Epidemiological studies are key to determining the distribution (frequency) and determinants (risk factors) for disease. Although we know that contact lens discomfort is a very frequent problem, we have not seen a large-scale, prospective, well controlled study that has confirmed true risk factors for dry eye in contact lens wearers (or really in dry eye disease in general for that matter). One of the problems here is funding—the National Institutes of Health in the United States has not shown significant interest in funding much in the way of contact lens research through the years, perhaps due to the perception that contact lens wear is “elective” and removal of a contact lens usually eliminates the problem, so the “industry” should fund this sort of work. While industry does fund plenty of contact lens research, it is often a challenge for them to bear this burden for a variety of reasons presenting a real barrier to the development of our understandings that would ultimately improve patient care.
A new iPad app, the Dry Eye Tool Box, developed by Dr. Heiko Pult is based on computer software (PULT-test) that was launched in 2009 to help predict contact lens related dry eye in naïve and experienced contact lens wearers. The app consists of three modules: the Dry Eye Screening module for non-contact lens wearers, naïve-contact lens wearers and experienced lens wearers; the Dry Eye Management module to diagnose dry eye type and provide appropriate treatment and contact lens recommendations; and the “Symptometer” module, consisting of one validated questionnaire for non-contact lens wearers (Ocular Surface Disease Index) and one for contact lens wearers.
The app leads the user through a practical and evidence based workflow which includes low-tech tests and optional high-tech tests. Based on the user's equipment, different tests can be used including objective tests which can all be performed using a standard slit lamp microscope, as well as optional tests like the evaluation of tear film osmolarity or meibography. The tests are described in a comprehensive manual. Additionally by clicking on each test in the app, a pictorial description of the test can help the user to analyze tear film and ocular signs and to also educate and involve the patient in the dry eye management process.
The “Symptometer” can be used for a quick dry eye screening especially if a slit lamp microscope cannot be used. Additionally this can be used to observe treatment success based on patient's symptoms.
Essilor International announced that it has completed the acquisition of all outstanding common stock of Coastal.com. The transaction, announced last February 27, was approved by Coastal.com shareholders in a meeting on April 16. It has also been cleared by regulatory authorities.
Based in Vancouver, British Columbia, Canada, Coastal.com designs and distributes one of the widest online selections of optical equipment, including contact lenses, prescription and non-prescription eyeglasses, sunglasses and accessories. It reported revenue of CAD 218 million for the fiscal year ended October 31, 2013. The price of the transaction was CAD 12.45 per Coastal.com share, which represents an equity value of approximately CAD 430 million.
Coastal.com will be consolidated by Essilor from May 1, 2014. Coastal.com shares will be withdrawn from trading on the Toronto Stock Exchange and the NASDAQ on the same date.
The GPLI (GP Lens Institute), the educational resource for customized lenses, offers monthly webinars as part of their ongoing commitment to eyecare practitioner education. These webinars had an average attendance of greater than 100 in 2013 and early this year. The coming months offer several opportunities to join in and see what you are missing.
The schedule for the rest of the year includes:
May 20, 2014: Brooke Messer, OD: GP Multifocal Fitting and Troubleshooting
June 17, 2014: Michael Ward, FCLSA: Contact Lens Management of the Irregular Cornea: Case Grand Rounds
July 22, 2014: Mile Brujic, OD and Dave Kading, OD: Basic Clinical Considerations for Scleral Lens Fitting
August 19, 2014: Steven Byrnes, OD: Management of Common Scleral Lens Problems.
September 16, 2014: Clarke Newman, OD: Coding and Billing for the Specialty Contact Lens Patient Update
October 21, 2014: Michael Lipson, OD: Fitting Strategies for Keratoconus: New Options
November 18, 2014: Robert Davis, OD and Bruce Anderson, OD: GP and Hybrid Case Grand Rounds
December 16, 2014: Ed Bennett OD, MSEd: Bitoric GP Lens Design and Fitting
The no charge webinars do require preregistration at www.gpli.info/webinars. Previous webinars are archived on the organization’s website and many also offer an opportunity for COPE-approved CE (nominal fee involved).
While you are visiting the site, www.gpli.info, checkout the many other educational resources offered by the GPLI such as a variety of fitting and troubleshooting lectures, the Toric and Spherical Lens Calculator, the Contact Lens Clinical Pocket Guide, Grand Rounds, case studies and more.
The U.S. Food & Drug Administration (FDA), American Optometric Association (AOA) and the Entertainment Industries Council (EIC) have teamed with entertainment industry-leading artists from the TV series American Horror Story on a first-of-its-kind Decorative Contact Lens Campaign to bring the dramatic realities of illegal and unsafe lens use to the forefront.
Used often in Hollywood characters from X-Men to American Horror Story, and reality shows like FaceOff, eye-changing lenses create certain character traits or appearances that, in some instances, become iconic and sought-after “looks” by fans. The purpose of this important public health campaign is to raise awareness, especially among American youth and their parents, of the severe consequences that can result from purchasing and using decorative contact lenses that are not obtained through a valid prescription.
