It has often been considered that inflammation may play roles both in normal/asymptomatic contact lens wear and in contact lens discomfort. Inflammation may be a general ocular surface response to the contact lens itself as a foreign object on the eye. Inflammation may also be associated with the common dry eye symptoms that patients may experience while wearing contact lenses. This week’s abstract highlights a potential role of IL-17A in contact lens wearers who have dry eye symptoms. IL-17A is a proinflammatory cytokine produced by T cells that can stimulate cyclooxygenase-2 (COX-2) among other mediators of inflammation. While there is a long way to go in understanding these pathways as they relate to dry eye in contact lens wear, this study is an important step in helping to understand these biological processes.
Jason J. Nichols, OD, MPH, PhD
J&J Vision Appoints Carol Alexander, OD, as Head, North America Vision Care Professional Relations
Johnson & Johnson Vision (J&J Vision) appointed Carol Alexander, OD, as Head, North America Vision Care Professional Relations for Johnson & Johnson Vision. In this role, Dr. Alexander will work to strengthen the relationship between Johnson & Johnson Vision and the optometric community in the United States, with a focus on partnering with national optometric associations and organizations to advance eye health and patient care. She will continue to partner with Mike Mayers, OD, in supporting the company’s advocacy efforts.
CORE Appoints Dr. William Ngo as Head of Biosciences
The Centre for Ocular Research & Education (CORE) has appointed William Ngo, PhD, OD, as head of Biosciences. Dr. Ngo is currently a postdoctoral fellow at the University of Alabama at Birmingham School of Optometry and will join CORE in early 2019.
Dr. Ngo’s research interests include clinical diagnosis and management of dry eye disease, contact lens discomfort, tear film biology and chemistry, and the mechanisms of oxidative stress in meibomian gland disease. During his schooling, he was a two-time American Academy of Optometry Foundation Ezell Fellow, was awarded the Desmond Fonn Contact Lens Research Award from the University of Waterloo, and received multiple grants from the Canadian Optometric Education Trust Fund.
Cris Garza Joins B+L SVP as Clinical Consultant with Alden Optical
Bausch + Lomb Specialty Vision Products (B+L SVP) announced that Cris Garza has joined the business as a fitting consultant with Alden Optical. In this role, he will provide customers with assistance in fitting Alden’s custom contact lenses, including Zenlens, Zen RC, and NovaKone.
Prior to joining the Alden Optical team at B+L, Mr. Garza was working as a senior technical product specialist for SynergEyes. He is a Fellow of the Contact Lens Society of America and has earned the Master in Contact Lens Technology designation from the National Contact Lens Examiners.
Pioneers Lecture to Explore Drivers of MGD Development
The annual British Contact Lens Association (BCLA) Pioneers Lecture, to be delivered this year by Associate Professor Jennifer Craig from the New Zealand National Eye Centre at the University of Auckland, will explore new studies and emerging data to shed new light on factors driving the development of meibomian gland dysfunction (MGD). The Pioneers Lecture is the highlight of the BCLA Visionaries meeting, being held for the first time in conjunction with the Medical Ocular Surface and Contact Lens Association (MCLOSA).
Registration is now open for the Annual BCLA Pioneers and Visionaries meeting, which will also feature the MCLOSA Kersley Lecture to be presented by Professor Christopher Liu OBE. Other highlights will include a session titled “Contact Lenses – the side that ophthalmologists don’t see” to be delivered by Professor Phil Morgan and Dr. Nicola Logan and chaired by Professor Sunil Shah.
Lynn Winterton, PhD, Named to OcuMedic, Inc. Scientific Advisory Board
OcuMedic, Inc., a developer of a drug-eluting soft contact lens and clear corneal bandage technology, appointed Lynn Winterton, PhD, as a key member of its Scientific Advisory Board. He also has taken an ownership position with the company.
Dr. Winterton is an internationally recognized expert in polymeric biomaterials and contact lens research and development. He worked for 30 years with Ciba Vision and Alcon, Novartis companies, where he held various research leadership and corporate executive roles. He is also a named inventor and has led the research and development of a number of commercial contact lenses. In 2013, Dr. Winterton retired from corporate life and now leads three consulting companies.
