There is no doubt that there is significant traction and activity in the world of myopia control. However, there are also unanswered questions owing to the need for additional data and evidence to further develop our guidance for evidence-based clinical care. We are assembling such a list, and we want to hear from you. What myopia control topics do you feel need to be addressed? Please send your thoughts to me at firstname.lastname@example.org. We look forward to hearing from you.
Jason J. Nichols, OD, MPH, PhD
Novartis to Acquire Xiidra from Takeda
Novartis has entered into an agreement with Takeda Pharmaceutical Company Limited to acquire the assets associated with Xiidra (lifitegrast ophthalmic solution) 5% worldwide. Closing of the transaction is expected in second half of 2019, subject to customary closing conditions including regulatory approvals. On closing, Novartis plans a smooth transition of operations and integration of Xiidra into its pharmaceuticals portfolio.
In addition to powering Novartis' ability to serve more patients suffering from eye disease, the company says that the additional commercial experience established with Xiidra is expected to better position the company for front-of-the-eye pipeline products currently in development.
Deal terms include a $3.4 billion upfront payment with potential milestone payments of up to $1.9 billion. As part of the agreement, Novartis will be taking on approximately 400 employees associated with the product.
IACLE to Mark 40th Anniversary at Industry Shows
IACLE will be celebrating 40 years of 'Exceptional Education. Exponential Impact' with special events at the British Contact Lens Association (BCLA) Clinical Conference & Exhibition in Manchester, UK and at the Asia Pacific Optometric Congress (APOC) in Manila, Philippines.
At both events, delegates will be invited to "Make Your Mark" at the IACLE exhibition booth on a time wall of milestones in the association’s history. IACLE will also host a 40th Anniversary celebration and cake-cutting at the BCLA conference and a 40th Anniversary celebration and Awards Ceremony at APOC.
IACLE will also celebrate its 40th year with events at the Colegio Federación Colombiana de Optómetras (FEDOPTO) Congress in Bogotá, Colombia and at the American Academy of Optometry meeting 2019 and the 3rd World Congress of Optometry in Orlando, FL.
Myopia Awareness Week – May 13 to 19
The World Council of Optometry (WCO) and the Brien Holden Vision Institute (BHVI) are collaborating to bring Myopia Awareness Week from May 13 to 19. Together, WCO and BHVI are addressing the prevalence of myopia globally by building an awareness of the effect that myopia has on billions of people. The Myopia Movement website offers calls-to-action and recommendations for both patients and children. In addition, there are links to posts that can be tweeted during Myopia Awareness Week.
For more information about Myopia Awareness Week, visit www.myopiamovement.com or its social media accounts @MyopiaMovement.
"Meet the Myopia Experts" Half-Day Workshop Offered
Paragon Vision Sciences, part of the CooperVision Specialty Eye Care division, is offering a "Meet the Myopia Experts" half-day workshop on May 16, 2019. Held concurrently with Vision by Design in San Antonio, the interactive seminar is focused on helping eyecare professionals better differentiate their practices through expanded clinical knowledge of myopia and myopia management.
Speakers and topics include Michael Lipson, OD, Quality of Life with Myopia Management; Maria Liu, OD, PhD, MPH, MBA, What We Know and Don’t Know About Myopia & Ortho-k; Kathryn Richdale, OD, PhD, Evidence-Based Practice in Myopia Management; Mark Bullimore, MCOptom, PhD, Safety in Children with Contact Lenses; and Jason Nichols, OD, MPH, PhD.
Contact Lens with a Flexible Micro-Battery Under Development
The Optics Department at IMT Atlantique, headed by Professor Jean-Louis de Bougrenet de la Tocnaye, and the Flexible Electronics Department at the Centre Microélectronique de Provence Georges Charpak (Mines Saint Etienne), headed by Professor Thierry Djenizian, are currently working together to design an oculometer embedded in a scleral contact lens. They have recently created an autonomous contact lens incorporating a flexible micro-battery.
A partnership with contact lens manufacturer LCS has enabled the first elements of this new type of intelligent contact lens to be encapsulated (the LED can be easily integrated into the contact lens if necessary).
The battery integrated within the lens will complement and power other functions being developed at IMT Atlantique, such as radio frequency (RF) communication (wireless function) and, particularly, optical detection of gaze direction. This project will involve numerous collaborations, including one with the Institut de la Vision in Paris for a visual assistance device for the blind.
Aveo Vision Launches Aveo Joy
Aveo Vision announced the launch of Aveo Joy, a direct-to-consumer daily disposable contact lens specifically created for individuals who have astigmatism. Aveo Joy is now available for pre-orders and will begin shipping in June 2019. Aveo Joy joins Aveo Hello, a daily disposable contact lens.
