We continue to see lots of activity as it relates to advanced treatments for the irregular cornea, especially in keratoconus. Whether it is new designs in traditional contact lenses, or in advanced scleral, hybrids or custom soft lenses, there are a multitude of options we have for these patients. I think it is important to keep a broad arsenal in this regard such that all options can be tried before surgical intervention is required.
Jason J. Nichols, OD, MPH, PhD
Allergan Introduces Restasis Multidose
Allergan plc announced that it has received approval from the U.S. Food and Drug Administration (FDA) for Restasis Multidose (Cyclosporine Ophthalmic Emulsion) 0.05%, a preservative-free, multi-dose bottle offering the same preservative-free formulation of Restasis available since the launch in 2003. Restasis is the one and only prescription treatment FDA approved to help patients with a type of chronic dry eye make more of their own tears.
Restasis helps increase the eyes' natural ability to produce tears, which may be reduced by inflammation due to chronic dry eye. Restasis did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.
Restasis Multidose is designed with a patented unidirectional valve and air filter technology that eliminates the need for a preservative. The new multi-dose bottle uses less plastic than a package of single-use vials and will be available for the same price.
The Global Specialty Lens Symposium (GSLS) announced the co-location of the Contact Lens Manufacturers Association (CLMA) annual meeting during the January 26-29, 2017 event at the Las Vegas Rio Hotel.
CLMA members have played an integral role in supporting the GSLS over the past 11 years, and since so many of their members are already at GSLS, it makes sense for CLMA to co-locate their meeting at the same site. The GSLS Exhibit Hall is the perfect place for contact lens manufacturers to demonstrate their products and services to a focused audience of contact lens specialists and educators from more than 30 countries every year.
Attendees will also have several opportunities in the 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.
A new report on myopia and high myopia, the result of a joint World Health Organization (WHO) and Brien Holden Vision Institute meeting, was announced in Durban, South Africa, at the 10th General Assembly of the International Agency for the Prevention of Blindness. Dr. Silvio Mariotti, from Blindness Prevention and Deafness at WHO, presented the report during a special myopia session at the conference.
“The Impact of Myopia and High Myopia” report captures the evidence presented during the meeting held in Sydney, Australia, in March 2015, on the magnitude of myopia, vision impairment and blindness in myopia, terminology and classification, pathological consequences, the impact on society, etiology, risk factors, and evidence for myopia control. It also identifies gaps in current knowledge, and makes recommendations to address the gaps with the aim to better inform clinical practice and public health policy. The meeting was an initiative of the then Australian Minister for Health, the Hon Peter Dutton MP. Experts in myopia representing each WHO region attended and contributed to the final report. The meeting was chaired by the late Professor Brien Holden (Brien Holden Vision Institute), Professor Serge Resnikoff, Dr. Ivo Kocur (WHO) and Dr. Marriotti (WHO).
Winners of Third Annual ABB Cares Program Announced
ABB Optical Group announced that seven non-profit organizations, nominated by eyecare professionals nationwide, will receive grants ranging from $1,000 to $5,000 in recognition of the charities' outstanding programming and community impact. The grants are presented through the company's third annual ABB Cares program.
The 2016 ABB Cares grant recipients are: Platinum Grant of $5,000 goes to Addi’s Faith Foundation in Kingwood, TX, nominated by Family Vision Center of Porter & Crosby. Gold Grants of $2,500 go to:
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Outdoor Activity in Children Protective for DED?
A recently published study adds interesting information to digital device-related dry eye risk in the pediatric population. In this study, children from first to sixth grades were enrolled and subdivided into patients from an urban vs. a rural environment.1 The study also investigated “outdoor activity” as a protective measure for DED. Children were defined as having DED based on the International Dry Eye Workshop guidelines (punctate epithelial erosion or short tear break-up time; subjective symptoms: modified OSDI score).2
The investigators found that 8.3% of children in the urban group were diagnosed with DED compared to 2.8% in the rural group. The mean daily duration of smartphone use was longer in the DED group than controls and the mean daily duration of outdoor activities was shorter in the DED group than controls. The rate of smartphone use was higher in older-grade children. After cessation of smartphone use for four weeks in the DED group, both subjective symptoms and objective signs had improved.
This study suggests that smartphone use in children was strongly associated with pediatric DED. However, outdoor activity appeared to be protective against pediatric DED.
More research needs to be done regarding the protective nature of outdoor activity in DED. With the epidemic rates of obesity and diabetes in children (childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years),3 the necessity of outdoor activity to a healthy lifestyle cannot be overlooked.
1. Moon JH, Kim KW, Moon NJ. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study. BMC Ophthalmol. 2016 Oct 28;16(1):188.
