Although daily disposables continue to grow substantially in the U.S. marketplace, the majority of our patients are still fitted in other frequent replacement soft lenses. This, of course, necessitates the use of a contact lens care system. We have observed over the last several years in Contact Lens Spectrum's Annual Report that hydrogen peroxide use continues to grow incrementally each year—at the expense of multipurpose solution use (https://www.clspectrum.com/issues/2017/january/contact-lenses-2016). We know that practitioners often use hydrogen peroxide for "problem" patients, but we now know that a large percentage of practitioners are using hydrogen peroxide as their go-to first-line care system. We will continue to watch these dynamics and look forward to reporting associated trends in our 2017 Annual Report, published in our January 2018 edition.
Jason J. Nichols, OD, MPH, PhD
Tear Film Innovations Completes $9 Million Series A Funding
Tear Film Innovations, Inc. (TFI) has completed a $9 million Series A Preferred Stock funding round led by Visionary Ventures Fund, L.P. and Tigris Ventures, LLC.
TFI’s flagship product, the iLux system, is an investigational device currently under review by the U.S. Food and Drug Administration. The device would enable eyecare professionals to provide in-office treatment of blocked meibomian glands through targeted heating and compression of affected eyelids.
BCLA Visionaries 2017 to Discuss Dry Eye Disease
The British Contact Lens Association (BCLA) Visionaries Conference will take place on Dec. 13, 2017 at The Wellcome Collection in London. In keeping with the tradition of the Pioneers and Visionaries events to incorporate something for every interest, the lectures will present current and new thinking on key topics of relevance to everyday contact lens practice and will earn delegates CET points.
During the Visionaries Conference, a multi-disciplinary discussion will take place as part of a drive to bring together the optometry profession and to formulate a strategy to better manage dry eye disease (DED). Consultant ophthalmologist and BCLA council member Professor Teifi James will chair the debate.
Panelists will include Professor James Wolffsohn, associate pro-vice chancellor at Aston University Birmingham; Professor David D’Cruz, director of the Lupus unit at Guy’s and St Thomas’s London; Professor Sunil Shah, corneal specialist from Birmingham and BCLA president-elect; Nick Rumney; Dr. Waqaar Shah; and other representatives from the College of Optometrists, Local Optical Committee Support Unit (LOCSU), and the Association of British Dispensing Opticians (ABDO). The event will ask if DED is intrinsically linked to contact lens wearer success and will examine the management of ocular surface health prior to and during contact lens wear.
The event is being held in conjunction with partners Alcon and CooperVision and sponsors Johnson & Johnson Vision, Menicon, Mark’ennovy, Supermax Vision UK Aveo, Thea Pharmaceuticals, Topcon, and UltraVision.
AAOF Announces 2017 Johnson & Johnson Vision J. Pat Cummings Scholarship Recipients
The American Academy of Optometry Foundation (AAOF) in collaboration with Johnson & Johnson Vision is pleased to announce the 2017 J. Pat Cummings Scholarship recipients. This award is bestowed annually to second- or third-year optometry students who best demonstrate the ideal eye care standards of practice, achievement in both academic performance and extracurricular activities, and participation with other professional pursuits such as involvement with patients through internships, community service, and other volunteer activities.
Alcon Picks Atlanta to Expand Manufacturing Facility
Alcon Laboratories announced plans to invest $250 million in an expansion at its contact lens manufacturing hub at Alcon’s 77-acre Johns Creek campus. The project will create about 250 engineering and production jobs. Alcon also does contact lens manufacturing in Indonesia, Malaysia, Singapore, and Germany.
See GPs Fabricated Live!
Attendees will again have four opportunities in the Global Specialty Lens Symposium (GSLS) exhibit hall to watch the live fabrication of scleral, corneal, multifocal, and toric GP lenses from start to finish. For any practitioner who has not been able to see this process with their respective CLMA labs, this is a great opportunity to see how your specialty GP lenses are manufactured. Click here for more information or to register.
If you haven't voted yet in this month's poll...
What do you believe is the most common cause of contact lens discomfort in your contact lens wearers?
This image shows dimple veiling in a patient wearing a GP corneal lens that is too tight.
We thank Dr. Orjuela 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
Monovision: It Seems to Work, but at What Cost?
Monovision contact lens fitting for the treatment of presbyopic ametropia is one of the most commonly performed contact lens procedures in clinical practice. With the advent of many new and improved multifocal contact lens options, the percentage of patients being fit in multifocals has increased over the past years. However, monovision still remains a mainstay of presbyopic contact lens treatment. Practitioners who tend to favor multifocal contact lenses over monovision point to obvious limitations of induced anisometropia that potentially negatively impact binocularity. Those who favor monovision point to the relatively high acceptance rate, less complicated fitting methods with reduced chair time involved, and the affordability of using standard-design contact lenses for monovision. Perhaps we need to continue to look deeper into the implications of monovision.
