Time flies when you are having fun (or so the saying goes)! It is hard to believe that autumn is already here with thoughts of Halloween just around the corner. Thinking of this holiday prompts a great reminder about cosmetic contact lenses—many patients (in addition to the general public) are often sent confusing messages about cosmetic contact lenses thinking you can just buy them at a gas station and wear them. Obviously that is not the case as all contact lenses are medical devices and need clearance from the Food and Drug Administration to be sold in the United States. Make sure that you and your staff do your best to keep this message coming across to your patients.
Jason J. Nichols, OD, MPH, PhD
B+L Creating New Division:
Advanced Vision Products
Earlier this year, Bausch + Lomb combined its Boston division with the newly acquired Paragon Vision Sciences, Inc. to effectively address the dramatic increase in myopia in the United States and abroad.
Considered a serious children’s health care issue, the incidence of myopia in the United States alone has increased 66% since the late 1970s. High levels of myopia increase the risk of significant ocular health problems. In addition, serious eye disease has created a need of better specialty contact lens options for keratoconus, severe dry eye, post-surgical needs, and corneal transplants, which can be addressed through GP options such as scleral lenses.
To help address these growing concerns, B+L announced that in coming weeks the company will launch a newly created division, Bausch + Lomb Advanced Vision Products, which will be dedicated to addressing severe ocular conditions, including myopia, irregular corneas, ocular surface diseases and other serious visual challenges with superb quality, state-of-the-art specialty and custom contact lenses. The new structure has been designed to provide the latest information on products, training events and other helpful tools.
The team at Bausch + Lomb Advanced Vision Products will help to further develop and grow the specialty lens segment by providing:
Customized contact lenses, including ortho-k and scleral lenses
Continued innovation across GP, customized soft lens and lens care categories
Comprehensive training in scleral lens and ortho-k fitting.
Continued support for the development of state-of-the-art diagnostic fitting and dispensing systems of these advanced technology products.
Lens care products to help ensure patients closely follow lens care regimens.
Alcon to Offer Dailies Total1 in Plus Powers
Alcon has extended its line of Dailies Total1 water gradient contact lenses to include plus power lenses for hyperopic patients. The plus power lenses will be available in the U.S. in November 2015. The new plus powers will include from +0.50 to +6.00D (in 0.25D steps).
Dailies Total1 contact lenses launched in the U.S. in 2013. Designed to mimic the environment of the cornea with water content of almost 100% at the outermost surface, the lenses maintain 100% of their surface lubricity, even after a full day of wear - delivering exceptional end-of-day comfort, according to the company. For more information on Dailies Total1 contact lenses visithttps://www.myalcon.com/products/contact-lenses/dailies/dt1-technology.shtml.
Plan Now to Attend the GSLS in January at Caesars Palace, Las Vegas
The 10th Global Specialty Lens Symposium will be held January 21 – 24, 2016 at Caesars Palace Las Vegas, Nevada. The GSLS is a must-attend meeting, brought to you by Contact Lens Spectrum, focusing on the successful management of ocular conditions using today's specialty contact lenses. This meeting will include insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.
The 2015 event was attended by almost 600 registrants from 36 countries, 42 states, Puerto Rico and Guam. It continues to be the largest conference of its kind in the U.S.
Join your peers in 2016 for the 10th anniversary in Las Vegas! Visit www.GSLSymposium.com for more information and to register.
First Subject Enrolled in Study of Topical Treatment for Presbyopia
Encore Vision, Inc., a privately-held ophthalmic pharmaceutical company, announced that the U.S. Food and Drug Administration (FDA) has granted Encore's Investigational New Drug (IND) application as safe to proceed with the clinical development of EV06 topical ophthalmic solution to treat presbyopia. The company has since enrolled the first subject into their Phase 1 & 2 trial, which it believes to be the first ever clinical evaluation of a new chemical entity intended to address an underlying process that causes presbyopia.
EV06 (Lipoic Acid Choline Ester, 1.5%) is a first-in-class new chemical entity that targets a biochemical cause of presbyopia, believed to be associated with an increase in the formation of disulfide bonds between the crystalline proteins within lens fiber cells. EV06 is intended to increase lens flexibility by breaking these bonds, thereby restoring elasticity, allowing the lens to focus on nearby objects. EV06 is a prodrug that penetrates the cornea and is subsequently broken down into lipoic acid and choline, two naturally occurring substances. According to the company, administration of EV06 may potentially halt or reverse the stiffening that occurs, allowing the lens to maintain or regain its ability to accommodate.