2. [No authors listed] The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Work Shop (2007). Ocul Surf. 2007 Apr;5(2):75-92. Review.
A Lesson to Learn… Dissatisfaction After Implantation of Presbyopia-Correcting Intraocular Lenses
So many of us in clinical practice are referring patients for cataract surgery and consideration of multifocal/presbyopia-correcting intraocular lenses (IOLs). The challenge for all of us (including the surgeons) is to know what patients are more likely to succeed with these lenses and those who may be at higher risk of failing. Many factors go into the formula for success or failure in multifocal IOLs. Technical developments in lens designs have come a long way and paying special attention to the placement of the optics during surgery are some of the critical elements we have seen in our cases. In addition, we have found that those patients who, prior to the development of visually significant cataracts, did well in simultaneous multifocal contact lenses tended to do well in multifocal intraocular lens implants. That being said, a significant number of patients will experience dissatisfaction following implantation of these IOLs.
A study was recently published that attempted to assess the causes and possible solutions for patient dissatisfaction after the implantation of presbyopia-correcting intraocular lenses. A retrospective review of clinical records of patients whose primary reason for consultation was dissatisfaction with visual performance after presbyopia-correcting IOL implantation were included in the study. A single treating physician, who determined the most probable cause of dissatisfaction, decided which interventions to pursue following the initial consultation.
Data from 74 eyes of 49 patients were analyzed. The most common cause for complaint was blurry or foggy vision both for distance and near (68%). Complaints were most frequently attributed to residual refractive error (57%) and dry eye (35%). The most common interventions pursued were treatment of refractive error with glasses or contact lenses (46%) and treatment for dry eye (24%). Corneal laser vision correction was done in 8% of eyes; 7% required an IOL exchange. After the interventions, 45% of patients had completed resolution of symptoms, 23% of patients were partially satisfied with the results, and 32% remained completely dissatisfied with the final results.
The authors concluded that the most identifiable causes of dissatisfaction after presbyopia-correcting IOL implantation are residual refractive error and dry eye. Most patients can be managed with conservative treatment, though a significant number of patients remained unsatisfied despite multiple measures.
Although we have come a long way in multifocal IOL technology we still have a significant percentage of those who have had these lenses implanted who are dissatisfied. Of those, this study shows that a very significant percentage (32%) remain dissatisfied. Obviously we still have work to do. I think that the experience and input from those of us who work closely with multifocal contact lenses lends a great deal of value to this further development. Thankfully for us, if our vision correction modality does not work – we just can take the contact lens off the eye!
1. Gibbons A, Ali TK, Waren DP, Donaldson KE. Causes and correction of dissatisfaction after implantation of presbyopia-correcting intraocular lenses. Clin Ophthalmol. 2016 Oct 11;10:1965-1970.
Effect of Corneal Cross-Linking on Contact Lens Tolerance in Keratoconus
The aim of this study was to investigate changes in corneal sensation and rigid gas-permeable (RGP) contact lens tolerance after corneal cross-linking (CXL) on patients with keratoconus.
Thirty eyes of 30 patients, who were RGP lens intolerant, were treated with CXL. The main outcome measures were corneal sensation evaluation by Cochet-Bonnet esthesiometry, sub-basal nerve fiber assessment by corneal in vivo confocal microscopy and RGP contact lens tolerance evaluation with the Likert scale and wearing time. All eyes were evaluated preoperatively and post-operatively at one, three and six months after CXL procedure.
The mean age was 25.3 ± 6.2 years. Preoperatively, the maximum keratometry (Kmax) in study eyes was 56.89 ± 4.60 D. Six months after CXL, it reduced to 56.03 ± 4.85 D (p = 0.01). Preoperative mean corneal sensation was 0.44 ± 0.05 g/mm2, (range: 0.40 to 0.55); it was significantly decreased at the first month and increased to preoperative values after six months. The sub-basal nerve plexus could not be visualized in 90 percent of the patients by confocal microscopy at one month post-operatively. Gradual restoration of corneal innervation with almost similar preoperative levels at post-operative month six was noted. There were significant differences in Likert scores between preoperative and third and sixth months after CXL. Likert scale scores correlated significantly with corneal sensitivity.
The authors concluded that increased RGP contact lens tolerance after CXL may be associated with the potential role of decreased corneal sensitivity and corneal flattening after CXL.
Ünlü M, Yüksel E, Bilgihan K. Effect of corneal cross-linking on contact lens tolerance in keratoconus. Clin Exp Optom. 2016 Sep 22. doi: 10.1111/cxo.12470. [Epub ahead of print]