Following the Quick Poll results reported last week regarding scleral lens wear and intraocular pressure, it is apropos to look at the abstract this week, which evaluated this relationship. While there are limitations to this study, and it certainly needs to be replicated by others using prospective designs, it is one piece of evidence that can be considered in evaluating the entirety of the issues.
Jason J. Nichols, OD, MPH, PhD
Johnson & Johnson Vision to Cease Customer-Facing Operations for Sightbox
Johnson & Johnson Vision announced that it will cease customer-facing operations for Sightbox, its U.S.-based online contact lens subscription service, while it evaluates options for the business over the next few months. The company said that this was a strategic decision and will enable it to focus its connected commerce investments, which remain a priority, in other program areas.
Sightbox will ship existing members their remaining annual contact lens subscriptions free of charge but will accept no renewals nor new subscriptions during the evaluation period. Johnson & Johnson Vision is reducing the Sightbox workforce but maintaining some roles key to the evaluation process.
EyePrint Prosthetics Releases ScanFitPro Software
EyePrint Prosthetics announced the development of its new scleral lens fitting software, ScanFitPro. This new technology employs EyePrint Prosthetics’ scleral lens designer algorithm to automatically design a lens in 3D. According to the company, practitioners have the ability to customize the fitting of the lens using patented Elevation Specific Technology.
ScanFitPro utilizes Oculus Pentacam’s Corneal Scleral Profile (CSP) for scleral mapping precision. The CSP Report is generated by 250 Scheimpflug images covering a diameter of up to 17mm. All images of the CSP scan are taken in a straight-on gaze without the need for secondary gazes, preventing off-axis elevation disparities, according to the company.
The company says that this custom software gives physicians the ability to design a device with a patient’s own scleral profile, allowing for the highest level of design accuracy and speeding up the fitting process. The topographical data received from the CSP Report is combined with an overlaid iris image to allow physicians to visualize the device on patients’ eyes. The company says that the ScanFitPro automatically aligns the optics with patients’ line of sight, eliminating the need for guessing and multiple trial lens fittings.
Lensabl Raises $4 Million, Adds Frames and Contact Lenses
Lensabl Inc., an online service that offers lens replacements for old glasses, has raised a $4 million funding round to support the company’s move into the contact lens and frame business. According to the company, it plans to launch sales of contact lenses next year at a much lower price point than that of brick-and-mortar retailers. Until recently, Lensabl focused on replacement lenses for eyeglasses. The company began selling its own frames, starting at $77, about a month ago. This round of financing was led by Rogue Venture Partners.
NovaBay Pharmaceuticals to Distribute the NuLids System in Certain U.S. Geographies
NovaBay Pharmaceuticals, Inc. announced an exclusive 90-day agreement with NuSight Medical to distribute the NuLids System for treatment of blepharitis and dry eye in six of NovaBay’s top-performing territories. The NuLids System is a hand-held, cordless device that removes accumulated scurf from eyelashes and eyelids while stimulating meibomian gland production in dry eye and blepharitis patients, according to the company. The NuLids System is available through eyecare professionals for home use by patients.
Allergan Donates Refresh to California Firefighters
Allergan recently provided 15,000 bottles of Refresh products to the Los Angeles Fire Department to be distributed to the first responders fighting the California wildfires. The donation is part of its Refresh America program, which has donated over $4.2 million (approximately 290,000 units) to first responders across the United States since its launch in 2015.
AAOF Announces the 2019 Johnson & Johnson Vision J. Pat Cummings Scholarships
The American Academy of Optometry Foundation (AAOF) in collaboration with Johnson & Johnson Vision announced the 2019 J. Pat Cummings Scholarship recipients. This award is bestowed annually to second- or third-year optometry students who best demonstrate the ideal eyecare 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.
The Global Specialty Lens Symposium (GSLS) is excited to announce the launch of the 2020 GSLS App. Attendees can use this app onsite to create a personal agenda, map out visits to their favorite exhibitors, provide feedback, interact with speakers and sessions, and more! You can download the app on the Apple Store or Google Play Store. Once you register, you will be provided information on how to login to your account.
Have online channels for contact lens sales negatively impacted the contact lens portion of your practice?
This 45-year-old male had a history of self-medication with topical steroids. He was diagnosed with herpes simplex dendritic keratitis and successfully managed with oral and topical acyclovir.
We thank Dr. Chukwuemeka 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
Treatment Zone Decentration Influence on Axial Length Progression
The efficacy of corneal reshaping/orthokeratology (ortho-k) in controlling myopia progression and axial length elongation has been shown in multiple studies. Although the exact mechanism of action still is controversial, we can feel comfortable in stating that, on average, myopia progression can be reduced by at least 50% and axial length elongation by at least 40% or more when corneal reshaping/ortho-k treatment is applied for young progressive myopes. The question has been raised pertaining to specific elements of the lens designs utilized and corneal reshaping outcomes obtained by ortho-k treatment that may impact efficacy of myopia management.
A recent study was published that evaluated the relationship between magnitude of orthokeratology (ortho-k) treatment zone decentration and two-year axial length (AL) elongation in myopic children.1 The subject population was 101 Chinese children who wore ortho-k contact lenses for two years. The magnitude and direction of the ortho-k treatment zone center from the entrance pupil center along with AL measurement were recorded after three and 24 months of lens wear. Stepwise multiple linear regression analysis was performed to assess which factors significantly affected an increase in AL.
