Several contact lens-related risk factors for corneal infiltrative events have been confirmed. What is not clear is the biological mechanism for their role in infiltrative events. While some behaviors and practices of our patients can be modified to reduce risk, it is noted that infiltrative events are indeed relatively infrequent in daily soft lens wear, unlike several other complications.
Jason J. Nichols, OD, MPH, PhD
Contact Lens Spectrum’s Practice Profile Survey Underway
How does your contact lens practice stack up against those of your peers? The best answer is determined by you. Contact Lens Spectrum needs your feedback for our annual Practice Profile Study that we field to vision care professionals. Your responses, trended with previous years' results, will be featured in Contact Lens Spectrum’s annual report in its January issue. You will find invaluable information about trends in the contact lens field relative to contact lens materials, designs, and fitting.
Please take a few minutes (it will most likely take less than 10 minutes) to complete the questionnaire to which we provided a link below. If you provide an email address, you will be entered into a blind drawing for one of three $50 American Express gift cards.
Nicox, Eyevance Enter into Licensing Agreement for Commercialization of Zerviate in the United States
Nicox S.A.’s subsidiary Nicox Ophthalmics, Inc. has entered into an exclusive licensing agreement with Eyevance Pharmaceuticals LLC for the commercialization of Zerviate (cetirizine ophthalmic solution) 0.24% in the United States. Approved by the U.S Food and Drug Administration (FDA) in May 2017, Zerviate (formerly AC-170) is the first topical ocular formulation of the antihistamine cetirizine approved for the treatment of ocular itching associated with allergic conjunctivitis.
Bausch + Lomb Renews IACLE Sponsorship
Bausch + Lomb (B+L), a division of Valeant Pharmaceuticals International Inc., has renewed its support for the International Association of Contact Lens Educators (IACLE) by becoming a sponsor at Bronze level. B+L joins IACLE’s other sponsors, including Platinum Sponsor Alcon, Silver Sponsors CooperVision and Johnson & Johnson Vision, and Donor Sponsor Euclid.
Visionary Optics Offering Tangible Hydra-PEG on Custom Scleral Lens Product Line
Visionary Optics is now offering Tangible Hydra-PEG (Tangible Science) on its complete line of FDA-approved, fully customizable scleral lenses manufactured in Contamac Optimum materials. The addition of this polymer coating is especially useful in patients who have ocular surface disease and dry eye, according to the company.
CCLR Invites Academy 2017 Attendees to Co-Create Massive Mural
When doors open to the exhibit hall at Academy 2017 in Chicago, attendees will have the chance to literally leave their mark at the meeting. In celebration of its 30th anniversary in 2018, the Centre for Contact Lens Research (CCLR) commissioned Los-Angeles-based artist John Park to co-create a massive 12-foot x 8-foot acrylic mural, which is focused on the complexity and wonder of the eye and sight.
During exhibit hours on Oct. 11 and 12, all badged attendees are encouraged to visit the CCLR booth, slip on a protective lab coat, and add their own distinctive brush strokes to the one-of-a-kind portrait.
Park will then complete the mural during exhibit hours on Oct. 13, simultaneously painting and talking with visitors about the piece. The final artwork will be unveiled at a reception that evening, and permanently installed at CCLR headquarters at the University of Waterloo’s School of Optometry & Vision Science in Waterloo, ON.
Blanchard Contact Lenses Releases New Onefit Med Scleral Lens
Blanchard Contact Lenses has unveiled its latest scleral lens design, Onefit Med. With a standard diameter of just 15.6mm, Onefit Med is an intuitive and fully customizable scleral lens for the highly irregular, medically indicated cornea, including numerous applications, such as nipple and oval cones, post-RK, post-LASIK, ocular surface disease, pellucid marginal degeneration, and more. Practitioners control the design and fit by selecting the parameter options for four separate fitting zones—central, midperipheral, limbal, and edge.
With an instinctive online fitting tool, customizing and calculating the final lens order is simple, according to the company. The design serves as its own platform from which multifocal, oblate, and front-toric geometries can be ordered. Just like the Onefit Scleral Lens Platform, Onefit Med minimizes both lens thickness and tear layer to maximize oxygen transmission to the cornea and stem cells for long-term ocular health.
