As you will note, this week’s abstract relates to a newer potential form of treatment for meibomian gland dysfunction (MGD)–intense pulsed light treatment. There are certainly other new therapies for MGD (and dry eye), both emerging and on the horizon. While this is an exciting time in this field, given these new options, we need more data on how these new, novel therapies may beneficially impact our contact lens wearers. There are so many contact lens wearers who have significant issues with discomfort that we need data showing potential promise in this cohort.
Jason J. Nichols, OD, MPH, PhD
CCLR to Change Its Name to CORE
Beginning Jan. 2018, the Centre for Contact Lens Research (CCLR) at the University of Waterloo’s School of Optometry & Vision Science will adopt a new name: The Centre for Ocular Research & Education (CORE).
The organization’s new logo echoes its primary focus on the eye, according to CORE. Interlocking elements in distinct blue, green, and orange colors represent biosciences, clinical research, and education expertise coming together in support of its mission.
The CORE brand was premiered at the American Academy of Optometry’s 96th annual meeting on Oct. 11 in Chicago. The official CORE name change will occur following final ratification by the University of Waterloo Board of Governors.
Bio-Tissue Announces Availability of New Prokera Medical Coding
Bio-Tissue, Inc., a business unit of TissueTech, Inc., announced that a new Prokera Medical Coding and Compliance Guide is now available for practitioners.
John Rumpakis, OD, MBA, a leading authority on medical coding and compliance issues in eye care, developed the Prokera Medical Coding and Compliance Guide, which provides practitioners with all of the information needed for medical coding and billing of Prokera. This includes medical necessity and importance, ocular use and approval, Merit-based Incentive Program (MIPS) and the health economics of Prokera, considerations for insurance companies and Medicare, modifiers and their use, valuable reference material, and more.
Dr. Harue Marsden Honored with Great Western Council of Optometry’s Lifetime Achievement Award
The California Optometric Association (COA) announced that past president Harue Marsden, OD, was honored by the Great Western Council of Optometry’s “Lifetime Achievement” award. Dr. Marsden was a leader and educator in the profession of optometry until her passing in February 2017, following a long battle with cancer.
Dr. Marsden was actively involved in professional optometric associations since her time as a student, contributing in roles with the American Optometric Association; the COA, where she served in a number of positions, including president in 2010-2011; the COA Orange County Optometric Society; and the American Academy of Optometry. She was also a director with the Great Western Council of Optometry from 2009 until her passing.
As COA president, she led the organization’s effort to secure regulations allowing doctors of optometry to treat glaucoma, a significant step forward for patients’ eye health. Dr. Marsden also shaped a generation of eye doctors through her work as a counselor and teacher at the University of Houston, College of Optometry and later as a professor, associate dean, and director of externships at her alma mater, Southern California College of Optometry. She generously shared her expertise and insights, speaking nationally and internationally on topics of interest to eye doctors and serving as a reviewer for the Journal of the American Optometric Association and other prestigious scholarly journals.
AB 443 Expands Scope of Practice for California Optometrists
California Governor Jerry Brown signed AB 443, a bill authored by Assembly Member Rudy Salas (D-Bakersfield) that enables doctors of optometry to safely expand the number of procedures they may offer to patients.
Effective Jan. 1, 2018, AB 443 will allow therapeutic pharmaceutical agent (TPA)-certified doctors of optometry to use all non-controlled substance medications, noninvasive medical devices and technology that are FDA-indicated for a condition optometrists can treat. As new technologies are made available, the State Board of Optometry may authorize their use by optometrists via regulation. In addition, the bill clarifies that optometrists may prescribe currently allowable drugs “off label”; clarifies that TPA optometrists may treat blepharitis; allows TPA optometrists to use a skin test limited to the superficial layer of the skin to diagnose ocular allergies; and much more.
BCLA Social Media Campaign Targets Beauty Bloggers
The British Contact Lens Association (BCLA) is targeting a network of “superstar” beauty bloggers to help warn of the dangers of novelty Halloween contact lenses. The social media campaign will target 20 of the top beauty bloggers in the United Kingdom.
The campaign will warn against buying lenses from fashion outlets, market stalls, and unregistered online sellers. Additionally, it will stress the importance of visiting an eyecare professional to ensure lenses fit properly and receive expert advice on how to wear and store them safely.
