This last week concluded the annual Association for Research in Vision and Ophthalmology’s annual meeting, held in Baltimore. As usual, there was a tremendous amount of exciting new research on many things related to contact lenses—dry eye, meibomian gland dysfunction, and keratoconus, among many other topics.
One thing that was striking was the significant amount of research presented on the many promising and innovative approaches to treating ocular surface disease, including both new devices and pharmaceutical options. Given the significant comfort issues that plague many contact lens wearers, I believe that we are seeing a new horizon approach filled with many new treatment options that will help our contact lens wearers remain even more comfortable in their contact lenses. Stay tuned as we report on these exciting developments.
Jason J. Nichols, OD, MPH, PhD
Conclusions and Recommendations of the TFOS DEWS II Announced
The Tear Film & Ocular Surface Society (TFOS) presented the conclusions and recommendations of the TFOS Dry Eye WorkShop II (DEWS II) during a special session of the Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting. TFOS DEWS II was designed to achieve a global consensus concerning multiple aspects of dry eye disease and is the sequel to the original TFOS DEWS of 10 years ago.
At ARVO, Dr. J. Daniel Nelson, the workshop chair, presented the new definition of dry eye: “Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
The TFOS DEWS II report will be published by The Ocular Surface (scheduled for the end of June) and distributed to scientists, clinicians, and patients worldwide. A downloadable version of the document and additional material will be available on the TFOS website: www.TearFilm.org. Translations of the report will be offered in numerous languages, including but not limited to English, Chinese, French, German, Italian, Korean, Spanish, and Vietnamese.
Visioneering Technologies Expands U.S. Sales Force
Visioneering Technologies, Inc. has expanded its U.S. sales force. In line with the company’s plan to broaden and accelerate its U.S. launch of NaturalVue Multifocal contact lenses, it has appointed Joshua Suarez as new district sales manager for the western United States and added 10 new sales representatives across the country.
Mr. Suarez has more than 14 years of experience in senior sales roles in the healthcare and medtech industries in the United States. Most recently, he was the regional business manager at Voyce (i4C Innovations Inc.), where he built a new region and led sales and training for the start-up remote monitoring device company. Prior to this, he was the senior area business manager at Zoetis Inc.
CheckedUp and TearScience Team Up to Impact Dry Eye Patient Education
CheckedUp, a specialty point of care company, announced a nationwide partnership with TearScience to introduce the CheckedUp Engagement Platform to TearScience customers. The CheckedUp platform engages patients at each stage in the decision-making process and is proven to increase patients’ understanding of their disease and confidence in their treatment options, according to the company.
Under the agreement, TearScience representatives will provide the CheckedUp Explorer waiting room package to its customers as the first component of the full CheckedUp Platform. The Explorer package includes a 43” flat panel TV, engaging full-motion HD video programming that is updated monthly, a customizable sidebar that rotates from practice information and marketing to patient questions, and lifetime system maintenance.
Dr. Stephen S. Lane to Join Alcon
Alcon appointed Stephen S. Lane, MD, as chief medical officer (CMO) and global head Franchise Clinical Strategy. He will join the company on June 1.
In his new role, Dr. Lane will lead the integration of scientific, clinical, and commercial priorities across Alcon's Surgical and Vision Care franchises, with a focus on the needs of patients and eyecare practitioners. Dr. Lane will also support the generation of Surgical and Vision Care clinical evidence and will represent Alcon to academic, scientific, and industry communities and to government agencies.
He is a founding partner of Associated Eye Care, past president of the American Society of Cataract Surgeons (ASCRS), serves on the editorial boards for several ophthalmic journals, is a distinguished lecturer, and has published numerous academic articles and book chapters. In addition, Dr. Lane is an adjunct professor of ophthalmology at the University of Minnesota, co-chair of the ASCRS Foundation, and a visiting faculty member of ORBIS International, an Alcon partner.
If you haven’t voted yet in this month’s poll…
Which of the following do you most frequently recommend for the daily cleaning and disinfection of a scleral contact lens?
A gentleman with a prior history of radial keratotomy (RK) presented to the clinic with eye pain and redness in his left eye after an injury from a cat claw. A 1.5mm x 1.5mm central corneal laceration was found connecting the 5 o’clock and 6 o’clock RK scars.
We thank Dr. Wilkins 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.
CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
Predicting Patient Compliance
Compliance in the world of contact lenses could be defined as wearing and caring for your contact lenses correctly 100% of the time. While it would be wonderful if patients were perfectly compliant with using their contact lenses, there is a good chance that they are not compliant. In fact, up to 90% of contact lens wearers are noncompliant with at least one aspect of their care regimen.1-3 Furthermore, Friedman et al estimated from the literature that patients who have a chronic condition for which they are being treated (e.g., dry eye that could result in contact lens dropout) take only between 30% and 70% of their medication doses.4 These startling departures from the ideal likely contribute to decreased treatment effectiveness and patients’ decreased satisfaction with their contact lenses.5
Detecting noncompliance should be a top priority for clinicians; however, they are terrible at accomplishing this task.6 In a study on patient-practitioner communication, Friedman et al found that practitioners usually failed to predict which patients were noncompliant with their treatments.6 This issue may be related to the clinicians performing practitioner-centered rather than patient-centered exams and to the practitioners asking closed-ended questions.6 Friedman and his colleagues also found that patients typically report to their practitioners much better compliance than is actually true, potentially because patients want to please their medical providers.6
Fully involving patients in the care process is critical to circumventing the noncompliance epidemic.6 According to the study, you should allow them to fully take part in the exam; encourage them to ask their own questions; and ask them open-ended questions that allow them to elaborate on topic areas that you are concerned about. You could also allow patients to complete a compliance survey on their own to decrease the chances that you will skew their responses.6 All of this information should then be used in collaboration with the patients to best suit their lifestyle and treatment needs.