Optometry Giving Sight Leads Global Coalition to Support World Sight Day Challenge
As people deal with global eye health and vision care, leading North American optometric companies, networks, schools, and practices are once again joining a coalition led by Optometry Giving Sight in support of World Sight Day (Oct. 12, 2017) and the World Sight Day Challenge, which runs through October.
Coalition members include ABB Optical Group, Alcon Foundation, AllAboutVision.com, Bausch + Lomb, CooperVision, Essilor, EyePromise, FYidoctors, Vision Source, VSP Global, and Zeiss Vision. In addition, another 45 companies are participating in the challenge, plus 21 schools of optometry. Participating companies include A&A Optical, Acuity Pro Software, Advance Optical, Allergan, Amcon, Boore Family Foundation, Charmant USA, ClearVision, DAC Vision, De Rigo REM, Edison Optics, Europa Eyewear, Gateway Professional Network, Glimpse Live, Good-Lite Co., Heidelberg Engineering, Icare USA, Jobson Optical Group, Johnson & Johnson Vision Care (Canada), Konan USA, Liberty Sport, Macuhealth, Modern Optical International, MODO, Morel Eyewear, Nordic Naturals, Oasis Medical, Oculus Inc. USA, OptiSource International, Optos, PentaVision LLC, PCON / Slack Incorporated, Ron's Optical, RX Optical, Signet Armorlite Inc., Synergeyes Inc., TearScience Inc., Vision One Credit Union, Vmax Vision, Wave Contact Lens System LLC, Westgroupe, Wiley X Eyewear, Younger Optics, and Zyloware. Eye Recommend and OSI in Canada are also adding their support. More companies, networks, and practices are signing up every day.
For more information about the World Sight Day Challenge, or to make your donation today, visit givingsight.org or call (888) OGS GIVE in the United States or (40) 670-2619 in Canada.
In which of the following areas do you feel that daily disposable contact lenses have the greatest impact?
Bubbles beneath a scleral lens are always a concern. Usually they are the result of poor application technique or not enough fluid in the lens bowl. However, they can creep in—as in this case—when the fit is too loose. Blinking generates a pumping action that admits air under the lens. This should be addressed, as I have found that the epithelium under the bubbles will become desiccated, leading to superficial keratitis.
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.
S. Barry Eiden, OD
Contact Lens Aftercare Protocols: Is It Time to Rethink Our Approach?
Following the fitting, design, and dispensing of contact lenses, eyecare practitioners typically will suggest a series of aftercare visits to ensure appropriate response to lens wear. As I have stated in prior columns, there are only three key elements needed to achieve contact lens success: vision, comfort, and physiological health response. Aftercare visits should be conducted to confirm that these success criteria have been met.
An article was recently published that attempted to address the implementation of contact lens aftercare protocols based upon contemporary contact lens technologies.1 The authors state: “The evolution of contact lens technology and clinical practice over the past three decades has been remarkable, with dramatic improvements in material biocompatibility, better lens designs and care systems, and more flexible and convenient modalities of wear. However, our approach to the aftercare examination has remained conservative, with the general modus operandi having not fully evolved from the difficult, early years of fitting non-regular replacement rigid and low water content hydrogel lenses. In this paper, we review current aftercare practice and in particular, the preferred frequency that lens wearers should return for routine visits and the appropriateness of regulations governing contact lens prescription expiry. Four key clinical reasons for conducting a routine aftercare visit are identified: preserving ocular health, maintaining good vision, optimizing comfort, and ensuring satisfactory lens fitting performance.
"Commercial reasons for conducting aftercare visits are also considered. A decision matrix is presented to help practitioners decide on an appropriate time interval between routine aftercare visits. The first aftercare visit should always take place within one to two weeks of lens dispensing. After this, the following time intervals between routine aftercare visits are advised as a general guideline: soft daily disposable, 24 months; soft daily reusable and rigid daily wear, 12 months; soft and rigid extended wear, six months. These aftercare visit frequencies may need to be adjusted when rapid rates of refractive change are anticipated, such as every six months during child/teenager myopic progression and every 12 months during the advancement of presbyopia. Numerous clinical caveats for varying these recommended aftercare frequencies are also discussed. Those new to lens wear should be seen within the first two months of lens dispensing. Regulatory authorities charged with the responsibility of stipulating the validity of a contact lens prescription should continue to allow optometrists to set an expiry date relevant to the circumstances of individual lens wearers."