ABB Optical Group Participates in Optometry Giving Sight’s World Sight Day Challenge
As a World Sight Day Challenge coalition member, ABB Optical Group will donate a percentage of all Digital Eye Lab sales for the month of October.
In addition to its donation, ABB Optical Group also participated as a moderator in a Twitterchat focused on children’s eye health, hosted by Optometry Giving Sight that took place on Oct. 12. Parents, vision care practitioners and industry professionals around the world participated by following @givingsightorg and using the hashtag #shareforsight.
Eyecheck Offers New Ocular Supplement Line
Eyecheck LLC, an ocular supplement and technology startup, announced its line of natural, vegan, gluten-free, and non-GMO ocular health supplements, two of which are available now and additional formulations to be available in the upcoming months. The premium supplements are offered primarily through eyecare professionals.
All products within the Eyecheck line are formulated by leading eyecare professionals utilizing natural, premium ingredients, according to the company. Macutene Protect is available for optimal macular health based on the Age-Related Eye Disease Study 2 (AREDS2), a study designed to test supplements for the treatment of age-related macular degeneration (AMD). Pristene is formulated to support healthy tear production based on several clinical studies. Looking forward, Eyecheck plans to release several more products: a general eye health supplement, a pediatric supplement, an optic nerve and blood sugar support supplement, and Macutene Boost for patients who have one eye that has converted to wet AMD.
The company’s tech platform, www.eyecheck.com, offers online product ordering, find-a-doctor functionality, and a comprehensive patient education forum. Eyecare providers can utilize the website, offering a place to review their patients currently taking Eyecheck supplements, their compliance, and practice growth via Eyecheck’s discretionary physician revenue model.
Last Chance to Participate in Contact Lens Spectrum’s Practice Profile Survey
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 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.
In David L. Kading’s last Material & Design column, he stated that the 90% water polyethylene glycol (PEG)-based polymer coating treatment can be applied after your finished lens has been produced. At this point, many labs across the country are producing the coating and, according to the product’s 510(k), it needs to be applied at the time of manufacturing, not post-production. We apologize for any confusion this may have caused.
If you haven’t voted yet in this month’s poll…
In which of the following areas do you feel that daily disposable contact lenses have the greatest impact?
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.
S. Barry Eiden, OD
Thicken It Up: The Influence of Drop Viscosity on Corneal Reshaping Lens Performance
Instructions pertaining to the application of corneal reshaping (orthokeratology [ortho-k]) contact lenses vary from practitioner to practitioner with no specific standard of care. Some instruct patients to directly place lenses onto the cornea, while others suggest placing some form of lubricating solution into the bowl of the lens prior to application. A recent study compared the use of a viscous artificial tear drop versus saline solution for the application of ortho-k lenses.1
In this double-masked, crossed, randomized, and prospective study, 20 subjects (14 males and six females) who had a mean age of 16.29 years ± 6.22 years (range: 10 to 26 years) were fit with ortho-k lenses. For the study, non-preserved 0.9% NaCl commercial saline solution and nonpreserved artificial teardrops with 0.3% hyaluronic acid were used. Corneal staining, tear breakup time (TBUT), topography, refraction, visual acuity, and subjective comfort and vision with the visual analog scale (score from 0 to 10, 10 = better comfort and vision) were evaluated at one day, one week, and one month of contact lens wear.
Results indicate that corneal staining was statistically greater in the saline group than in the nonpreserved artificial teardrops with 0.3% hyaluronic acid group for the first day and during one week of wear (P < 0.05). Comfort was found to be statistically better with the nonpreserved artificial teardrops with 0.3% hyaluronic acid than with the saline solution, 7.17 ± 1.94 and 6.37 ± 1.63, for the first day, and 8.78 ± 0.43 and 8.15 ± 0.62 for day 28, respectively (P < 0.05). However, no differences were found for subjective vision scores, TBUT, spherical equivalent, best-corrected and uncorrected visual acuity, and mean keratometry between groups for any visit (P > 0.05).
The authors concluded that viscous artificial tears improve the subjective comfort of patients and reduce the corneal staining compared with saline solution during the ortho-k lens fitting process. However, no differences between solutions for the treatment efficacy (in vision and corneal topography) were found.
At our practice, we have observed similar subjective and objective findings in the fitting outcomes of corneal reshaping/ortho-k patients over many years. It has resulted in a change to our initial protocol whereby we routinely suggest the use of viscous artificial tear drops to fill the bowl of these lenses followed by a vertical application method (similar to application of scleral lenses). The cushioning influence of the viscous agent has resulted in improved comfort for our patients without a doubt. If you have not tried this, give it a go.