1. Bui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: perceptions, awareness, and behavior. Eye Contact Lens. 2010 Nov;36:334-339.
2. Robertson DM, Cavanagh HD. Non-compliance with contact lens wear and care practices: a comparative analysis. Optom Vis Sci. 2011 Dec;88:1402-1408.
3. Ramamoorthy P, Nichols JJ. Compliance factors associated with contact lens-related dry eye. Eye Contact Lens. 2014 Jan;40:17-22.
4. Friedman DS, Hahn SR, Gelb L, Tan J, Shah SN, Kim EE, Zimmerman TJ, Quigley HA. Doctor-patient communication, health-related beliefs, and adherence in glaucoma results from the Glaucoma Adherence and Persistency Study. Ophthalmology. 2008 Aug;115:1320-1327, 1327e1-1327e3.
5. Koo H, Kim TH, Kim KW, Wee SW, Chun YS, Kim JC. Ocular surface discomfort and Demodex: effect of tea tree oil eyelid scrub in Demodex blepharitis. J Korean Med Sci. 2012 Dec;27:1574-1579.
6. Friedman DS, Hahn SR, Quigley HA, Kotak S, Kim E, Onofrey M, Eagan C, Mardekian J. Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice. Ophthalmology. 2009 Dec;116:2277-2285.e1-3.
MATERIALS & DESIGNS
David L. Kading, OD
Whatever You Say, Doc
I saw a patient yesterday whom I have been seeing for years. I took him from misery to happiness several years ago with the introduction of specialty lenses for his keratoconus. Since then, he has had fantastic vision and fantastic comfort. He is a top-level executive who is crushing it in his career. He realizes that without his vision, he would be sunk.
When completing his annual evaluation, I expressed his meibomian glands. Although they looked beautiful, they did not flow at all (non-obvious meibomian gland dysfunction [MGD]). After removing his lenses, I applied lissamine green dye, and his eyes lit up like a spotlight in a dark field. He had grade 2 conjunctival staining, and his lid wiper was grade 3. Evaluation of his lipid layer thickness showed 50nm (normal is 100+). Symptoms: None.
What do we do for this patient? He has all the signs, but none of the symptoms. Given that I no longer believe dry eye disease to be defined by symptoms, I proceeded to treat him the same way I would if he had them. I prescribed lifitegrast to decrease his inflammation and performed Lipiflow (TearScience) on him.
His response to the added cost and introduction of a daily medication? “Whatever you think is best.” Why would he say this? He realized that my best interest was for his long-term benefits. I practice for tomorrow, not just for today. Although every patient is not as willing, I think we can all think back to those patients who have been moved by the treatments we have given them and the trust that we have built.
As clinicians, we need to treat all of our patients with this level of respect, even if they do not treat us with the same level. Do what is best for your patients regardless of the cost, because if you are concerned about cost in early stage disease, it could cost patients dearly in end-stage disease.
Simulation of Commercial Versus Theoretically Optimised Contact Lenses for Presbyopia
The purpose of this study was to compare theoretically optimized bifocal contact lens optical designs to commercially available optical designs for presbyopia.
Retinal images were simulated, using a numerical eye model, from –6.00D (i.e., near vision) to +2.00D for each 0.25D. Ten optical profiles were simulated. Four of them corresponded to commercial contact lenses (Acuvue Oasys for Presbyopia, Johnson & Johnson Vision; Air Optix Aqua Multifocal, Alcon; Purevision Multifocal, Bausch + Lomb; and Distance Biofinity Multifocal, CooperVision). The authors also included six optimized profiles: 1) a combination of primary and secondary spherical aberration; 2) bifocal profiles with two, five, and eight concentric zones; and 3) a combination of spherical aberrations with the five- and eight-zone profiles.
Twenty subjects scored the quality of vision of calculated images (i.e., three high-contrast 0.40 logMAR letters) for each design and vergence with a five-item continuous grading scale. Subjects viewed these images through their best sphero-cylindrical correction and a 3mm pupil to limit the impact of their aberrations. To quantify the ability of a bifocal optic to maintain a certain level of quality of vision, the researchers calculated two criteria: the area under the through-focus quality of vision curve higher than two (i.e., limit between poor and fair quality of vision), normalized by the same area calculated on the naked eye's curve, and the width of the curve at a level of two (i.e., depth-of-focus).
The authors found that commercial contact lens profiles did not provide an image quality and depth-of-focus as good as the theoretically optimized optical profiles did. Based on these two criteria, the best bifocal profiles were those with five and eight concentric zones. Important inter-individual variations were observed for all profiles. The authors also observed that some subjects did not obtain any benefit with all of the designs whereas others seemed to be satisfied whatever the optical profiles.
The authors concluded that their previously optimized designs with five and eight zones provided the best benefit and depth-of-focus. As their image quality is better compared to commercially available designs, it would be interesting to prototype these designs and to test them in a clinical setting.
Legras R, Rio D. Simulation of commercial vs theoretically optimised contact lenses for presbyopia. Ophthalmic Physiol Opt. 2017 May;37(3):297-304.