The Phase 1 & 2 prospective, randomized, double-masked, multicenter study will compare the safety and efficacy of EV06 to placebo in subjects 45 to 55 years of age with presbyopia. The 90-day study will aim to enroll 72 subjects and evaluate mean change in distance corrected near visual acuity (DCNVA) and best corrected distance visual acuity (BCDVA), along with additional secondary outcomes.
Alcon a Title Sponsor of TFOS DEWS II
Alcon is a title sponsor of the Tear Film & Ocular Surface Society’s (TFOS) second International Dry Eye Workshop (DEWS II). This year’s workshop is intended to update the definition, classification and diagnosis of dry eye disease, critically assess the etiology, mechanism, distribution and global impact of this disorder, and address its management and therapy. Since 2000, Alcon has partnered with TFOS to advance ocular surface research, contributing more than $1.5 million in support of research reports, summaries, publications and conferences.
The first TFOS International Dry Eye Workshop (DEWS) produced a comprehensive report published in a special 2007 issue of The Ocular Surface journal. This report was made available to TFOS members through Alcon’s support, spurring increased research in the dry eye disease area. A second report from this year’s Dry Eye Workshop (DEWS II) is expected to be published by TFOS in early 2017.
Vision Source Reaches $500,000 Fundraising Milestone for Optometry Giving Sight
Vision Source announced that the independent optometric alliance has reached a fundraising milestone in its Million Dollar Campaign benefitting Optometry Giving Sight (OGS). Through the generous donations of member optometrists, patients, employees of Vision Source, and matching funds from Essilor, the 2015 giving campaign total now exceeds $500,000.
Vision Source has set forth the goal of raising $1,000,000 by August of 2016 in order to help underwrite the building of Haiti’s first optometry school, l’Université d’Etat d’Haiti. As Haiti is a country with a population of 10,000,000 people and only three optometrists, the Vision Source Million Dollar Campaign will provide a significant part of the funding required to launch a school that will make a difference.
NovaClear with intelli-Case Test Market Launch Expected in Early 2016
In a recent announcement NovaBay provided an update on its intelli-Case for hydrogen peroxide contact lens disinfection. The company has combined the intelli-Case device with two hydrogen peroxide bottles into a new consumer-packaged product called NovaClear, which is sufficient for 60 days’ use. NovaBay is set to launch a test market program in select cities in California either late this year or early in 2016.
intelli-Case monitors the neutralization of hydrogen peroxide during the disinfection cycle with sophisticated microprocessor electronics embedded in the cap of what otherwise looks like a standard peroxide lens case. The LED indicators on the lid inform the user if the lenses are safe to insert into the eyes, resulting in a disinfection system that is safe yet simple to use like multipurpose solutions.
BHVI Reports Up to One Billion People at Risk of Blindness by 2050
Up to 1 billion people could be at risk of blindness by the middle of the century if an emerging myopia epidemic is ignored according to researchers at the Brien Holden Vision Institute.
They predict that half the world’s population (nearly 5 billion) will be myopic by 2050, with up to one-fifth of them in the high myopia category and at a significantly increased risk of blindness, if behavioral interventions and optical treatments are not developed and implemented. Currently, it’s estimated that over 2 billion people in the world suffer from myopia.
Myopia has become particularly prevalent in East Asia, where in urban areas of Singapore, China, Taiwan, Hong Kong, Japan, and Korea, the prevalence is 80-90% among school leavers.1 However, the problem is not limited to Asian countries alone, with data from western countries like the United States showing that the rate has increased markedly in adults in the last 30 years, from 25% in the early 1970s to 42% in 2004.2
According to the Institute, reducing the progression of myopia in individuals by 50% will prevent almost 90% of myopes reaching high levels of myopia.
1. Dolgin E. The Myopia Boom. Nature. 2015 Mar 19;519(7543):276-8.
2. Vitale S, Sperduto R D, Ferris FL. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol. 2009 Dec;127(12):1632-9.
Foreign Body Lindsay A. Sicks, OD, FAAO, Chicago, IL
This patient was fit with an empirically designed orthokeratology lens. At the dispensing appointment, a mild foreign body tracking appeared after about 15 minutes of lens wear. Upon closer inspection, an eyelash had become caught in the reverse curve of the lens.
We thank Dr. Sicks for this image and we 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 an explanation of the photo and your full name, degree or title and city/state/country.
A recent published work of mine outlining a certain type of contact lens fitting was met with some online criticism from a fellow practitioner. Apparently my colleague had a less than ideal outcome from a similar treatment with one of his patients due to the patient’s improper hygiene patterns which lead to a rather unsettling and unfortunate corneal infection. The practitioner wrote, that because of his experience and those of his colleagues that have experienced similar issues, he has elected to not fit his patients into that type of contact lens ever again. We are certainly all led by our clinical experiences and have the pleasure of practicing however we want. I respect this colleague for trying the lens type, for the care that he has for his patient, and how he did not want to not put future patients at the same level of risk. To each their own.
