There is significant interest in the fitting of scleral lenses, as the fit may relate to the ultimate physiological success of scleral lens wearers. Factors to consider include material properties such as oxygen permeability (Dk), lens thickness, tear exchange, and vault, among others. While we do not have all of the answers, and this topic is still being debated, I think we can all agree that more research on scleral lenses and how to fit them deserves attention.
Jason J. Nichols, OD, MPH, PhD
Warby Parker Expands into Contact Lenses
Warby Parker has announced the launch of Scout, the company’s first-ever contact lens. The company is working with a Japanese manufacturer to produce the daily disposable lenses in hioxifilcon A material, with a 57% water content and a Dk/t of 25. The lenses will have a base curve of 8.4mm and a diameter of 14.2mm. According to Warby Parker, the manufacturer is employing CentraForm technology, which makes for smoother lens edges. Additionally, the lenses will be available in a space-saving flat pack.
With a valid prescription, customers will be able to get a six-day trial lens pack for $5. The lenses will be sold for $110 for a 90-day supply of two lenses, or approximately $440 a year.
While the Scout lenses won’t be on display like Warby Parker spectacles, they will be sold online as well as in the company’s new “eye exam suites.” The company has plans to triple its number of in-house optometrists, to 80, and to add the exam suites to 40 more of its stores this year.
In addition to the Scout lenses, Warby Parker will be selling contact lenses from Acuvue, Alcon, Bausch + Lomb, Clerio Vision, and CooperVision.
C&E GP Specialists Inc. Awarded ISO 13485:2016 Certificate
C&E GP Specialists, Inc., a manufacturer of orthokeratology specialty GP contact lenses, has been awarded the ISO 13485:2016 management system certificate. This certificate is provided exclusively to organizations that manufacture and sell medical devices while meeting the standards for a management system that provides consistent customer and applicable regulatory requirements.
ABB Optical Group Announces Country Manager for Canada Business Operations
ABB Optical Group announced that Marc Tersigni has joined the company as country manager for its Canadian operations. In this role, Mr. Tersigni will be responsible for leading business operations in Canada; ABB Optical Group will begin distributing contact lenses to Canadian eyecare professionals starting in the first quarter of 2020. Tersigni comes to ABB Optical Group with more than 20 years of experience in the eyecare industry. He most recently served as country manager for Essilor’s Canadian operations. Prior to that, he was Essilor's country managing director in the United Kingdom.
NovaBay Pharmaceuticals Launches NovaSight on Amazon.com
NovaBay Pharmaceuticals, Inc. launched NovaSight—a proprietary daily vitamin and mineral supplement that has 23 active ingredients and that is specially formulated to support ocular health—on Amazon.com. NovaSight is a companion product to Avenova Direct, NovaBay’s prescription-strength lid and lash spray available on Amazon.com without a prescription.
Aerie Pharmaceuticals to Acquire Avizorex Pharma, S.L.
Aerie Pharmaceuticals, Inc. announced the signing of an agreement for the acquisition of Avizorex Pharma, S.L. (AVX Pharma), a Spanish ophthalmic pharmaceutical company developing therapeutics for the treatment of dry eye disease.
Under the terms of the Agreement, Aerie will acquire AVX Pharma in an all-cash transaction. Aerie will make an upfront payment of $10 million, subject to customary adjustments, and AVX Pharma shareholders will be eligible to receive additional payments subject to achievement of certain clinical and regulatory performance milestones, plus royalties on net sales of approved products from AVX Pharma’s development pipeline.
The active ingredient in AVX Pharma’s lead product, AVX-012, is a potent and selective agonist of the TRPM8 ion channel, a cold sensor and osmolarity sensor that regulates ocular surface wetness and blink rate, according to the company. By stimulating these processes in a physiological manner, AVX Pharma says that TRPM8 agonists have the potential to restore tear film stability and reduce discomfort in patients who have dry eye. In addition to AVX-012, Aerie will also be acquiring rights to other compounds targeting TRPM8. The parties expect to close the acquisition before the end of the year pending the completion of certain pre-closing obligations.
PECAA Launches Dry Eye Program for Members
Professional Eye Care Associates of America (PECAA) launched a new dry eye program to its membership. The program, developed in conjunction with Dry Eye University, is a comprehensive learning experience that walks participants through the process of building a dry eye profit center in just 90 days, according to the company.
Titled “90 Days to Dry Eye,” the program will utilize live events, online module courses, and interactive coaching to help provide participating practices with customized implementation strategies to help build their dry eye service. Participating practices will receive clinical dry eye education, staff training, vendor selection coaching, equipment recommendations, facility layout consultations, marketing and referral outreach strategies, and more.
The member-exclusive “90 Days to Dry Eye” program costs $899 and includes a one-year subscription to Dry Eye Access for the entire office; it covers the Dry Eye University registration fee and all meals at the live event taking place on March 20 and 21, 2020.