Analysis of outcomes indicated that after three and 24 months of ortho-k treatment, the mean (± standard deviation [SD]) magnitude of the ortho-k treatment zone decentration was 0.64mm ± 0.38mm and 0.68mm ± 0.32mm, respectively. After two years of ortho-k contact lenses wear, the mean (± SD) AL growth was 0.36mm ± 0.34mm. The axial elongation was slightly correlated with baseline age of subjects (r = –0.073, P < 0.001), baseline spherical equivalent refractive error (r = –0.088, P < 0.001), and magnitude decentration of treatment zone (r = –0.190, P = 0.027). The authors concluded that the decentration of ortho-k treatment zone stabilizes after three months of lens wear and slightly decreases AL growth.
It surely is interesting to see that decentration of corneal reshaping/ortho-k treatment zones might have a beneficial influence on AL progression. According to personal communication with one of the study’s authors (Dr. Michael Lipson), future investigation may incorporate a control group of well-centered treatment zone cases and should also tighten up the age range control, because we know that myopia progression rates significantly vary according to age ranges (i.e., younger children tend to progress at greater rates).
For me, I think that this study sparks thoughts of determining how we may use corneal reshaping/ortho-k for myopia management in a more effective way. We may need to consider factors such as the amount of peripheral myopic defocus induced by the specific lens design or the size of the treatment zone among others as a means to maximize the efficacy of treatment for myopia progression. Incorporation of lens design customization may be beneficial.
1. Chen R, Chen Y, Lipson M, et al. The effect of treatment zone decentration on myopic progression during orthokeratology. Curr Eye Res. 2019 Sep 27. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine Mastrota, MS, OD
How Money Makes You a Better Practitioner
Recently, I examined a patient who had CREST syndrome. Also known as the limited cutaneous form of scleroderma (a.k.a. progressive systemic sclerosis), CREST syndrome is a multisystem connective tissue disorder. The acronym “CREST” refers to the five main features of the condition: calcinosis, which is the formation of calcium deposits in any soft tissue; Raynaud’s phenomenon; esophageal dysmotility; sclerodactyly, which is localized thickening and tightness of the skin of the fingers or toes; and telangiectasia, a collection of dilated blood vessels under the skin.1
Scleroderma is a poorly understood illness that causes widespread hardening of the skin, especially on the hands and face. It also can damage the lungs, heart, kidneys, digestive tract, muscles, and joints. It is a long-lasting (chronic) autoimmune disorder and an illness in which the body’s immune defenses mistakenly attack the body’s own cells.
According to at least one literature review, dry eye is associated with systemic sclerosis.2 Therefore, a handshake could be the first clue to identifying a contributor to dry eye disease. More on CREST syndrome in my next column.
1. Winterbauer RH. Multiple telangiectasia, Raynaud’s phenomenon, sclerodactyly, and subcutanious calcinosis: a syndrome mimicking hereditary hemorrhagic telangiectasia. Bull Johns Hopkins Hosp. 1964;114:361-83.
2. Kreps EO, Carton C, Cutolo M, et al. Ocular involvement in systemic sclerosis: A systematic literature review, it’s not all scleroderma that meets the eye. Semin Arthritis Rheum. 2019 Aug;49:119-125.
Effect of Scleral Lens Wear on Central Corneal Thickness and Intraocular Pressure in Patients With Ocular Surface Disease
The purpose of this study was to determine the effect of scleral lens wear on central corneal thickness (CCT) and intraocular pressure (IOP).
Twenty-five subjects (46 eyes), fit with scleral lenses that ranged in diameter from 17.0mm to 18.0mm, were included in this retrospective study at the University of Southern California, Department of Ophthalmology. All subjects had ocular surface disease and were categorized into the following groups based on etiology of their dry eye: chronic graft-versus-host disease, Stevens-Johnson syndrome, Sjögren’s syndrome, or general dry eye syndrome. Measurements of CCT and IOP were obtained at the initial scleral lens consultation (pre-CCT and pre-IOP) and at follow-up visits (post-CCT and post-IOP) immediately after lens removal.
The total average difference between pre- and post-CCT was 7.19μm (544.90μm ± 31.29μm versus 552.09μm ± 30.30μm), which was a statistically significant increase of 1.01% (P ≤ 0.05). On the other hand, the total average difference between pre- and post-IOP was –0.89 mmHg (14.47 mmHg ± 3.63 mmHg versus 13.58 mmHg ± 3.61 mmHg), which was not statistically significant (P ≥ 0.05). There were no statistically significant correlations between change in CCT (ΔCCT) and visual acuity (P ≥ 0.05), between ΔCCT or change in IOP (ΔIOP) in relation to lens diameter (P ≥ 0.05), between etiology of dry eye affecting ΔCCT or ΔIOP (P ≥ 0.05), between wearing time today and ΔCCT or ΔIOP (P ≥ 0.05), and between average wearing time (AWT) and ΔCCT (P ≥ 0.05). In addition, there was no statistically significant correlation between AWT and ΔIOP (R = 0.08) over a range of wear time hours.
The researchers determined that there was a statistically significant increase in CCT after scleral lens wear in subjects who have ocular surface disease, which may be attributed to subclinical hypoxic conditions created by scleral lens wear. They also found no significant relationship between scleral lens wear and IOP.
Shahnazi KC, Isozaki VL, Chiu GB. Effect of Scleral Lens Wear on Central Corneal Thickness and Intraocular Pressure in Patients With Ocular Surface Disease. Eye Contact Lens. 2019 Oct 24. [Epub ahead of print]