Although the topic of contact lens dry eye and discomfort is not new to this forum, I think you will find the results of our November Quick Poll intriguing. Many of the respondents believe that the root cause of discomfort in their contact lens wearers is due to meibomian gland dysfunction (43%), followed by wear schedule noncompliance (33%). The good news is that, while these two factors are certainly impactful, there are management strategies we can implement to help reduce their role in discomfort.
Paragon Vision Sciences hosted nearly 30 pediatric and cornea and contact lens optometry residents from universities around the United States and Canada. The symposium was developed to provide these residents with clinical expertise and information about the diagnosis and treatment of myopia. The event was held Oct. 27 through Oct. 29 at the Paragon Education and Training Academy at the company’s headquarters in Gilbert, AZ.
The symposium provided a unique educational experience for attendees to learn about current treatment options and ongoing and planned myopia research from leading myopia experts. Presenters included Professor Kovin Naidoo, OD, CEO, Brien Holden Vision Institute; Maria Liu, OD, assistant professor of Clinical Optometry at the University of California, Berkeley (UCB) and founder and chief of UCB’s Myopia Control Clinic; and Randy Kojima, research scientist, Pacific University.
During the two-day symposium, residents also received instruction on the use of topography to achieve optimal treatment outcomes, including “wet lab” sessions with patients being fit in orthokeratology contact lenses.
Bausch + Lomb Launches Expanded Parameters of Bausch + Lomb Ultra for Astigmatism
Bausch + Lomb has expanded the parameters of its Bausch + Lomb Ultra for Astigmatism contact lenses. This expansion will extend the lens parameter range to +6.00D to –9.00D in 0.25D steps (in 0.50D steps above –6.00D) in cylinder powers of –0.75D, –1.25D, –1.75D, and –2.25D in axes of 10° to 180˚ (in 10˚ steps). The company says that this provides eyecare professionals the opportunity to offer more of their astigmatic patients an exceptional toric lens that features all-day comfort, stability, and consistently clear vision.
iVeena Delivery Systems Receives FDA Orphan Drug Designation for IVMED-80
iVeena Delivery Systems (iVeena), a biopharmaceutical company that develops innovative ophthalmology products, announced that the U.S. Food and Drug Administration (FDA) has granted orphan drug designation for IVMED-80 for the treatment of keratoconus.
According to the company, IVMED-80 is the first eye-drop, non-surgical, non-laser treatment for medical crosslinking of the cornea. It biomechanically strengthens the cornea through the daily application of a non-invasive, proprietary eye drop. It will begin clinical development early 2018.
ABB Optical Group Announces Winners of Fourth Annual ABB Cares Program
ABB Optical Group announced that seven nonprofit organizations, nominated by eyecare professionals nationwide, will receive grants ranging from $1,000 to $5,000 for outstanding programming and community impact through its Fourth Annual ABB Cares Program.
The 2017 ABB Cares grant recipients are: Platinum ($5,000) – Nevada Blind Children’s Foundation in Las Vegas; Gold ($2,500) – Junior Charity League of Concord in Concord, NC, and Special Olympics Florida in Clermont, FL; Silver ($1,000) – Mercy Health Center in Athens, GA, Plano Child Development in Chicago, Strathmere Volunteer Fire Company in Strathmere, NJ, and Valley Center for the Blind in Fresno, CA. For more information about the winning organizations, go to https://abboptical.com/about-us/pressroom/11_15_2017.
GSLS Track Offered at OMS
At the 2017 Optometric Management Symposium (OMS), held Nov. 2 to 5 at Disney World’s Yacht & Beach Club, in Orlando, FL, close to 400 attendees convened at the resort to personalize their education by attending courses from across various optometric disciplines. The bonus: A total of 60 hours of CE from the following tracks: Clinical Management, Retail Strategies, Clinical Business, and the Global Specialty Lens Symposium (GSLS).
The specialty lens track included all of the hot topics and expert speakers you’d expect from GSLS but in a smaller program than the annual GSLS in Las Vegas. Speakers included Edward Bennett, OD, MSEd; Patrick Caroline; Lynette Johns, OD; Randy Kojima; Langis Michaud, OD; Craig W. Norman; and Eef van der Worp, BOptom, PhD. Attendees had the chance to earn 13 hours of CE while learning about corneal reshaping, custom soft and hybrid contact lenses, scleral lenses, myopia control, and more.
Next year’s OMS will take place at Disney World’s Yacht & Beach Club on Nov. 1 to 4, 2018.
What do you believe is the most common cause of contact lens discomfort in your contact lens wearers?
Thomas Arnold, OD, Sugar Land, TX
This image shows a 16.0mm oblate scleral lens over a very high and proud graft. The graft is still clear after 20 years. Sagittal depth of the lens is 6,100µm. The patient’s best-corrected visual acuity is 20/20. Additionally, the patient was able to wear the lens 15+ hours per day.
