This week’s poll results tell a remarkably different story from when we asked our readers this question four years ago (http://www.cltoday.com/issues/CLToday_042813.htm). As noted by the current results (see below), most respondents (52%) appear to be recommending hydrogen peroxide systems for the care of scleral contact lenses today. When we asked this question four years ago, most respondents (62%) stated that they recommended a GP lens daily cleaner and conditioning solution for scleral contact lenses. Certainly, both systems have their own advantages, but the large shift in responses warrants further discussion. Stay tuned as our scleral lens and lens care experts weigh in on this trend.
Jason J. Nichols, OD, MPH, PhD
Alcon Introduces AREDS2 Eye Vitamin
Alcon introduced Systane ICaps Chewable AREDS2 Eye Vitamin in the U.S market. Systane ICaps Chewable AREDS2 Eye Vitamin contains ingredients used in the Age-Related Eye Disease Study 2 (AREDS2), a clinical trial conducted by the National Eye Institute that evaluated the effects of various combinations of nutrients on the progression of age-related macular degeneration.
In a two-tablet serving, the new Systane ICaps Chewable AREDS2 Eye Vitamin contains 500mg vitamin C (as Ascorbic acid), 400 IU of vitamin E (as d-alpha-tocopheryl acetate), 25mg of zinc (as zinc oxide), 2mg copper (as copper citrate), 10mg lutein, and 2mg zeaxanthin.
Contact Lens Spectrum has launched a new resource page on its website that covers all things scleral at www.clspectrum.com/resources/specialty-lens-resources/scleral-lens-resources. Highlighting the page are exclusive videos from the Scleral Lens Education Society that feature conversations with several scleral lens pioneers, including Rients Visser, MD; Don Ezekiel, OD; and Perry Rosenthal, MD. The webpage also has links to a scleral lens-focused editorial supplement to CLS and recent articles from the magazine as well as troubleshooting FAQs, fitting guides, and scleral lens care information.
Supermax to Enter U.S. Contact Lens Market
Supermax, a latex glove manufacturer in Malaysia, has begun distribution of its Aveo Vision brand of soft lenses. The lenses are made by SuperVision Optimax Sdn Bhd (a 98%-owned subsidiary of Supermax International Sdn Bhd, which is a wholly owned subsidiary of Supermax). Manufacturing currently takes place in a production facility in Sungai Buloh, Malaysia.
Through a growing worldwide distribution network, Supermax has started exporting its Aveo Vision lenses, first to Hong Kong in September 2016 and then to Brazil, South Korea, and Singapore in January, February, and April 2017, respectively. The company is launching Aveo Vision in Malaysia next month. Elsewhere, the group will be bringing the brand to the United Kingdom, Canada, the United States, and Mexico later this year and to Japan in the first quarter of 2018. Supermax’s contact lenses will be available in daily, bi-weekly, and monthly modalities.
SynergEyes Expands Hydra-PEG Coating to UltraHealth and Duette Lenses
SynergEyes, Inc. announced the expansion of the Tangible Hydra-PEG coating to UltraHealth hybrid contact lenses. The lubricous polymer coating developed by Tangible Science recently became available on SynergEyes’ Duette and Duette Progressive lenses.
Second Annual Optometry Student Challenge Announced
ABB Optical Group, in partnership with Paragon Vision Sciences, announced that it is accepting abstracts for its 2017-2018 Optometry Student Challenge program. Students who are interested in participating must register by June 16. Registered students must then submit an abstract on their proposed poster topic by Oct. 31. Abstracts must focus on study projects or student-based case histories related to contact lenses. Topics can include, but are not limited to, contact lens applications for presbyopia, keratoconus, corneal topography, post-penetrating keratoplasty or related irregular corneal surface, myopia control, lens care/solutions, and orthokeratology.
Abstracts will be judged in two categories: case study report and research. Five finalists will be selected and notified by Nov. 17. The finalists will then be required to convert their abstracts into scientific posters for further judging. The posters must be submitted in PDF format to ABB Optical Group by Nov. 30. Only digital files will be accepted. Judges will then select the top three posters by Dec. 5.
