Technology is a great thing—most of the time. Recently, a study published in the Journal of American Medical Association (JAMA Dermatology) on 16 online medical services found concerning results.1 These online services and doctors misdiagnosed both minor and serious (syphilis, skin cancer, herpes) conditions. The study’s lead author was quoted as saying “The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses.” Further, regardless of diagnosis, “treatments prescribed were sometimes at odds with existing guidelines.” Additionally, some of the sites were found to link patients to international practitioners, who were not licensed to practice in the United States. I think this is such an important and insightful study as it relates to attempting to provide healthcare, including eyecare, online. Something to consider as technology evolves.
1. Resneck JS Jr, Abrouk M, Steuer M, Tam A, Yen A, Lee I, Kovarik CL, Edison KE. Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease. JAMA Dermatol. 2016 May 15. doi: 10.1001/jamadermatol.2016.1774. [Epub ahead of print]
Jason J. Nichols, OD, MPH, PhD
Blanchard Launches New Scleral Lens Design for the Asian Eye
Blanchard Contact Lenses has launched a new scleral lens design, the Onefit A lens for the Asian eye. The Onefit A lens addresses the physiological nuances of the Asian eye, embracing Blanchard’s minimalist approach to fitting scleral lenses for long-term corneal health. Just like the existing Onefit Scleral Lens Platform, these lenses offer the crisp acuity of a GP lens with the hydrating comfort of a soft lens.
Compared to the Caucasian cornea, the Asian cornea has a smaller HVID and is more prolate with a smaller palpebral fissure. Therefore, to provide optimal limbal clearance and easier handling, the company designed the Onefit A lens with a smaller diameter and an altered para central geometry.
Onefit A is specifically designed for the Asian cornea with a normal prolate profile, irregular corneas, post grafts (prolate), Forme Fruste Keratoconus, and post-refractive surgical corneas. Design applications include: normal prolate, presbyopia, astigmatic (front surface toric), toric peripheries, multifocal, oblate post refractive surgical, oblate toric, and oblate multifocal.
Positive Pivotal Trial Results for Oculeve Intranasal Tear Neurostimulator
Allergan plc announced that two pivotal trials of the Oculeve Intranasal Tear Neurostimulator, OCUN-009 and OCUN-010, each met their primary and secondary efficacy endpoints. With these new results, a premarket submission for the device is on-track to be submitted to the Food and Drug Administration (FDA) in the second half of 2016.
According to the company, this handheld stimulator and daily disposable tips increases tear production upon stimulation in patients with dry eye disease due to decreased tear production. There have been several Oculeve Intranasal Tear Neurostimulator clinical studies completed with more than 200 adult patients, showing positive safety and efficacy of the device.
The OCUN-009 study is a prospective, randomized, controlled, double-masked, multicenter, cross-over trial in which participants used an active device and two control applications. The primary effectiveness endpoint of increased tear production over basal during intranasal application as measured by Schirmer score compared to both controls was met. The OCUN-010 study design is a prospective, single-arm, multicenter, open-label clinical trial in which participants used the Oculeve Intranasal Tear Neurostimulator to stimulate tear production for 180 days. The primary effectiveness endpoint of increased tear production as measured by Schirmer score during application of the device compared with basal Schirmer score at Day 180 was met. Secondary endpoints of increased tear production as measured by Schirmer score during application of the device compared with basal Schirmer score at Days 0, 7, 30 and 90 were also met. All device-related adverse events were mild in nature. There were no device-related serious adverse events. No patients discontinued treatment due to adverse events.
The Oculeve Intranasal Tear Neurostimulator is limited by United States law to investigational use.
Successful Ortho-K and Resolved Dry Eye Theodore Sees, OD, Rockford, MI
A -4.00 patient who was struggling with dry eye issues is now loving the better than 20/20 vision with her new Ortho-K lenses. Plus…dry eye issues have resolved.
We thank Dr. Sees 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, FAAO
Caring for Contact Lenses While Traveling
Traveling can be an exhilarating experience. It can reunite you with family, or it may even take you to a new exotic location. While traveling can be great fun, it typically requires some planning. You need to find the best route, make accommodation plans, and you need to determine what to pack.
