There is no doubt that 2020 will be a big year in the eyecare field! And, in preparation, we are already starting our editorial planning for Contact Lens Spectrum for 2020! As always, we want to provide the most up-to-date, cutting-edge, clinically relevant information—and we cannot do that without your input. So, please send us your thoughts and ideas on topics that you would like to see both more and less of within the pages of Contact Lens Spectrum (firstname.lastname@example.org). We are grateful for this valuable information that you provide.
Jason J. Nichols, OD, MPH, PhD
FTC Seeks Additional Public Comment on Proposed Changes to the Contact Lens Rule
The Federal Trade Commission (FTC) announced it is seeking additional public comment about newly proposed changes to the agency’s Contact Lens Rule. The new proposal follows an extensive review and consideration of thousands of public comments and material received by the Commission between 2015 and 2018, including surveys, studies, analyses, and information generated at an FTC workshop devoted to the Rule and the evolving contact lens marketplace.
The FTC is now seeking comment on modifications to its earlier proposal to enhance compliance with the Fairness to Contact Lens Consumers Act’s requirement that prescribers automatically provide their patients with a copy of their prescription upon completion of a contact lens fitting. The FTC believes the newly developed modifications will achieve the goals of its original proposal, while imposing less of a burden on prescribers. Complete information is detailed in the soon-to-be-published Supplemental Notice of Proposed Rulemaking.
Sight Sciences Launches TearCare
Sight Sciences announced the official commercial launch of TearCare, a wearable device that allows a patient’s eyes to remain open and blinking during the procedure where localized heat application is needed. The company says that soft, flexible thermal devices conform to the eyelids to deliver a therapeutic level of heat for a specific period of time to soften and liquefy meibum.
TearCare is indicated for the application of localized heat for conditions in which the current medical community recommends the application of a warm compress to the eyelids. Such applications would include meibomian gland disfunction (MGD), dry eye, or blepharitis.
ZEISS Launches Dual-Speed Swept-Source OCT/OCTA
ZEISS Medical Technology Segment launched the PLEX Elite 2.0, a dual-speed swept-source optical coherence tomography (OCT)/OCT angiography (OCTA) that will scan at 200kHz, in addition to 100kHz, providing doctors with a deeper and more detailed view into the retina and enabling visualization options for various diseases, according to the company.
Hardy Capital Acquires LD Vision Group
Hardy Capital, a Canadian investment firm, has completed the acquisition of LD Vision Group. LD Vision Group is an independent direct retailer in eyecare; its brands include OptiContacts.com and ContactsExpress.ca.
Roger Hardy, CEO of Hardy Capital, previously founded Coastal.com, owner of Clearly.ca and Lensway.se, that was acquired by Essilor in 2014. Mr. Hardy is joined by Sabrina Liak, who was previously with Goldman Sachs Investment Partners, and Joseph Thompson, who was previously with Amazon and Procter & Gamble.
Hardy Capital expects to announce broader expansion plans into the eyecare industry in the months ahead. The purchase of LD Vision Group marks the second investment in the eyecare category by the Hardy Capital team. In 2018, the team made a seed-stage investment in the millennial hypergrowth brand, Privé Revaux.
Canaccord Genuity Petsky Prunier served as the exclusive financial advisor to LD Vision Group in this transaction.
Call for CE Courses for GSLS 2020
The Global Specialty Lens Symposium (GSLS) Program Committee invites you to submit one-hour continuing education courses for consideration for the GSLS 2020, which will take place in Las Vegas from January 22 to 25, 2020. Course submissions can cover all aspects of contact lenses (such as materials, designs, lens care) in addition to related topics such as corneal and ocular surface disease, diagnosis and treatment approaches, and practice management. Submissions must be received by 5:00pm ET on May 10, 2019.
Do you consider practicing myopia control with contact lenses to be “specialty” contact lens fitting?
This image shows the right eye of a 63-year-old female patient. She had –1.25 –1.25 x 60, 20/40 vision, intraocular pressure of 15 mmHg, and persistent iridopupillary membrane. The persistent pupillary membrane (PPM) is the most frequent congenital anomaly of the pupil, due to incomplete involution of the tunica vasculosa lentis. In general, iris, corneal, and crystalline endothelium elements are irrigated by the tunica vasculosa lentis that comes from the hyaloid vessels. During the fifth month of gestation, regression mechanisms and phagocytosis produce the destruction of the central portion of the pupillary membrane; most involute in the sixth week of gestation. The dysfunction of these mechanisms determines the persistence of the pupillary membrane or its remains. Treatment of PPM depends on the age and characteristics of the membrane. Membranes that do not affect the visual axis can be treated by refractive and occlusion therapy prior to surgical or laser treatment. The dense and iridopupillary membranes that generate risk of amblyopia due to deprivation in children can be removed, and lens extraction (phacoemulsification) can be performed when it is compromised (e.g., if the fibers of this membrane are firmly attached to the lens).