According to the company, Aveo Joy features AquaLock for comfort; BlissEdge to keep the lens centered; SteadyView, a proprietary toric design combined with aspheric optics to eliminate distortion for sharp HD vision across the entire lens; and built-in Class II UV blockers to protect eyes from 97% of UVB and 87% of UVA radiation. The lenses are made from the omafilcon A lens material. All of Aveo's contact lenses are cleared by the U.S. Food and Drug Administration. Cost is $55 per month ($45/month pre-order offer).
AAOF Announces the 2019 William C. Ezell Fellowship Recipients
The American Academy of Optometry Foundation (AAOF) announced the 13 recipients of the 2019 William C. Ezell Fellowships. The Ezell Fellowship program is named after the founding president of the AAOF, William C. Ezell, OD. It was established to provide recognition and support to talented post-doctoral students who are pursuing an advanced degree in optometric research and education.
AAO Section on Cornea, Contact Lenses and Refractive Technologies Ezell Fellow
Kelsy R. Steele, OD, MS, The Ohio State University College of Optometry
American Academy of Optometry Foundation Robert Mandell Ezell Club Fellow
Heinz Otchere, OD, MS, University of Waterloo School of Optometry and Vision Science
American Academy of Optometry Ezell Fellow
Billie Beckwith-Cohen, DVM, MBA, University of California Berkeley School of Optometry
Baycross Christian Family Foundation Binocular Vision & Pediatrics Ezell Fellow
Maureen D. Plaumann, OD, The Ohio State University College of Optometry
Danne Ventura - Essilor Ezell Fellow
Eugene Appenteng Osae, OD, University of Houston College of Optometry
Irvin M. Borish - Essilor Ezell Fellow
Hin Cheung, OD, Indiana University School of Optometry
John N. Schoen Ezell Fellow
Reza Abbas Farishta, BSc, MSc, OD, University of Montreal School of Optometry
Merton C. Flom Leadership Ezell Fellow
Jessica V. Jasien, MEn, University of Alabama at Birmingham School of Optometry
Mike Daley - Essilor Ezell Fellow
Revathy Mani, BSOptom, MPhil, University of New South Wales School of Optometry and Vision Science
Michael G. Harris Ezell Fellow
Rajendra Gyawali, BOptom, MOptom, University of New South Wales School of Optometry and Vision Science
Optometric Glaucoma Society Ezell Fellow
Laura Pardon, OD, MS, University of Houston College of Optometry
Rod Tahran – Essilor Ezell Fellow
Gareth D. Hastings, MPhil, BOptom, University of Houston College of Optometry
Vision Impact Institute Ezell Fellow
Afua Asare, OD, MPH, MSc, University of Toronto
Nicholas Rumney, MScOptom, FCOptom DipTp(IP), ProfCertMedRet, Hereford, UK
Don't forget that the eye continues past the corneal endothelium. The image on top shows an exfoliative ring on the anterior lens capsule. The image on the bottom is an optical coherence tomography (OCT) B-scan of the exfoliative ring and shows the change in the capsular surface.
This patient is a 74-year-old Caucasian female under regular monitoring for exfoliative glaucoma.
We thank Nicholas Rumney for these images 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
Moving Further Toward Reduction of Disease Severity in Keratoconus
Great strides have taken place in our ability to control progression of keratoconus with the introduction of corneal cross-linking (CXL). This has dramatically changed the paradigm of care by emphasizing the importance of early diagnosis and treatment of progression. Further developments will surely improve upon efficacy, safety, and comfort issues with CXL. For patients who have established disease that has significantly impacted vision and quality of life, the challenge remains to develop treatments that can reduce or hopefully eliminate the severity of the disease.
A recent study was published that evaluated a novel approach to disease severity reduction along with control of progression.1 The treatment involved partial topography-guided photorefractive keratectomy combined with topographically customized, higher fluence and variable-pattern CXL applied on the same day of the treatment of keratoconus. A topography-guided partial photorefractive keratectomy treatment of maximum 30µm over the thinnest cone area was applied initially, followed by a 7mm, 50µm phototherapeutic keratectomy treatment to address epithelial removal. In addition, 0.02% Mitomycin C was applied for 20 seconds, and then the exposed stroma was soaked with 0.1% riboflavin solution for five minutes. The cornea was then treated with a customized, variable-pattern and 20 mW/cm2 fluence for a total of 5J to 10J, and up to 15J of energy was delivered with the KXL-II (Avedro) device employing an active tracker. The center of the pattern that received the 1J was topography-matched with the thinnest area of the cone. Visual acuity, refractive error, cornea clarity, keratometry, topography, pachymetry with a multitude of modalities, and endothelial cell density were evaluated over 36 months.