The lead authors of the top three posters will be awarded travel grants of $1,500 each to attend the Global Specialty Lens Symposium (GSLS) and present their posters. The cost of their conference registration will be covered as well. Additionally, the two runners-up will receive honorable mention prizes of $250 each. The 2018 GSLS will be held Jan. 25-28 in Las Vegas.
GfK Releases Sales Data, Daily Disposables Gain Top Market Share
Point-of-sale (POS) data from GfK show continued strong momentum for daily disposable contact lenses, helping to drive overall dollar growth in the U.S. soft contact lens market. However, the number of new contact lens wearers remains flat overall.
GfK says that its contact lens POS panel captures sales data from eyecare practitioners throughout the United States. In January 2017, for the first time, monthly sales of daily disposable contact lenses surpassed those of monthly lenses in dollar volume, reaching 38.1% market share—up from 31.5% in January 2016. In 2012, daily disposable lenses accounted for just 17.9% of the market.
The company reports that in the U.S. market, the daily disposable lens segment continues to grow at a faster pace compared to any other modality, increasing 21% in dollar volume year over year. New products and innovation continue to drive daily lens sales growth; in 2016, 42% of the growth in the daily category was from product launches in the prior year. Daily disposable multifocal lenses alone grew 45.4% in 2016 over the prior year, with more than three quarters (77.9%) of that growth driven by products launched in 2015.
GfK also says that growing the number of new wearers and keeping wearers in contact lenses continues to be a challenge. In 2016, new lens wearers accounted for just greater than 21% of all contact lens fittings, according to GfK’s FITS panel, which tracks optometrist visits; that figure is down slightly versus the prior year and is in line with a four-year trend of contraction. Growth in total wearers was also negative, down 0.3% in 2016 over 2015.
According to GfK FITS data, toric contact lenses were the only category to increase in wearers from 2015 to 2016 (up 3.6%). As other lens types saw growth in daily disposable lenses at the expense of their reusable counterparts, toric lenses experienced growth in daily, monthly, and weekly lenses year over year (18.7%, 2.0%, and 1.7%, respectively)—indicative of a true increase in toric wearers. This pattern, combined with new toric products slated to release throughout 2017, may aid in patient retention by supplying the astigmatic patient base with more options, according to GfK.
Quidel Acquires Diagnostic Testing Businesses from RPS Diagnostics
Quidel Corporation, a provider of rapid diagnostic testing solutions, cellular-based virology assays, and molecular diagnostic systems, has completed the acquisition of the InflammaDry and AdenoPlus diagnostic businesses from RPS Diagnostics, a developer and manufacturer of rapid, point-of-care (POC) diagnostic tests for the eye health and primary care markets, for approximately $14 million in cash.
The InflammaDry and AdenoPlus products are rapid, lateral-flow based, POC products for the detection of inflammatory and infectious diseases and conditions of the eye. InflammaDry detects elevated levels of MMP-9, a key inflammatory marker for dry eye. AdenoPlus differentiates between a viral and bacterial infection of acute conjunctivitis (pink eye). Both products utilize innovative, patented technology; are CE marked, FDA-cleared, and CLIA-waived; and complement Quidel’s existing rapid diagnostic testing solutions. Manufacturing for both products will be transferred to Quidel's San Diego facility in the near term.
InflammaDry and AdenoPlus revenues will be reflected in Quidel's Immunoassay revenue category.
AAOF Announces The 2017 William C. Ezell Fellowships
The American Academy of Optometry Foundation (AAOF) announced the 11 recipients for the 2017 William C. Ezell Fellowship program. The Ezell Fellowship program is named after the founding president of the AAOF, William C. Ezell, OD. It was established to provide talented post-doctoral students who are pursuing an advanced degree in optometric research and education with recognition and support. More than 300 Ezell Fellowships have been awarded since the inception of the program in 1949.