Alcon Launches Air Optix Colors Contact Lenses Sweepstakes
Alcon has invited people to play with their eye color as part of the Air Optix Colors contact lenses sweepstakes for a chance to go backstage at New York Fashion Week: The Shows. To enter, wear or virtually try on one of 12 colors in the Alcon Air Optix Colors portfolio and upload a public photo of your look to Instagram using the hashtags #Sweepstakes and #ReadytoPlay. The sweepstakes, which runs through Dec. 11, 2018, highlights the newly launched Gemstone Collection of contact lenses.
Alcon has enlisted the help of two fashion-forward social media influencers, Laura Sanchez and Raye Boyce, to showcase their own favorite Air Optix Colors looks and to help spread the word about the sweepstakes to aspiring fashionistas from coast to coast. Ms. Sanchez will also be teaming up with Air Optix Colors at SEPHORiA , a one-of-a-kind experience curated by Sephora in Los Angeles.
Aveo Vision launched its new online vision test, making it even easier to order Aveo Hello contact lenses from the comfort of your home, according to the company. This allows customers to take an online vision test from their computer and/or mobile phone, have their prescription renewed by a licensed eyecare professional, and order daily disposable contact lenses—all with the click of a button.
The new online refractive eye test, which costs $20, removes the inconvenience of visiting a brick-and-mortar eyewear store to renew a prescription, according to Aveo. The online vision test is delivered through a partnership with Opternative.
I-Med Pharma Partners with Quidel to Introduce Products to the U.S Market
I-Med Pharma Inc. signed an exclusive distribution agreement with Quidel Corporation for I-MED Pharma’s I-Lid ’N Lash product line, the I-Relief Hot & Cold Therapy Eye Mask with Thermabeads, and the SMTube.
ABB OPTICAL GROUP Names New Chief Information Officer
ABB Optical Group has announced that Jonathan Mish has joined the company as chief information officer. In his new position, Mr. Mish will be responsible for overseeing the company's information technology (IT) department and leveraging technology to improve business operations and to deliver effective technology services and solutions.
He has more than 18 years of technology experience across multiple industries including retail, supply chain, distribution, and transportation. Prior to joining ABB Optical Group, he served as vice president of IT strategic operations for Ryder System, a provider of transportation and supply chain management products. He previously served as vice president of IT business transformation for Brightstar Corp. and as senior manager of IT corporate systems for Burger King Corporation.
A Few Minutes of Your Time Please
There has been a growing academic interest in myopia management over the past few years, but there is little information on what is actually happening in clinical practice. A partnership, between Contact Lens Spectrum and various international organizations such as the British Contact Lens Association, is conducting a follow-up global survey to one conducted in 2015 on myopia management. The 2018 survey can be found at https://www.surveymonkey.co.uk/r/Myopia2018en. We would really value less than five minutes of your time to share your current thoughts and practice. The information gathered will allow us to report back what is happening across the globe as well as what your peers are thinking/doing. Thank you in advance for your time.
Join Us at GSLS 2019
Plan now to attend the Global Specialty Lens Symposium (GSLS) to be held Jan. 24 – 27, 2019 at Tropicana Hotel, Las Vegas. This meeting will include insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products, and valuable continuing education credits.
GSLS is excited to offer its attendees another clinical photo contest this year. We are seeking interesting photographs of conditions, diseases or other occurrences from your clinical practice, with a special interest in contact lenses and the anterior segment. Three winning photos will be selected by a committee and will be featured on a near future issue of Contact Lens Spectrum.
This image shows the case of radial keratotomy with obstacle in the conjunctiva and on the limbus. We designed a microvault that had a 300-micron depth, 4.00mm width, and 7.00mm decentration.
We thank Kyriakos Telamitsi 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.
SPECIALTY LENS SPACE
Karen DeLoss, OD
Contact Lenses for Dry Eye?
I often see many patients referred for scleral lenses who were told that they cannot wear contact lenses. Eyecare practitioners know that the level of dry eye and contact lens tolerance varies for each patient, and symptoms do not necessarily equal signs. Many patients are referred for scleral lenses, which are an excellent option for dry eye; however, in some cases, bandage contact lenses are a viable option. Bandage contact lenses, or therapeutic lenses, are part of a large group of high-oxygen-permeability lenses that aid in healing or protecting the ocular surface.1 In many cases, they can help mitigate patients’ common dry eye complaints.