A review of the results indicated that keratoconus was stabilized in all cases. The severity of keratoconus stage by Amsler-Krumeich criteria improved from an average of 3.2 (1 to 4) to 1.8 (0 to 3). Uncorrected distance visual acuity changed from preoperative 20/80 to 20/25 at six months. A maximum astigmatic reduction of 7.8D (5.3D to 15.6D) and a significant cornea surface normalization (an index of height decentration improvement from 0.155 [± 0.065] to 0.045 [± 0.042]) were achieved by one month and remained relatively stable for 36 months postoperatively. Two cases delayed full re-epithelialization for up to nine days.
The author concluded that this treatment protocol may facilitate the use of less tissue ablation in comparison to utilizing a homogeneous ultraviolet light beam for CXL as used in Athens Protocol cases. It broadens the number of potential candidate cases that would have been limited to employ this technique due to tissue thickness limitations.
The comprehensive management of keratoconus is complex and extensive. It includes a clear understanding of the underlying disease state; risk factors for development and progression; genetic elements; early diagnosis; control of progression; visual rehabilitation; and finally, reduction of disease severity or, hopefully someday, a true cure. As we realize that many more people suffer from keratoconus than we ever thought before, it is incumbent upon us to consider this comprehensive approach to keratoconus management.
1. Kanellopoulos AJ. Management of progressive keratoconus with partial topography-guided PRK combined with refractive, customized CXL - a novel technique: the enhanced Athens protocol. Clin Ophthalmol. 2019 Apr 2;13:581-588.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
An Occupation’s Influence on Dry Eye
I generally start my clinical exam with two questions: 1) "What brings you to see us today?" and 2) "What is your occupation?" The answers to these two questions not only drive the final spectacle Rx, they also set up the patient’s risk profile for dry eye.
Environmental factors play an important etiological role in dry eye. And, a recent report corroborated some of my suspicions.1 This cross-sectional study investigated the relationship between types of occupation and symptomatic dry eye.
The study included 40,501 employed people working ≥ 8 hours per week from a population-based cohort in the Netherlands. After correction for age and sex, professionals (e.g., legal, health, and business and administration professionals) and clerical support workers had the highest risk of dry eye. Skilled agricultural workers and elementary occupations (such as cleaners and care companions) carried the lowest risk of dry eye. After additional correction for 45 dry eye-associated comorbidities, professionals and clerical support workers no longer showed increased risk, while craft and related trades workers (e.g., building workers and metal and machinery workers) showed the highest risk of dry eye.
This study underlines the importance of asking about type of occupation in dry eye patients. Screening for symptomatic dry eye in populations that work in high-risk occupations (such as building workers) and in indoor occupations that have high screen use is relevant from an occupational health and work productivity perspective. The lower risk of dry eye in outdoor and active occupations is intriguing and justifies future studies to investigate potential protective and treatment effects. Remember to ask this important occupation question to identify the higher-risk job profiles in your patient demographics.
1. Bazeer S, Jansonius N, Snieder H, Hammond C, Vehof J. The relationship between occupation and dry eye. Ocul Surf. 2019 Apr 2. [Epub ahead of print]
Peripheral Refraction and Eye Lengths in Myopic Children in the Bifocal Lenses In Nearsighted Kids (BLINK) Study
The purpose of this study was to provide a detailed assessment of peripheral refractive error and peripheral eye length in myopic children. Subjects were 294 children aged 7 to 11 years with –0.75D to –5.00D of myopia by cycloplegic autorefraction. Peripheral refraction and eye length were measured at ±20° and ±30° horizontally and vertically, with peripheral refraction also measured at ±40° horizontally.
Results showed that relative peripheral refraction became more hyperopic in the horizontal meridian and more myopic in the vertical meridian with increasing field angle. Peripheral eye length became shorter in both meridians with increasing field angle, more so horizontally than vertically with correlations between refraction and eye length ranging from –0.40 to –0.57 (all P < 0.001). Greater foveal myopia was related to more peripheral hyperopia (or less peripheral myopia), shorter peripheral eye lengths, and a consistent average asymmetry between meridians.
The researchers determined that peripheral refractive errors in children do not appear to exert strong local control of peripheral eye length given that their correlation is consistently negative and the degree of meridional asymmetry is similar across the range of refractive errors. The BLINK study will provide longitudinal data to determine whether peripheral myopia and additional peripheral myopic defocus from multifocal contact lenses affect the progression of myopia in children.
Local retinal control of ocular growth has been demonstrated numerous times in animal experimental myopia models but has not been explored in detail in human myopia development. These BLINK baseline results suggest that children's native peripheral optical signals may not be a strong stimulus for local growth responses.
Mutti DO, Sinnott LT, Reuter KS, Walker MK, Berntsen DA, Jones-Jordan LA, Walline JJ; Bifocal Lenses In Nearsighted Kids (BLINK) Study Group. Peripheral Refraction and Eye Lengths in Myopic Children in the Bifocal Lenses In Nearsighted Kids (BLINK) Study. Transl Vis Sci Technol. 2019 Apr 12;8:17.