The following students were selected as the 2017 - 2018 Ezell Fellows:
American Academy of Optometry Ezell Fellow
Maria K. Walker, OD, University of Houston College of Optometry
American Academy of Optometry Foundation Karla Zadnik Ezell Fellow
Katherine M. Bickle, OD, MS, The Ohio State University College of Optometry
AAO Section on Cornea, Contact Lenses and Refractive Technologies Ezell Fellow
Erin Rueff, OD, MS, The Ohio State University College of Optometry
Baycross Christian Family Foundation Binocular Vision and Pediatrics Ezell Fellow
Ann Morrison, OD, MS, The Ohio State University College of Optometry
Irvin M. Borish – Essilor Ezell Fellow
Ian Erkelens, OD, University of Waterloo School of Optometry and Vision Science
Mike Daley – Essilor Ezell Fellow
Suraj Upadhyaya, OD, University of Houston College of Optometry
Merton C. Flom Leadership Ezell Fellow
Phillip Thomas Yuhas, OD, MS, The Ohio State University College of Optometry
Michael G. Harris Ezell Fellow
Elise N. Harb, OD, MSc, University of California Berkeley School of Optometry
Optometric Glaucoma Society Ezell Fellow
Nevin W. El-Nimri, OD, MS, University of California Berkeley School of Optometry
John H. Schoen Ezell Fellow
Kevin Thomas Willeford, OD, MS, State University of New York College of Optometry
William C. Ezell Fellow sponsored by Vision Impact Institute
Kaitlyn Anne Sapoznik, OD, Indiana University School of Optometry
Funding for these fellowships is provided by leading optometric companies, private endowments, and other generous business organizations that represent most sectors of the industry. This year’s Ezell Fellows will be honored at the AAOF’s Annual Celebration Luncheon on Oct. 14, 2017 during the American Academy of Optometry’s Annual Meeting in Chicago.
Paragon Vision Sciences Expands Practice Management Training and Education Team
Paragon Vision Sciences appointed Jon Hudson, ABOC, NCLEC, to the position of practice management consultant, responsible for assisting in the development and coordination of practice management training and education programs. Prior to joining Paragon Vision Sciences, Mr. Hudson served as an optometric consultant to Maui Jim, Inc., while also providing optometric management counsel to multiple optometric practices within Arizona.
POLL: Which of the following do you most frequently recommend for the daily cleaning and disinfection of a scleral contact lens?
Mirko Chinellato, DOO, Treviso, Italy
The description of a topographic map of a cornea affected by pellucid marginal degeneration (PMD) is commonly thought to resemble images that look like two birds kissing, a lobster’s claw, a butterfly, a seagull’s wings, and the shape of a moustache.
In this clinical image, our patient was a 60-year-old male whose eye was affected by PMD. We noted the typical distortion of the rings that indicates a strong against-the-rule astigmatism in the corneal optical zone, with a very narrow corneal apex located at the outer boundary at 6 o’clock. Based on this image, I propose a new image that could be used to describe a topographic analysis of a PMD disease—“The Scream” by Edvard Munch (Edvard Munch, “Skrik” 1893)
We thank Dr. Chinellato 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.
S. Barry Eiden, OD
Settle Down Now
The issue of scleral lens settling is something about which all of those involved in the fitting of these lenses must be aware. We have come to know that the vaulting characteristics of a scleral lens on the ocular surface at the time of dispense can be quite different when compared to the way the lens “fits” on the eye after settling for a good number of hours. So, we must pose the following question: “Does scleral lens settling influence the optical characteristic of the lens on the eye as expressed by over-refraction?”
A study was recently published that addressed this very question.1 The purpose of this study was to determine the change in over-refraction, if any, after a scleral lens settled on the eye for six to eight hours. Sixteen patients of varying refractive errors and normal corneal curvatures (measured with the Oculus Pentacam) were fitted with trial Mini-Scleral Design (MSD; Blanchard Contact Lenses) scleral lenses in one eye; the lenses were 15.8mm in diameter. The sagittal depths of the scleral lenses were selected by adding 350μm to the corneal sagittal heights measured at a chord length of 15mm with the Visante optical coherence tomographer (OCT; Zeiss) anterior segment scans and picking the closest available trial lens in the set.
Initial measurements were taken 30 minutes after lens application and included an auto-refraction, subjective refraction, and best sphere refraction over the contact lens. Visual acuities and Visante OCT anterior segment scans were also taken. These measurements were repeated after six to eight hours of lens wear.
