As we enter the holiday season, it is important to reflect on the many things for which we are thankful. Professionally, this likely includes our patients, practices, and the profession itself. It is also important to consider other related things as well. For instance, we have seen so many new entries in the market over the last year or two that have created opportunities to care for patients in ways that we have not been able to in the past. Contact lenses with advanced designs. Changes in materials and parameters. Treatments for ocular surface disease. The list goes on and on. Please join us in saying a hearty "thank you" to the industry for their efforts in helping us improve eyecare for our patients.
Jason J. Nichols, OD, MPH, PhD
J&J Vision Receives Medical Device License from Health Canada
Johnson & Johnson Vision (J&J Vision) announced that Acuvue Oasys with Transitions was issued a medical device license by Health Canada. According to the company, these contact lenses function by adjusting from clear to dark in response to changing light conditions, balancing the amount of light entering the eye, including filtering blue light, as well as blocking harmful UV rays.
CooperVision’s OptiExpert App Now Available in the United States and Canada
CooperVison’s OptiExpert app, which has been updated with U.S. and Canadian data, provides a series of tools that aid in contact lens-related decision support and patient communication, including confidence-building multifocal and toric calculators plus oxygen profiles. OptiExpert includes diagnostic lens recommendations from CooperVision product families, including Clariti 1 day, MyDay, Biofinity, Avaira Vitality, and Proclear.
The app is available for free for iOS and Android devices and can be downloaded from the Apple App Store and Google Play. With this launch, OptiExpert is now available in 15 languages and in 76 countries and territories.
BHVI Unveils Global Myopia Centre
Brien Holden Vision Institute (BHVI) has announced the new online Global Myopia Centre, bringing its expertise and resources in myopia research, practitioner training, and global advocacy all onto one platform to educate eyecare professionals and to equip them to manage the impending escalation in myopia. The platform will host the global online Myopia Education Program, several online tools for myopia management, global prevalence data, the latest relevant peer-reviewed references, and information and resources for advocacy initiatives. The Global Myopia Center, which is found at www.globalmyopiacentre.org, went live on Nov. 7, 2018.
OcuMedic, Inc. Granted European Patent for Contact Lens Drug Delivery System
OcuMedic, Inc. announced that the European Patent Office has granted the patent Contact Drug Delivery System, covering the company’s intellectual property for timed-released delivery of drugs directly to the eye through prescription soft contact lenses.
The claims allowed by the patent cover extended-wear contact lenses that deliver a wide variety of drugs for the treatment of conditions such as glaucoma and dry eye. The lenses also provide controlled release of anti-inflammatory, antibiotic, and pain-reducing drugs for postoperative care for procedures such as cataract surgery and LASIK.
iChek Creates New Medical Advisory Board
iChek announced the formation of its medical advisory board (MAB) with two key appointments: David Klonoff, MD, and Joe Rappon, OD, MS.
Dr. Klonoff is an endocrinologist with extensive clinical experience in glucose monitoring technology. He also serves as a medical director of the Dorothy L. and James E. Frank Diabetes Research Institute of Mills-Peninsula Medical Center in San Mateo, CA and as a clinical professor of Medicine at UCSF.
Dr. Rappon has spent more than a decade developing new medical devices. He has a deep level of expertise in contact lenses and associated glucose monitoring devices. During his time working with Alcon, he held multiple roles spanning several functional areas, including Clinical and Medical Affairs as well as R&D program management.
Virtual Field Announces Visual Field Test for VR Headsets
Virtual Field, Inc. launched its virtual reality platform for diagnostic eye exams. The product, which consists of a VR headset, computer, and clicker, runs Standard 24-2 and suprathreshold visual field tests. The company is also developing 10-2, 30-2, kinetic, and frequency doubling tests for its headset, which will be released as updates to its platform. Unlike conventional devices, which require an eye patch to be worn on the opposite eye during testing, Virtual Field tests both eyes simultaneously, without the need for an eye patch. It also features fixation and sleep monitoring features that reduce invalid test results, according to the company.
Global Forum: Specialty Lens Research – Jan. 27, 2019
The Global Forum: Specialty Lens Research (GFSLR) is a unique meeting functioning as a think tank, of which everyone can be a contributor. While in Las Vegas at the Global Specialty Lens Symposium, make plans to extend your stay one more day to attend GFSLR.
Questions being discussed this year include: Corneal environment under a scleral lens – normoxic or hypoxic? How is our understanding of ocular asymmetry and dimensions shaping up? and Presbyopia – translating lenses and what else works?
To find out more and to register for this one-day forum, Click here.
Do you believe that silicone hydrogel materials are generally a healthier option for your patients than hydrogel materials?
This image shows an eye with corneal trauma and iris loss. We fitted this eye with a scleral lens.
We thank Kyriakos Telamitsi 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
It’s Time to Button Down Best Practices in Scleral Contact Lens Management
More and more eyecare practitioners are embracing scleral contact lenses within their practices. The advantages of scleral lenses make their utilization attractive in terms of both patient benefits and potential practice financial benefits. Up until this point in time, there has been little attention paid to the establishment of standards of care and best practices as they relate to scleral lenses.
A recent study was published that addressed some of these issues in which the authors describe prescriber-reported scleral lens fitting and assessment strategies.1 The SCOPE (Scleral Lenses in Current Ophthalmic Practice Evaluation) study group designed and administered an IRB-approved electronic survey regarding current scleral lens fitting and assessment methods. The survey was distributed to attendees of the 2017 Global Specialty Lens Symposium. Ninety-five practitioners responded to the survey. More than half of the respondents (58%, 55/95) reported fitting scleral lenses for less than five years (new prescribers), and 42% (40/95) reported fitting scleral lenses for more than five years (experienced prescribers).