Have online channels for contact lens sales negatively impacted the contact lens portion of your practice?
Your Interesting Case Photo Here in the Next Issue
Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in Contact Lenses Today in the coming weeks!
We welcome photo submissions from our 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
A “Lengthy” Discussion of Myopia
It is probably no shock to anyone that the prevalence of myopia is increasing and that the level of awareness and utility of myopia control serves as an opportunity to intervene or slow the rate of prevalence and progression. That is the simple part. However, because there are a ton of studies that are being conducted, it is easy to get lost in the clinical outcomes. And, more importantly, we may struggle with how to translate those clinical research outcomes into real discussions with patients, parents, and colleagues.
Axial length is becoming commonly used as a tool to measure the efficacy of slowing myopia progression. While there are various methods used in controlling myopia—such as atropine (of various dosages), orthokeratology contact lenses, progressive addition lenses, and multifocal contact lenses—high-dose atropine and orthokeratology have shown the greatest impact on axial length over one year. Reports show a change of –0.21mm per year and –0.14mm per year, respectively.1 Clinically, there is a direct relationship between lengthening of the eye, dioptric power, and an increased risk of ocular complications; however, the mechanism behind the change or slower rate of change of axial length is not fully understood.2 It is important to understand that axial length is a metric to demonstrate the impact of myopia control2-4 but that the clinical impact of axial length on long-term outcomes remains unknown for these methods.
1. Huang J, Wen D, Wang Q, et al. Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. Ophthalmology. 2016 Apr;123:697-708.
2. Chen Z, Xue F, Zhou J, Zhou X. Effects of orthokeratology on choroidal thickness and axial length. Optom Vis Sci. 2016 Sep;93:1064-1071
3. Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012 Oct 11;53:7077-7085.
4. Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Curr Eye Res. 2005 Jan;30:71-80.
MATERIALS & DESIGNS
David L. Kading, OD
Wrap It Up
You are almost there. Your year is coming to a close. If you have not achieved your goals for the year, the likelihood that a mad dash is going to get you there is not realistic at this point. Let’s face it, it happened again. We started the year strong but got comfortable in the middle, and now we are wishing for a different outcome.
But you don’t have to wait to start the new cycle in January—the best time to start something is now. In fact, now is a great time to start a new contact lens habit in your practice. Regardless of whether you want to bring in myopia management, start fitting sclerals, increase your daily disposable percentage, or fit more presbyopes—the right time is now. These very patients are in your practice today. They are probably walking in the door as we speak.
When was the last time that you did a myopia management case? If it has been longer than five days, you are missing out. For the next myopic child who walks in, the time is now. Get the K readings, the Rx, and the horizontal visible iris diameter, and perform corneal topography if you have the equipment. Send those measurements to the orthokeratology manufacturer of your choice.
Or, order trial lenses for the next toric multifocal patient who comes into the office. Don’t know if they will work for this patient? You’ll never know until you try.
Don’t wait to start something new. Wrap up your year with something new so that when the new year comes around, you will already be ahead of the curve.
Regional Variations in Post-Lens Tear Layer Thickness During Scleral Lens Wear
The purpose of this study was to quantify regional variations in the post-lens tear layer (PLTL) thickness during scleral lens wear.
Fifteen healthy adults (22 years ± 3 years) who had normal corneas were fitted with a 16.5mm-diameter rotationally symmetric scleral lens on one eye. The PLTL thickness was measured across the central 5mm at 0, 15, 30, 45, 60, 90, 120, 240, and 480 minutes after lens application using a 12-radial-line scan optical coherence tomography (OCT) imaging protocol. Regional analyses were conducted by dividing the PLTL into eight equal 45° segments.
A tilted optic zone was observed immediately after lens application; the greatest PLTL asymmetry was between the nasal and temporal regions (156μm ± 22μm more clearance temporally) and between the superior-nasal and inferotemporal regions (124μm ± 12μm more clearance inferotemporally). The magnitude of lens settling observed in each region was associated with the initial PLTL (r = 0.59 to 0.77, P ≤ 0.02). The superior-nasal PLTL furthest from the pupil center stabilized after 90 minutes compared with other regions that stabilized after four hours. On average, after eight hours of lens wear, the PLTL decreased by 29%, and PLTL asymmetries between opposing regions decreased by 30%.
The researchers determined that the PLTL was thickest temporally and thinnest nasally in healthy eyes that were fitted with rotationally symmetric scleral lenses, most likely because of regional differences in underlying scleral elevation, eyelid forces, and lens centration. PLTL asymmetries diminished with lens wear, and stabilization occurred more rapidly in regions that had less corneal clearance immediately after lens application.
Vincent SJ, Alonso-Caneiro D, Collins MJ. Regional Variations in Postlens Tear Layer Thickness During Scleral Lens Wear. Eye Contact Lens. 2019 Nov 8. [Epub ahead of print]