We thank David F. Croes Barreto 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.
SPECIALTY LENS SPACE
Karen DeLoss, OD
The Power of the Pinhole
Pinhole acuity is commonly used to distinguish between refractive error or pathology. The pinhole acuity increases the depth of focus and can decrease light scattering effects.1,2 I find it useful in specialty lens fitting to aid in determining best-corrected "specialty lens" acuity. The key is knowing when to use this tool during the fitting process.
During my initial encounter with a patient, I am scanning for clues, such as entering acuity and the initial best-corrected acuity with pinhole. I also look for potential barriers such as scars, retinal pathology, or fluctuations in vision due to dryness. From there, I often will use pinhole during diagnostic fitting if a patient does not achieve 20/20 with a basic spherical over-refraction.
Pinhole can usually be a clue to perform a sphero-cylindrical over-refraction or an indication to consider other alternatives. For any specialty GP lens, I will then order a front-surface toric, provided it will remain stable on the eye. For a scleral lens, I will either consider ordering or trying a flatter base curve (which can sometimes help) or incorporating a front-surface toric into my order. Worst-case scenario, spectacles over the lenses can help with the clarity.
1. Azar DT, Strauss L. Principles of applied clinical optics. In Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology: Clinical Practice. Philadelphia: Saunders, 1994;5:Chapter 291.
2. Lebensohn JE. The pinhole test. Am J Ophthalmol. 1950 Oct;33:1612-1614.
MATERIALS & DESIGNS
David L. Kading, OD
The Healthiest Lens Choice
It should come as no surprise that daily disposables are considered by most of you as the healthiest modality for lens wear. While travelling around the globe speaking about innovation, I always ask practitioners what they believe is the healthiest modality for their patients. Without fail, 100% report that it is daily disposable lenses. But yet, we have not topped 40% of all lenses in the United States for use of the modality.
If we have a general consensus that daily lenses are the best, then why are we not fitting more of them worldwide? Most often, the answer to this question is “cost.” Many simply believe that daily disposable lenses are too expensive. But can we determine that cost is truly an issue? Do you ask your patients? I have yet to meet anyone who asks patients: “Are you able to afford the best contact lens option for you, or would you like me to make the judgement for what is best for you based on what I think you can afford?” With a 95% usage of daily disposable lenses in my office, I can tell you that patients can and will afford them. My experience shows that patients will find a way, and they will come back next year and pay for them again.
“Affordable” is really just a description that is placed on things based on what is seen as their “value.” People who do not see the value of something will always see it as too expensive. Therefore, unless patients see a problem, they will never buy into your solution.
When practitioners educate patients regarding the dropout rates of contact lens wearers, discuss end-of-day dryness, and talk about the feeling of a fresh lens and why it feels fresh, they can easily move their patients into what is ideal for them. Stop thinking about what is best for the pocketbook and instead think about what is best for their eyeballs.
Comparison of Wavefront-Guided and Best Conventional Scleral Lenses After Habituation in Eyes with Corneal Ectasia
The purpose of this study was to compare, in a crossover design, optical and visual performance of eyes that had corneal ectasias wearing dispensed best-conventional scleral lens corrections and dispensed individualized wavefront-guided (WFG) scleral lens corrections.
Ten subjects (20 eyes) participated in a randomized crossover study in which best-conventional scleral lenses and WFG scleral lenses (customized through the fifth radial order) were worn for eight weeks each. These corrections, as well as each subject's habitual correction and normative data for normal eyes, were compared using residual higher-order aberrations (HORMS), visual acuity (VA), letter contrast sensitivity (CS), and visual image quality (logarithm of the visual Strehl ratio, or logVSX). Correlations were performed between Pentacam (Oculus) biometric measures and gains provided by WFG lenses.
Mean HORMS was reduced by 48% from habitual to conventional and by 43% from conventional to WFG. Mean logMAR VA improved from habitual (+0.12) to conventional (–0.03) and further with WFG (–0.09); six eyes gained greater than one line with WFG over conventional. Areas under the CS curve improved by 26% from habitual to conventional and by 14% from conventional to WFG. The percentage of the eyes achieving normal levels were as follows: HORMS, 40% for conventional and 85% for WFG; VA, 50% for conventional and 85% for WFG; and CS, 60% for conventional and 90% for WFG. logVSX improved by 16% from habitual to conventional and 25% further with WFG. Reduction in aberrations with WFG lenses best correlated with posterior cornea radius of curvature.
The researchers determined that visual performance was superior to that reported with non-habituated WFG lens wear. With WFG lenses, HORMS and logVSX significantly improved, allowing more eyes to reach normal levels of optical and visual performance compared with conventional lenses.
Hastings GD, Applegate RA, Nguyen LC, Kauffman MJ, Hemmati RT, Marsack JD. Comparison of Wavefront-guided and Best Conventional Scleral Lenses after Habituation in Eyes with Corneal Ectasia. Optom Vis Sci. 2019 Apr;96(4):238-247.