We thank Dr. Arnold 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
Environmental Impact of Soft Contact Lens Use
With the ongoing debate surrounding climate change, more and more patients are becoming concerned about their personal impact on the environment. And, on occasion, I have had patients tell me that they were concerned about the amount of waste produced by using daily disposable contact lenses (CLs). If we think about this topic deeper, a fully compliant, full-time daily disposable CL wearer uses more than 700 CLs per year—a far from trivial number. But what kind of environmental impact does this treatment actually have on the Earth? Morgan et al analyzed the environmental impact of three CL modalities (conventional, monthly replacement, and daily disposable) in an attempt to answer this very question.1
They found that the primary waste product from conventional and monthly replacement CLs was liquid (mostly from care system solutions); for daily disposables, it was plastic (mostly CL materials and packaging).1 They further noted that most of the liquid waste was non-toxic water that is quickly biodegraded, so they focused their analysis on the impact of other materials such as plastic, paper, metal, and glass.1 Surprisingly, the researchers found that conventional CLs—due to the associated care products—had the highest environmental impact, which was followed by daily disposable CLs and then monthly replacement CLs.1
While the environmental impact of wearing CLs does vary by replacement schedule, the use of CLs has a relatively small overall impact on the environment compared with the overall amount of waste generated by an individual (~0.5% of a person’s total environmental footprint).1 In fact, if patients have concerns about the environmental impact of using CLs, you can simply educate them that wearing CLs has a similar environmental impact to consuming about 15 cans of soda per year and that the personal benefits of wearing CLs likely outweigh their environmental cost.1
1. Morgan SL, Morgan PB, Efron N. Environmental impact of three replacement modalities of soft contact lens wear. Cont Lens Anterior Eye. 2003 Mar;26:43-46.
MATERIALS & DESIGNS
David L. Kading, OD
All the Help We Can Get!
We live in an amazing digital age. Ten years ago, if you wanted resources about contact lenses, you would either need to email a friend, check at a local university, or search the web for a website that had some data (only to discover that it brought you little value). Today, things are much better, maybe too good.
Social media and the internet have put technology and innovation at our fingertips. We can literally become an expert by watching a video and reading an article. We can get our scleral lens education (CE) through digital conferences (as I recently did). We have groups on social media made up of the best of the best, which creates a format for us to share our challenging cases.
When does too much become too much? The greatest challenge that we face with lenses and technology is no longer a lack of knowledge, but a fear of starting. With so much knowledge available, it can be hard for some of us to get started if we do not feel that we know enough.
Instead, I think that it is important for us to get a foundation for lens fitting—i.e., a how-to primer. These are available at meetings and online. After that, get some lenses on patients, even if they are members of your team or another practitioner in your office. Work closely with your lab on several fits.
Then, come back to the internet and social media and share your perspective. Share what happened and how things went. Invariably, people will have an opinion (they always do). Take it all with a grain of salt and figure out how to be better.
As iron sharpens iron, so one of us can make the others better. Take the wisdom from others and become better. Take your insights and share them with those who need help. We can all become better through the innovation and sharing that is available at our fingertips, but we first have to start.
A Pilot Study on Corneal Langerhans Cells in Keratoconus
The purpose of this study was to report the density and morphology of cells that are analogous to corneal Langerhans cells and their associations in keratoconus.
This prospective cross-sectional study included a convenience sample of keratoconus subjects aged between 18 years to 65 years. Corneal topography, assessment of ocular symptoms, tear variables, corneal sensitivity, and in-vivo confocal microscopy were performed. The number of Langerhans cells were manually counted and averaged across three central corneal images. Cell morphology was graded on a 0 to 3 scale, in which grade 3 indicates cells with long visible dendrites. Associations of Langerhans cells with other variables were evaluated using Spearman’s correlation.
Twenty-one keratoconus subjects with a mean age of 43 years ± 11 years were included. Eighty-one percent of them were males, 48% had mild keratoconus, and 52% were contact lens wearers. Langerhans cells were present in the central cornea in 91% of subjects. Median cell density was 15 cells/mm2 (IQR: 3 to 21). Cell morphology of grades 2 or 3 (with short or long dendrites) was seen in 71% of subjects. There was a significant association between Langerhans cell frequency and density with male gender (rho and p-values: –0.669, 0.001 and –0.441, 0.045) and between Langerhans cell density and nerve fiber tortuosity (0.479, 0.028). No significant association was observed with age, contact lens wear, or ocular symptoms.
The authors concluded that Langerhans cells were present in a significant number of subjects, suggesting the possibility of inflammation in keratoconus. Based on the association of Langerhans cells with nerve parameters, they proposed inflammation as the underlying cause for corneal nerve changes in keratoconus.
Mandathara PS, Stapleton FJ, Kokkinakis J, Willcox MDP. A pilot study on corneal Langerhans cells in keratoconus. Cont Lens Anterior Eye. 2017 Oct 21. [Epub ahead of print]