There was a statistically significant difference between their initial use of technology in selection of a diagnostic lens. New prescribers consider base curve first (60%, 33/55), while experienced prescribers considered sagittal depth first (63%, 25/40) in their initial scleral lens selection. All of the experienced lens prescribers (100%, 39/39) reported estimating central clearance by comparing thickness of the post-lens tear reservoir to scleral lens thickness using a slit lamp beam at least some of the time, and 62% of new scleral lens prescribers (34/55; χ2 = 19.175, p < 0.0005) reported doing so. All (100%, 40/40) experienced prescribers schedule scleral lens follow ups at a specific time and assess conjunctival compression (40/40), conjunctival staining (39/39), and corneal staining (40/40) after lens removal.
Based on the outcomes and analysis of the survey data, the authors concluded that practitioners with varying backgrounds and experience have added sclerals to their lens inventories. However, definite guidelines for fitting have not been developed. The results of the survey demonstrate that, among practitioners who have greater than five years of scleral lens experience, a consensus has emerged for best practices. Strategies for lens evaluation, which may inform future efforts at generating scleral fitting standards, were described.
Without a doubt, this is just a small first step toward the goal of establishing standards of care and best practices for the fitting and management of scleral lens patients. Organizations such as the Scleral Lens Education Society and others will hopefully continue such efforts, with special attention being paid to proper selection of scleral lenses to address various clinical entities, most appropriate fitting criteria (e.g., corneal vault, landing geometry, lens thickness, and material considerations, etc.), and post-fitting aftercare strategies along with problem solving. Practitioners need to be sure that they are not putting the cart before the horse when it comes to moving forward so quickly and dramatically with scleral lenses. There is still so much we don’t know.
1. Harthan J, Shorter E, Nau C, et al. Scleral lens fitting and assessment strategies. Cont Lens Anterior Eye. 2018 Oct 31. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Ocular Problems Related to Parkinson’s Disease
Patients who have Parkinson’s disease present an interesting challenge to eyecare practitioners. As compared to controls, ocular findings associated with Parkinson’s disease include reduced contrast sensitivity and color discrimination. There is an increased frequency of convergence insufficiency, seborrhea blepharitis, meibomian gland disease, dry eye syndrome, nuclear and posterior subcapsular cataract, and glaucoma.1
A poster at the American Academy of Optometry 2018 presented a retrospective chart review of ocular complaints of 345 patients who have Parkinson’s disease. Interestingly, 90% of these patients reported ocular discomfort, and 70% reported blurred vision, among ocular-related complaints.2
Tear film and blink dysfunction are also known to exist in patients who have Parkinson’s disease.3 In all likelihood, ocular surface compromise contributes to the high rates of ocular discomfort noted in patients who have Parkinson’s disease that was noted in the aforementioned chart review.
Remember to pay special attention to dry eye needs of this special group of patients in your practice.
1. Nowacka B, Lubinski W, Honczarenko K, Potemkowski A, Safranow K. Ophthalmological features of Parkinson disease. Med Sci Monit. 2014 Nov 11;20:2243-2249.
2. Fabrykowski M, Mitchell J, Schwartz L. Retrospective chart review of opthalmolgical complaints in patients with Parkinson’s Disease. Poster presented at the American Optometry Association 2018 Meeting, Denver.
3. Tamer C, Melek IM, Duman T, Oksüz H. Tear film tests in Parkinson’s disease patients. Ophthalmology. 2005 Oct;112:1795.
Influence of Seasons Upon Personal Light Exposure and Longitudinal Axial Length Changes in Young Adults
The purpose of this study was to investigate the association between objectively measured ambient light exposure and longitudinal axial length changes (and their seasonal variations) over a period of 12 months in young adults.
This prospective longitudinal observational study included 43 healthy young adult university students (21 emmetropes and 22 myopes) aged between 18 and 30 years. Three axial length measurements were collected at six-month intervals (i.e., at baseline, at six months, and at 12 months) in summer and winter to determine the axial eye growth. Personal ambient light exposure data were measured in winter and summer months using wearable sensors, from which the mean daily time exposed to bright (outdoor) light levels (> 1,000lux) was derived.
The researchers found that greater daily bright light exposure was associated with less axial eye growth (β = –0.002, p = 0.006) over 12 months. In summer, myopes exhibited significantly greater changes in axial length (mean change 0.04mm ± 0.05mm) compared to emmetropes (–0.01mm ± 0.05mm, p = 0.001), but there was no significant difference between refractive groups in winter. Emmetropes also spent significantly greater time in outdoor light levels in summer compared to winter (p < 0.0001), while myopes spent similar time outdoors during both seasons (p = 0.12). Differences in light exposure between summer and winter were also associated with seasonal differences in axial eye growth (p = 0.026).
The authors concluded that, in young adults, greater time spent in bright light was associated with slower longitudinal axial eye growth. Seasonal light exposure and axial length changes were dependent on refractive error in this population and also exhibited an inverse relationship.
Ulaganathan S, Read SA, Collins MJ, Vincent SJ. Influence of seasons upon personal light exposure and longitudinal axial length changes in young adults. Acta Ophthalmol. 2018 Oct 4. [Epub ahead of print]