Surely, careful thought should be given to the establishment of practice guidelines and standards of care that pertain to contact lens professional service. However, care must be taken when suggesting such standards because it will impact not only professional behavior patterns, but it can also potentially impact managed care reimbursements, managed care required services, and standards of care that are applied to medical-legal considerations. We can appreciate the efforts of the authors, yet we may want to expand these discussions and bring various professional organizations into the establishment of standards for contact lens aftercare protocols based upon well accepted evidence of risk.
1. Efron N, Morgan PB. Rethinking contact lens aftercare. Clin Exp Optom. 2017 Sep;100:411-431.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Questions, No Answers This weekend, I attended an out-of-state funeral of a family member. Naturally, the proceedings of the day evoked emotion and...tears. Emotional tears. The act of crying is a complex secretomotor phenomenon characterized by the shedding of tears from the lacrimal apparatus without any obvious irritation of the ocular structures.
The human precorneal tear film is a special body fluid; it is a complex mixture primarily composed of aqueous, proteins, lipids, and mucins—the concentrations and relative distribution of which represent not only the metabolic state of the ocular surface but also the systemic and local homeostasis of the outer eye and the human body.1
Tears were clinging to my lateral canthi, and they burned—but why did they burn? What did my tears contain that made my eyes sting? Was something released into my tears caused by emotion? Was it makeup that my tears washed onto the ocular surface? Was it contamination of the ocular surface by skin oils or products used around my eyes? Was the burn evoked by something in the air of the county church or the chemicals in the environment for the products used to clean the old wood, walls, and wainscoting? Were my contact lenses irritating my eyes? Was I having a strange reaction to the plants, trees, mosses, and molds from the graveyard that was under the trees beyond the chapel? Was it allergies? Could it be the different contact lens solution I used that day? Was it the bright sun that provoked tears that burned?
Once I was home again after the service and repast, things went “back to normal.” I have no answers to my questions, only amazement for the complexity of the tears and the ocular surface. We are at the cusp of discovery in the pathogenesis of dysfunctional tears and ocular surface disease. I look forward to continued discovery.
1. Rentka A, Koroskenyi K, Harsfalvi J, Szekanecz Z, Szucs G, Szodoray P, Kemeny-Beke A. Evaluation of commonly used tear sampling methods and their relevance in subsequent biochemical analysis. Ann Clin Biochem. 2017 Sep;54:521-529.
Efficacy of Toric Contact Lenses in Fitting and Patient-Reported Outcomes in Contact Lens Wearers The purpose of this study was to assess whether patient-reported measures are improved with soft toric contact lenses (TCLs) compared with soft spherical contact lenses (SCLs) and whether clinical time needed to fit TCLs is greater than SCLs.
Habitual contact lens wearers who had vertexed spherical refraction of +4.00D to +0.25D or –0.50D to –9.00D and cylinder of –0.75DC to –1.75DC were randomly assigned to be binocularly fitted into a TCL or SCL and were masked to treatment assignment. Time to successful fit was recorded. After five days, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL-42) and modified Convergence Insufficiency Symptom Survey (CISS) were completed. After washout, subjects were fit into the alternative lens design (TCL or SCL). Outcomes were evaluated using linear mixed models for the time to fit and CISS score, generalized linear model for the successful fit, and Wilcoxon tests for the NEI-RQL-42.
Sixty subjects (71.7% women, mean age [± SD] = 27.5 years ± 5.0 years) completed the study. The mean time to fit the TCL was 10.2 minutes ± 4.3 minutes, and it was 9.0 minutes ± 6.5 minutes for the SCL (least square [LS] mean difference (TCL - SCL) = 1.2, P = 0.22).
TCLs scored better compared to SCLs in global NEI-RQL-42 score (P = 0.006), the clarity of vision (P = 0.006), and satisfaction with correction subscales (P = 0.006). CISS showed a 15% reduction in symptoms (LS mean difference [TCL - SCL] = –2.20, P = 0.02).
The authors concluded that TCLs are a good option when trying to improve the vision of patients who have low-to-moderate astigmatism given the subjective improvements in outcomes.
Cox SM, Berntsen DA, Bickle KM, Mathew JH, Powell DR, Little BK, Lorenz KO, Nichols JJ. Efficacy of Toric Contact Lenses in Fitting and Patient-Reported Outcomes in Contact Lens Wearers. Eye Contact Lens. 2017 Sep 21. [Epub ahead of print]