I want to remind us all of our risk/reward bone and how it drives us. Thousands of patients have been dramatically and negatively affected by cataract surgery, LASIK, and contact lens wear. And yet, innovation and research is constantly evolving to enable us to provide these risky procedures and lens wearing opportunities at much safer levels. I recently had a keratoconus patient ready for transplant because he could not get the vision the way he wanted from any prior practitioners. Knowing what had to be done, I fit him in a lens that is common for me, but where the fit of the lens was less than ideal for my normal comfort zone. Knowing the risks and educating the patient on them, I proceeded to provide the patient with phenomenal vision and saved him from immediate corneal transplantation. However, now it is up to me AND the patient to ensure that we keep his eyes healthy through frequent follow up, eye health assessment, and educating, educating, educating about what we can do to ensure his eyes stay healthy.
I know that keratoconus lenses can be risky. I realize that overnight wear has a higher risk of infection. I understand that ortho-k lenses are fit on children and have some risks. But, as someone who is looking for what is BEST for my patients, I have to be somewhat risk adverse, not cavalier, and work to ensure that my patients follow proper hygiene, lens replacement, and follow up appointments. And foremost, at the first glimpse of red eyes or blurred vision they return to the office for evaluation and, if needed, treatment. I get that our fears shape us, but realize that our materials and designs are ever improving and our patients can always benefit from something new. Maybe it’s up to us to have a new, fresh, realistic, and cautious outlook.
CARE SOLUTION CORNER Susan J. Gromacki, OD, MS, FAAO
In a recent report by the United States Centers for Disease Control (CDC), 55.1% of contact lens wearers reported “topping off” their solution at least once.1 This is defined as reusing the same disinfecting solution every night, and simply adding some new solution to the top of the old when it begins to run low.
As we know, used contact lens disinfecting solution has greatly reduced disinfection capability. Topping off considerably decreases the effectiveness of the contact lens solution.2 This can lead to eye infection.1
This noncompliant behavior can easily pass through a good case history if the patient uses the phrase, “I store it in my disinfection solution every night.” So if you really want to know, ask specifically, “Are you always using completely new disinfection solution every night?” If they say no, I instruct them that it’s like taking a bath in the same bath water that they used yesterday. It’s not a perfect analogy, but it helps to get the message across.
The Effects of Entrance Pupil Centration and Coma Aberrations on Myopic Progression Following Orthokeratology
The aim was to assess the potential association between entrance pupil location relative to the coaxially sighted corneal light reflex (CSCLR) and the progression of myopia in children fitted with orthokeratology (OK) contact lenses. Additionally, whether coma aberration induced by decentration of the entrance pupil center relative to the CSCLR, as well as following OK treatment, is correlated with the progression of myopia, was also investigated.
Twenty-nine subjects aged 6 to 12 years and with myopia of -0.75 to -4.00 DS and astigmatism up to 1.00 DC were fitted with OK contact lenses. Measurements of axial length and corneal topography were taken at six-month intervals over a two-year period. Additionally, baseline and three-month topographic outputs were taken as representative of the pre- and post-orthokeratology treatment status. Pupil centration relative to the CSCLR and magnitude of associated corneal coma were derived from corneal topographic data at baseline and after three months of lens wear.
The center of the entrance pupil was located superio-temporally to the CSCLR both pre- (0.09 ± 0.14 and -0.10 ± 0.15 mm, respectively) and post-orthokeratology (0.12 ± 0.18 and -0.09 ± 0.15 mm, respectively) (p > 0.05). Entrance pupil location pre- and post-orthokeratology lens wear was not significantly associated with the two-year change in axial length (p > 0.05). Significantly greater coma was found at the entrance pupil center compared with CSCLR both pre- and post-orthokeratology lens wear (both p < 0.05). A significant increase in vertical coma was found with OK lens wear compared to baseline (p < 0.001) but total root mean square (RMS) coma was not associated with the change in axial length (all p > 0.05).
The researchers concluded that entrance pupil location relative to the CSCLR was not significantly affected by either OK lens wear or an increase in axial length. Greater magnitude coma aberrations found at the entrance pupil center in comparison to the CSCLR might be attributed to centration of orthokeratological treatments at the CSCLR.
Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutiérrez-Ortega R, Suzaki A. The effects of entrance pupil centration and coma aberrations on myopic progression following orthokeratology. Clin Exp Optom. 2015 Aug 17. doi: 10.1111/cxo.12297. [Epub ahead of print]