The campaign launches just in time for end-of-school-year celebrations, a time when students are more likely to purchase and use decorative contact lenses. The first national viewing of the 30 second PSA occurred at the National Cable & Telecommunications Cable Show in Los Angeles, April 30. A longer 3-minute version will subsequently be released.
A 24 year old male presented wearing soft monthly disposable lenses that had been continually worn for over 3 months without removal. Below each lens covering the superior 1/3 of cornea was an accumulation of tiny bubbles. Upon removal obvious dimple veiling was noted. Anterior segment OCT images were taken that show the superficial depression areas of the corneal epithelium.
We thank Dr. Eiden for this image and we 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 an explanation of the photo and your full name, degree or title and city/state/country.
CARE SOLUTION CORNER Susan J. Gromacki, OD, MS, FAAO
Case History: Wearing Time
In two recent columns, I reported that we should be asking our contact lens-wearing patients how many hours per day they wear their contact lenses—at each and every visit.1,2 Why is this important? Of course, the answer to this question gives us information regarding lens overwear. But also, it can help us distinguish patients who will successfully wear lenses for years to come from those who will eventually drop out. What’s more, if we are able to detect this latter group early enough, we can take the steps necessary to prevent this dropout.
Over the years, I’ve learned that it is quicker for me to do the math myself, so the question has become, “What time do you insert your lenses in the morning, and what time do you take them out?” The answer provides a good opportunity to educate patients regarding the connection between lens overwear and diminished ocular health. Keep in mind that recommended wearing times can differ based on factors such as patient age, ocular health, systemic health, lens material, and lens replacement schedule. I next compare the wearing time to that from the previous visits. Diminished wearing times may indicate deposited contact lenses, solution sensitivity, ocular allergies, meibomian gland dysfunction, or the like.
I follow up with, “And your lenses are comfortable the entire time?” If the answer is, “no,” or if she states that she removes her contact lenses “as soon as I get home from work,” that may signal that a change should be made in managing ocular health, lens material, solution, replacement schedule, and/or compliance to prevent eventual dropout.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Honey in Eye Care?
I just spent some time with one of my favorite colleagues, Chris Sindt. She has been investigating the use of Manuka and other honeys in the treatment of lid disease. In a quick Google search you can find the following properties of honey among many others:1
the uses of honey in Ayurvedic medicines dates back 4000 years
it is believed to enhance weight loss and cure impotence
honey helps in treating urinary tract disorders, diarrhea, bronchial asthma and nausea
honey assists in treatment of disorders such as bacterial gastroenteritis and ulcers
it is a rich source of flavonoids and antioxidants which help reduce the risk of heart disease and some cancers
honey helps the body regulate blood sugar levels
it possesses antibacterial and antifungal properties because of the presence of an enzyme that makes hydrogen peroxide
honey helps heal burns and wounds
honey is used for skin conditioning using a moisturizing mask and can reduce facial redness and acne
honey can help allergies
A 2006 a study in Cornea suggested that there is sufficient preliminary data to warrant further study of the effects of antibacterial honey in chronic ocular surface diseases.2 Over the coming months I will keep you abreast of the scientific evidence and what I (and Chris) learn about the use of honey in eye care.
Surface Roughness and Refractive Index Changes in Contact Lens Induced by Lens Care Systems
The aim of this study was to analyze the influence of different lens care systems in surface roughness and refractive index (RI) of contact lenses (CL). This information provides us with a better understanding of how care solutions affect CL materials.
Several CL and three commercially available and appropriate lens care solutions were used (two polyhexamethylene biguanide and one hydrogen peroxide care systems). Lenses were immersed in the lens care systems, and then measurements with CLR 12-70 digital automated refractometer and atomic force microscopy analysis on Tapping mode were recorded. The measurements were performed before and after the lenses were immersed in each care solution.
Significant changes were observed on the CL materials when exposed to lens care systems. All the materials changed, to a greater or lesser extent, their roughness and RI, after being immersed in the different solutions. The water content varied between 0% (Nelfilcon A in ReNu MultiPlus, Senofilcon A in AOSEPT Plus, and Methafilcon A in Solocare Aqua) and 4.1% (Hilafilcon B in Solocare Aqua). The higher change in roughness was obtained with ReNu MultiPlus in the lens Comfilcon A (with an increase of 27.2 nm) and Senofilcon A (with an increase of 16.7 nm).
The researchers concluded that this study suggests that lens care systems play an important role in surface roughness and RI of CL.
Lira M, Franco S, Vazquez-Dorrio JB, Real Oliveira ME, Costa MF. Surface roughness and refractive index changes in contact lens induced by lens care systems. Eye Contact Lens. 2014 May;40(3):140-7.