful servant but a dangerous master.”
Jason J. Nichols, OD, MPH, PhD
VTI Launches NaturalVue Sphere 1 Day Contact Lenses
Visioneering Technologies, Inc., (VTI) has announced the launch of Sphere 1 Day Contact Lenses. These lenses feature ComfortEdge Technology, which helps promotes excellent tear exchange designed to keep the lenses clean, clear, and comfortable throughout the day, according to the company.
NaturalVue Sphere Contact lenses are available in a full power range from +4.00D to –12.00D in 0.25D steps. These daily disposable lenses come with a base curve of 8.5mm and a diameter of 14.2mm. They are available in 10-pack trials, as well as 30- and 90-pack bundles. The lenses are made of etafilcon A material, include a light blue visibility tint, and have a Class 2 UV blocker.
B+L Introduces Biotrue Oneday for Astigmatism Contact Lenses
Bausch + Lomb (B+L) introduced Biotrue Oneday for Astigmatism daily disposable contact lenses. Similar to Biotrue Oneday and Biotrue Oneday for Presbyopia, Biotrue Oneday for Astigmatism utilizes Surface Active Technology. This technology uses a large volume of hydrophilic polyvinylpyrrilidone (PVP), a water loving molecule, and Poloxamer 407, a surface active macromer, to form a unique dehydration barrier that helps the lens maintain 98% of its moisture for up to 16 hours, according to the company.
The lenses are made out of nesofilcon A material. The have a water content of 78% and oxygen transmissibility of 42 Dk/t at –3.00D. Base curve is 8.4mm and the diameter is 14.5mm. Initially, the lenses are available in plano to –4.25D (in 0.25D steps) with cylinder powers of –0.75D and –1.25D, and axes of 10°, 20°, 70°, 80°, 90°, 100°, 110°, 160°, 170°, and 180°. The full range, which will be available later this year, includes: plano to –6.00D (in 0.25D steps) and –6.50D to –9.00D (in 0.50D steps) with cylinder powers of –0.75D, –1.25D, and –1.75D, and axes of 10°, 20°, 60° to 120° (in 10° increments), and 160° to 180° (in 10° increments); plano to –6.00D (in 0.25D steps) with cylinder powers of –2.25D and axes of 20°, 90°, 160°, and 180°; and +0.25D to +4.00D (in 0.25D steps) with cylinder powers of –0.75D, –1.25D, –1.75D, and axes of 20°, 70°, 90°, 110°, 160°, and 180°.
J&J Vision Expands Portfolio with Acuvue Oasys 1-Day for Astigmatism
Johnson & Johnson Vision (J&J Vision) announced the U.S. launch of Acuvue Oasys 1-Day Brand Contact Lenses for Astigmatism, a daily disposable contact lens with: Blink-Stabilized Lens Design, which harnesses the natural power of the eyelids to help keep the lens in the correct position; and HydraLuxe, which includes tear-like molecules and highly breathable hydrated silicone that integrate with the patient’s own tear film.
The lenses are available in the following parameters: plano to –6.00D (in 0.25D steps) with cylinder powers of –0.75D, –1.25D, and –1.75D across all axes in 10° increments and –2.25D in axes of 10°, 20°, 70° to 110° (10º increments), and 160° to 180° (10º increments); –6.50D to –9.00D (in 0.50D steps) in cylinder powers of –0.75D, –1.25D, and –1.75D in axes of 10°, 20°, 70° to 110° (10º increments), and 160° to 180° (10º increments); and +0.25D to +4.00D (in 0.25D steps) in cylinder powers of –0.75D, –1.25D, and –1.75D in axes of 10°, 20°, 70° to 110° (10º increments), and 160° to 180° (10º increments).
CooperVision’s Clariti 1 Day Toric Lenses Now Available in 90-Pack
Coopervision, Inc. announced the availability of a 90-pack configuration Clariti 1 Day toric contact lenses, which provide astigmatic patients with the advantages of silicone hydrogel and the convenience of the one-day modality, according to the company.
All Clariti 1 Day options feature high water content. Additionally, the company says the WetLoc technology ensures the entire lens surface is continuously moist and mimics the moisture dispersion of naturally healthy eyes.
Clariti 1 Day Toric lens’ power ranges include plano to –9.00D (0.50D steps after –6.00D) with cylinder options of –0.75D, –1.25D, and –1.75D in axes of 10°, 20°, 60° to 120° (in 10° increments), and 160° to 180° (in 10° increments); +0.25D to +4.00D (0.25D steps) with cylinder options of –0.75D, –1.25D, and –1.75D in axes of 20°, 70°, 90°, 110°, 160°, and 180°; and plano to –9.00D (0.50D steps after –6.00D) with a cylinder power of –2.25DC in axes of 10°, 20°, 90°, 160°, 170°, and 180°.
Brayden Lundquist, OD, Goodyear, AZ
This patient, a 55-year-old female, presented with a refractive surgery relic—anterior lamellar keratoplasty (ALK). The original procedure was performed in 1998 with secondary radial keratotomy (RK) incisions. ALK was performed using a microkeratome to create a flap as well as remove additional stromal tissue where the thickness and diameter of the removed stromal disc determined the degree of refractive error correction for high myopia. A central oblate treatment zone is present on topography, with surrounding irregularity. This patient’s best-corrected visual acuity with spectacles is 20/50, and she is currently undergoing a multifocal scleral lens fitting to improve vision.