Results indicated that, when comparing the initial lens over-refraction to that found after six to eight hours of lens wear, the average change in the spherical component of the over-refraction was +0.06D (standard deviation [SD] 0.17) (p = 0.16). The average change in cylinder was +0.04D (SD 0.19) (p = 0.33). The average absolute change in axis was 1.06° (SD 12.11) (p = 0.74). The average change in best sphere was +0.13D ± 0.30D (p = 0.12). There was no significant change in visual acuity with the best sphere over-refraction over the six- to eight-hour wearing period. There was a significant change in central corneal clearance of 83μm (SD 22) (p < 0.0001) over the wearing period.
The authors concluded that despite a significant change in the central corneal clearance due to thinning of the fluid reservoir as the scleral lens settled (an average decrease of 83μm after wearing the lenses for six to eight hours), there was not a statistically significant change in the subjective over-refraction (sphere, cylinder, and axis) or best sphere or visual acuity. This study confirmed that there is no link between reduction in central corneal clearance and change in over-refraction for average corneas.
It is very important to consider the fact that scleral contact lenses do settle on the ocular surface over a period of hours after application. Our goal should be that we always maintain full corneal clearance even after full lens settling. Consideration of this should be given when assessing the characteristics of the lens vault at the time of initial diagnostic lens evaluation and initial dispensing evaluation of prescribed lenses. However, we can feel confident based on the outcomes of studies that the power effect of the lens on the eye should remain fairly stable.
1. Bray C, Britton S, Yeung D, Haines L, Sorbara L. Change in over-refraction after scleral lens settling on average corneas. Ophthalmic Physiol Opt. 2017 May 12. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
A New Threat to the Ocular Surface: Fidget Spinners
A fidget spinner is a type of stress-relieving gadget. A basic fidget spinner consists of a bearing (which allows for rotation along a fixed axis) in the center of a design made from any of a variety of materials including brass, stainless steel, titanium, copper, and plastic. The spinner has been touted as a therapy for patients who have trouble focusing or who fidget (such as those with Attention Deficit Hyperactivity Disorder, autism, or anxiety) by acting as a release mechanism for nervous energy or stress.
The spinner user can palm or spin the gizmo in a variety of ways; however, a popular pastime is to spin the spinner on the tip of one's finger, akin to balancing a spinning basketball. The faster you spin the better, especially with a friend focused on the somewhat competitive nature of spin velocity. As expected, the propeller-like motion of the spinner and delicate balance can often “launch” the spinner toward the attentive spinner gazer. We have treated two central corneal abrasions in school-aged patients.
We are all familiar with the risks of recurrent erosion in corneal abrasion patients. We may initiate antibiotic coverage in corneal abrasion patients, unwittingly contributing to antibiotic resistance. We also may be uncomfortable using bandage contact lenses on pediatric patients. Consider the spew of inflammatory molecules to the ocular surface. What are the other long-term considerations in corneal remodeling after spinner-related injury in these young patients?
Beware the fidget spinner.
New Insights Into the Lipid Layer of the Tear Film and Meibomian Glands
Meibomian glands secrete lipids (meibum) that form the surface lipid layer of the tear film and thereby prevent excessive evaporation of tear fluid. Meibomian gland dysfunction is a major cause of evaporative dry eye, which is more prevalent than aqueous-deficient dry eye. Noninvasive meibography with infrared light and an infrared charge-coupled device camera can detect morphological changes of meibomian glands in both upper and lower eyelids, whereas tear interferometry allows qualitative and quantitative evaluations of the lipid layer of the tear film.
This study examined 17 individuals by noninvasive meibography with standard infrared video security camera. The extent of meibomian gland loss as measured by digital image analysis was significantly correlated with the lipid layer pattern and noninvasive breakup time (BUT) of the tear film as determined by tear interferometry as well as with the Ocular Surface Disease Index (OSDI), suggesting that this technique may be of diagnostic value.
The authors concluded that this type of assessment of meibomian gland morphology provides clinical information that contributes to the diagnosis of evaporative dry eye, whereas that of the lipid layer of the tear film allows the monitoring of meibomian gland function. In addition, the balance between the lipid and aqueous layers of the tear film revealed by tear interferometry has provided both support for the operation of a compensatory system that maintains tear film homeostasis as well as insight into the pathophysiology of dry eye.
1. Arita R, Fukuoka S, Morishige N. New Insights Into the Lipid Layer of the Tear Film and Meibomian Glands. Eye Contact Lens. 2017 Apr 12. [Epub ahead of print]