A recent study evaluated electrophysiological responses to monovision as measured by visual evoked potential findings.1 The authors stated that monovision is a common and often successful option to correct presbyopia with contact lenses (CLs). This is an unbalanced correction across the two eyes in which one eye is corrected for far vision and the other eye is corrected for near vision. Monovision is therefore a form of acquired anisometropia that causes a superimposition of an in-focus image with a blurred image. In spite of this visual anisometropia, monovision has been successfully used for many decades; however, the brain mechanism supporting monovision is not well understood. The purpose of the study was to measure the visual evoked potentials (VEPs) with a high-density electrode array (64-channel) in a group of presbyopes and to provide a detailed spatiotemporal analysis of the cortical activity after a short period of adaptation to monovision with contact lenses.
When compared to a balanced-eye near correction, monovision produced both a clear reduction of the earliest VEP components, the C1 and the N1, and an amplitude increase of the P1 and pP1. These results indicate that the unilateral blurring induced by wearing monovision CLs reduces feed-forward activity in primary visual area and feedback activity in extrastriate areas (C1 and N1 reduction). Interestingly, other brain activities in both extrastriate visual areas (the P1 component) and in the anterior insula (the pP1 component) seem to compensate for this dysfunction, increasing their activity during monovision. These changes confirm the presence of fluid brain adaptation in visual and non-visual areas during monocular interferences.
I think most eyecare practitioners would agree that if a multifocal contact lens option could provide equally balanced vision between the two eyes for distance, intermediate, and near of high quality, then for the vast majority of binocular individuals, this would be the preferred method of contact lens vision correction as opposed to a monovision alternative. However, many factors come into play in the clinical management decision.
Although today’s multifocal contact lenses have advanced greatly and likely should be considered the first alternative for presbyopia correction, the Holy Grail referred to above still has yet to be achieved. As such, even with its many limitations, monovision still remains a viable alternative for the correction of presbyopia for some of our contact lens patients.
1. Zeri F, Berchicci M, Naroo SA, Pitzalis S, Di Russo F. Immediate cortical adaptation in visual and non-visual areas functions induced by monovision. J Physiol. 2017 Oct 25. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
As I listened to the Monroe J Hirsch Symposium at the 2017 American Academy of Optometry meeting, I learned about the National Institutes of Health’s (NIH) Precision Medicine Initiative. I could not help thinking about “precision” management of dry eye for our patients.
The Precision Medicine Initiative, a long-term research endeavor involving the NIH and multiple other research centers, aims to understand how a person’s genetics, environment, socioeconomic status, and lifestyle can help determine the best approach to prevent or treat disease. The Precision Medicine Initiative, under the banner of the All of Us Research Program, will include minority and under-represented populations in its dataset. As an example, Dr. Richardson-Heron, NIH’s chief engagement officer for the All of Us program, offered that minorities make up 38% of the population, and these numbers are projected to rise to more than 56% of the overall population by 2060.1 However, it is important to note that minorities are well under-represented in important clinical trials nationwide and beyond.
I wondered: Is this true for dry eye trials? The goal of the All of Us Research Program, although not targeting dry eye and ocular surface disease specifically, is to sequence the genome of 1 million volunteers.
I certainly can imagine how someday the information collected in this research program effort may direct how we manage dry eye in distinct populations. Although we have notions and anecdotes of risk profiles for ocular surface and dry eye disease patients, we acknowledge that we are far from having a perfect understanding of dry eye disease. I look forward to learning if and how the transformational approach of the All of Us program fits into the treatment of our dry eye patients.
Hydrogen-Peroxide and Silicone-Hydrogel Contact Lenses: Worsening of External Eye Condition and Tear Film Instability
The aim of this research was to discuss the origins of worsening of external eye condition (EEC) and of tear film (TF) instability after wear of silicone-hydrogel contact lenses (CLs) with a hydrogen-peroxide (H2O2) care system.
EEC and TF stability were evaluated before and after 15 days of wear with different care systems: 1) H2O2; 2) detergent solution and H2O2; 3) multipurpose solution (MPS); and (4) H2O2 and artificial tears. In-vitro cell mortality tests were performed after 24-hour cell incubation with the CLs treated with H2O2. Photon correlation spectroscopy (PCS) was carried out on the tears of non-wearers and of CL wearers who used MPS or H2O2 solution.
The researchers observed worsening of EEC only for the group using H2O2 (group 1). In-vitro cell mortality was found to be higher for worn CLs than for unworn CLs. Worsening of TF stability was observed regardless of care system. In addition, PCS results on tears of CL wearers were different compared to non-wearers regardless of care system. The only observed remedy for tear instability of CL wearers was found to be the administration of artificial tears.
Worsening of EEC in CL wearers using H2O2 is attributed to H2O2’s scarce cleaning efficacy, which can be solved by adding a CL detergent solution. The origin of TF instability is found to be different. It was remedied by the administration of artificial tears, whose effect could be attributed either to the role of specific components or to rinsing and replacement of TF during wear.
Moro A, Fagnola M, Picarazzi S, Di Dio A, Pastori V, Lecchi M, Tavazzi S. Hydrogen-peroxide and silicone-hydrogel contact lenses: Worsening of external eye condition and tear film instability. Cont Lens Anterior Eye. 2017 Oct 20. [Epub ahead of print]