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CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
Caring for Contact Lens Accessories
With the advent of new scleral contact lens materials and designs, this sector of the contact lens market continues to gain market share.1 In fact, Contact Lens Spectrum market data indicate that scleral contact lenses currently comprise about 4% of all contact lens fits.1 In addition to the standard care products that most daily wear contact lens wearers require (cases and solutions), scleral contact lens wearers frequently also need the help of contact lens application and removal devices (e.g., plungers or O-rings). These devices can also be sources of microbial contamination.
The importance of cleaning application and removal devices was recently highlighted by a presentation by Logan and Perrigin at the 2017 Global Specialty Lens Symposium.2 Specifically, their study found that plungers (application/removal devices) are capable of supporting microbial growth; they also found that it might be beneficial to clean such devices with an alcohol wipe.2
Similarly, past research on the care of orthokeratology lenses indicates that up to 58% of plungers are contaminated.3,4 Also, a study of neophyte orthokeratology lens wearers found that plunger contamination was associated with case contamination, while a study of existing orthokeratology lens wearers found that lens contamination was associated with both plunger and case contamination.3,4 This contamination of accessory devices could potentially result in ocular pathology. Unfortunately, the majority of application and removal devices are not regularly discarded or cleaned by users.4
The above works highlight the need to educate our patients about regularly replacing and cleaning their contact lens accessories. The need for this education and training is especially important because some of the microbial contaminants recovered from application and removal devices are known to cause sight-threatening microbial keratitis, a complication that we need to go to great lengths to help our patients avoid.3
1. Nichols JJ. Contact Lenses 2016. Contact Lens Spectrum. 2017;32:22-25, 27, 29, 55.
2. Logan AK, Perrigin J. Microbial growth after cleaning scleral DMV devices. Poster presented at the 2017 Global Specialty Lens Symposium, Las Vegas, Jan. 26-28, 2017.
3. Boost MV, Cho P. Microbial flora of tears of orthokeratology patients, and microbial contamination of contact lenses and contact lens accessories. Optom Vis Sci. 2005 Jun;82:451-458.
4. Cho P, Boost M, Cheng R. Non-compliance and microbial contamination in orthokeratology. Optom Vis Sci. 2009 Nov;86:1227-1234.
MATERIALS & DESIGNS
David Kading, OD
Presbyopia/Astigmatism Lens Options
How are you addressing your patients who have both astigmatism and presbyopia? For me, these patients are a big challenge. The industry has great options available to us, but the simplicity to prescribe a standard sphere, toric, or multifocal lens is confounded to a large degree.
Here are some things to keep in mind when looking for a solution for these patients.
1. It’s a process. Both you and the patient need to be aware that this is a journey that might take multiple lenses and a good amount of time to successfully complete. As such, choose your fitting fees and laboratories closely.
2. We all must compromise. As much as we try to ignore it, I believe that there is a level of “compromise” (oh my goodness, I said it) with multifocal contact lenses. Note: There are compromises with presbyopic spectacles as well, but patients just understand them better. As such, we need to educate our patients.
3. Look for a design that you like and can get to know. Use that contact lens for many patients to ensure you understand it fully. It doesn’t matter whether it is a soft multifocal toric, GP multifocal, scleral multifocal, or hybrid multifocal—all are great options.
We can do this. Our patients want us to do this. If we work…work…work, we shall succeed.
Effects of Multifocal Soft Contact Lenses Used to Slow Myopia Progression on Quality of Vision in Young Adults
The purpose of this study was to assess the effects of multifocal soft contact lenses (MF SCLs) used for myopia control on visual acuity (VA) and subjective quality of vision.
Twenty-four young adult myopes had baseline high and low-contrast VAs and refractions measured, and quality of vision assessed by the Quality of Vision (QoV) questionnaire with single-vision SCLs. Additional VA and QoV questionnaire data were collected immediately after subjects were fitted with CooperVision’s Proclear MF SCLs and again after a two-week adaptation period of daily lens wear. Data were collected for two MF SCL designs, incorporating +1.50D and +3.00D peripheral near additions, with a one-week washout period allowed between the two lens trials.
The study found that high- and low-contrast VAs were initially reduced with both MF SCL designs, but subsequently improved to be not significantly reduced in the case of high-contrast VA by the end of the two-week adaptation period (for the first study visit, p = 0.006 and 0.021 for the +1.50D and +3.00D lenses respectively; for the first visit compared to the second visit, all p > 0.05). Additionally, the effect of the +1.50D MF SCLs failed to reach statistical significance, even at the initial fitting session. The quality of vision was also reduced, more so with the +3.00D MF SCL. QoV scores describing frequency, severity, and bothersome nature of visual symptoms indicated symptoms worsening rather than resolving over the two-week period, particularly so with the +3.00D MF SCL.
The authors concluded that low- and high- add MF SCLs adversely affected vision on initial application, with sustained effects on low-contrast VA and QoV scores but not high-contrast VA. Thus, high-contrast VA is not a suitable surrogate for quality of vision. In prescribing MF SCLs for myopia control, the study determined that clinicians should educate patients about these effects on vision.
Kang P, Mc Alinden C, Wildsoet CF. Effects of multifocal soft contact lenses used to slow myopia progression on quality of vision in young adults. Acta Ophthalmol. 2017 Feb;95:e43-e53.