1. Carracedo G, Villa-Collar C, Martin-Gil A, Serramito M, Santamaría L. Comparison Between Viscous Teardrops and Saline Solution to Fill Orthokeratology Contact Lenses Before Overnight Wear. Eye Contact Lens. 2017 Sep 21. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
From Back to Front
Perfluorohexyloctane (F6H8), a liquid semifluorinated alkane (too much chemistry here? I think it’s OK), is water-free and used as an internal tamponade agent in surgery for complicated retinal detachments. F6H8 is known to have outstanding spreading properties and biocompatibility.
A recent study, however, reports that six to eight weeks of topical application of F6H8 significantly improves clinical signs of meibomian gland disease (MGD) and associated mild to moderate dry eye disease (DED).
During this six- to eight-week, observational, prospective, multicenter study, 72 patients who had MGD and associated dry eye received one drop of perfluorohexyloctane four times daily. Clinical assessment included, best-corrected visual acuity, Schirmer test I, tear film breakup time, anterior and posterior blepharitis assessment, number of expressible meibomian glands, meibum quality and quantity, ocular surface fluorescein staining, lid margin and symptom assessment, and Ocular Surface Disease Index (OSDI).
Results of the study demonstrated that tear film breakup time, corneal and conjunctival fluorescein staining, number of expressible meibomian glands, and severity of anterior and posterior blepharitis significantly improved after six to eight weeks of perfluorohexyloctane application. In addition, symptoms improved as demonstrated by a significant decrease of OSDI-values with no drop-associated visual blurring.
This small study certainly may prompt further investigation as to the efficacy of topical F6H8 for the management of MGD and DED.
Steven P, Augustin AJ, Geerling G, Kaercher T, Kretz F, Kunert K, Menzel-Severing J, Schrage N, Schrems W, Krösser S, Beckert M, Messmer EM. Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease Due to Meibomian Gland Disease. J Ocul Pharmacol Ther. 2017 Sep 18. [Epub ahead of print]
Intense Pulsed Light Treatment and Meibomian Gland Expression for Moderate to Advanced Meibomian Gland Dysfunction
The aim of this study was to evaluate the efficacy of periocular intense pulsed light therapy combined with meibomian gland expression for chronic dry eye due to moderate-to-advanced meibomian gland dysfunction.
This single-institution, open-label prospective study involved 26 participants who received bilateral treatments using a proprietary intense pulsed light device (E > Eye, E-Swin) combined with therapeutic meibomian gland expression at baseline, week 2, and week 6. Clinical evaluations performed at baseline, week 4, week 8, and week 12 were symptom scores (Ocular Surface Disease Index [OSDI], Ocular Comfort Index [OCI], daily lubricant use, tear breakup time [TBUT], and ocular surface staining). Tear secretion; tear osmolarity; InflammaDry tear immunoassay; corneal sensation; meibomian secretion quality and expressibility; bulbar conjunctival, limbal, and lid margin redness; and eyelid margin bacterial swab for cultures and colony counts were performed at baseline and week 8 only.
Significant improvements occurred at week 8 in meibomian gland expressibility (p = 0.002), meibum quality (p = 0.006), TBUT (p = 0.002), corneal staining (p = 0.001), lid margin redness (p = 0.001), bulbar redness (p = 0.05), and limbal redness (p = 0.001). Symptom survey outcomes, eyelid margin bacteria colony counts, Schirmer I test, tear osmolarity, corneal sensitivity, and daily lubricant use were unchanged. At week 12, significant improvements in symptoms (OSDI, p = 0.025; OCI, p = 0.003), TBUT (p = 0.001) and corneal staining (p = 0.001) occurred. Improvement in OSDI score was correlated to the improvement in ocular surface staining (R = 0.43, p = 0.03) and associated with baseline meibomian gland expressibility (Kendall tau: the distributions are ordered the same, p = 0.1). There were no adverse effects of treatment.
The authors concluded that serial intense pulsed light therapy combined with meibomian gland expression significantly improved dry eye symptoms and clinical signs, including meibomian gland secretion quality and expressibility and ocular surface inflammation. Treatment effects were cumulative and sustained for at least six weeks after the final treatment.
Albietz JM, Schmid KL. Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction. Clin Exp Optom. 2017 Jun 6. [Epub ahead of print]