Your contact lens wearers will most certainly need to make some special considerations before their departure. Domestic travelers will need to remember to bring their everyday care products (e.g., care system, saline solution), though they may want to also consider purchasing travel size versions or a leak proof contact lens case.1 Domestic travelers would also likely benefit from bringing an extra pair of contact lenses and their spectacles in case they lose their contact lenses or if they have an ocular emergency while on the road.1
Individuals traveling to foreign countries may need to take additional precautions, especially if they are visiting underdeveloped locations.2 Travelers should investigate the conditions of their destination before they depart.1 Specifically, they should determine things like if there will be clean water for hand washing, if the air will be highly polluted, or if there will be extreme weather conditions.1, 2 These individuals should also bring their regular care products; however, they may also need to consider bringing supplies like bottled water, soap, saline solution, or a mirror.1, 2
Many contact lens wearers fail to consult an eyecare provider before embarking on travel; therefore, you may want to include questions about travel on your case history forms.2 Asking these types of questions should help you better care for your patients, especially as we approach the unofficial start of summer next weekend.
1. Leggat PA, Speare R, Moon ME. Sore eyes and travelers. J Travel Med. 1999;6:45-47.
2. Bauer IL. Contact lens wearers' experiences while trekking in the Khumbu region/Nepal: a cross-sectional survey. Travel Med Infect Dis. 2015 Mar-Apr;13(2):178-84.
If you could purposely choose the worst room in the house for contact lens insertion, which room would you select? Chances are, our patients are already putting their lenses in their eyes in this room.
I realize the reality of potty rooms. They have a big mirror and the best lighting in the house for contact lens insertion, but could we pick a worse place? Have you ever seen any of the research or videos showing the amount of splatter that occurs when we flush the toilet and how many particles are released into the air? (Sorry for how gross this may be sounding.)
What are we to do? Let’s make an assumption that we are going to continue to insert contact lenses in the bathroom; does this not advocate all the more for single-use lenses? Additionally, it is a good idea for a patient to store their lenses, solutions and case away from the airborne bugs that may be floating around. If possible, have patients keep lenses and supplies in a drawer or cabinet away from the toilet. If they cannot use a single-use lens, make sure to have them open their contact lens case and then wash their hands. After all the case and solution may contain a plethora of “crap.”
There is no perfect way to be clean when a toilet is present, but what better way to force us and our patients to think of innovative ways to reduce our exposure to things that are lurking in the air.
Success of Rigid Gas Permeable Contact Lens Fitting
The objective of this study was to assess the percentage of successful rigid gas permeable (GP) contact lenses (CLs) fit for both refractive and therapeutic reasons.
New CLs (soft or GP) fittings were retrospectively analyzed and divided into refractive and therapeutic prescriptions. A standardized fitting protocol that included complete CLs information after a first eye examination, a diagnostic fitting visit, a dispensing visit, and a prescribing visit was used in all fittings. A GP fitting was defined as successful if full-time wear and optimal ocular surface physiology were both achieved at the review assessment 2 to 3 weeks after lens dispensing.
Of 232 new CLs fittings analyzed, 166 were refractive fittings (71.6%) and 66 were therapeutic (28.4%). Of the refractive fittings, 88 subjects (53%) were initially fitted with GP CLs and 61 (69.3%) of these met the criteria for successful GP fitting. Within this group, a different percentage of successful fits were found for neophyte (72%), previous soft lens wearers (62%), and previous GP wearers (92.3%). Of the therapeutic fittings, 61 subjects (92.4%) were initially fitted with GP CLs and 59 (96.7%) of these met the criteria for successful GP fitting.
The authors concluded that, following a standardized CLs fitting protocol, a relatively high percentage of successful GP fits was achieved for refractive (7/10 subjects) and therapeutic (9/10 subjects) prescriptions. These results will improve the information available to patients and aid in their CL choices by providing them with a realistic attitude. It will also help eyecare practitioners in their clinical activities by providing evidence-based information.
Ortiz-Toquero S, Martin M, Rodriguez G, de Juan V, Martin R. Success of Rigid Gas Permeable Contact Lens Fitting. Eye Contact Lens. 2016 Apr 13. [Epub ahead of print].