The goal of a bandage lens is to relieve symptoms of ocular surface disease by mitigating pain as well as to stabilize corneal wounds and to facilitate corneal healing.2 In addition, dry eye patients can present with symptoms in the absence of clinical signs.3 While there are many theories as to the etiology of the ocular pain, therapeutic contact lenses can be useful, particularly in this patient population or when scleral lenses fail to relieve dry eye or in the case of scleral lens intolerance.4 In the challenging setting of ocular surface disease, it can be helpful to have several options to offer to patients, and sometimes soft contact lenses may come back into the picture to serve as a therapeutic option.
1. Blackmore SJ. The use of contact lenses in the treatment of persistent epithelial defects. Cont Lens Anterior Eye. 2010 Oct;33:239-244.
2. Inamoto Y, Sun YC, Flowers ME, et. al. Bandage Soft Contact Lenses for Ocular Graft versus Host Disease. Biol Blood Marrow Transplant. 2015 Nov;21:2002-2007.
3. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004 Nov;23:762-770.
4. Rosenthal P, Baran I, Jacobs DJ. Corneal Pain without Stain: Is it real? Ocular Surf. 2009 Jan;7:28-40.
MATERIALS & DESIGNS
David L. Kading, OD
After 1 Million Lens Fits, My Conclusions*
Numbers don’t lie. That is why I love research. But in clinical practice, eyecare practitioners tend to get feelings about things that guide them in the way that they practice. These guiding principles are the things that make them better clinicians. Practitioners tend to have a lot of studies with N = 1, but each of those Ns represent a person whom they have impacted.
I am a big fan of daily disposable materials. On the other hand, many practitioners have offered numerous excuses as to why they do not have > 50% or 70% of their patients in that modality. I always note that daily disposables are more cost-effective for both part-time and daily wearers, and they are far more convenient and certainly result in better compliance. What practitioners still do not have is longitudinal studies showing that after 10 years of use, daily disposable wearers have less corneal pathology. That said, any time I ask practitioners what the healthiest lens modality is, I universally hear: “Daily Disposables.”
Our practice made the shift about five years ago and decided to go all-in on dailies. I remain disappointed that we are at 93% and that we cannot get it to 100%. What I am not disappointed about is the observed clinical impact. Patients don’t tend to return for contact lens-related pathology like they used to. Our optometric interns frequently report how often they don’t see a single patient who has an infiltrative event or bacterial-related infection caused by contact lens wear. In the past, therapeutics were frequently prescribed. Now, steroid and antibiotic medication usage is way down for our patients compared with five years ago.
In conclusion, daily disposables have shifted the patient base in terms of comfort, convenience, cost, and health. Isn’t it time for other practitioners to shift their patients into the healthiest modality?
* Note: although it seems like 1 million fits, that number in the title is a gross exaggeration
Tear Film Inflammatory Cytokine Upregulation in Contact Lens Discomfort
The purpose of this study was to investigate the ocular inflammatory response, using clinical and immunological techniques, in people experiencing contact lens (CL) discomfort.
This study involved 38 adults who were full-time, silicone-hydrogel CL wearers. Participants were categorized into groups based upon a validated Contact Lens Dry Eye Questionnaire (CLDEQ-8) (asymptomatic: n = 17, CLDEQ-8 score < 9; symptomatic: n = 21, CLDEQ-8 score ≥ 13). Examinations were performed at two visits (one with and one without CL wear), separated by one week. Testing included tear osmolarity, ocular redness, tear stability, ocular surface staining, meibography, tear production, and tear collection. Tear osmolarity was taken from the inferior- and superior-lateral menisci. The Inferior-Superior Osmotic Difference (I-SOD) was the absolute osmolarity difference between these menisci. Concentrations of seven cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-gamma, TNF-alpha) were assayed from basal tears using multiplex cytometric bead array.
The researchers found that, at baseline, there was no significant difference in key clinical signs between asymptomatic and symptomatic CL wearers (p > 0.05). The I-SOD was greater in symptomatic than in asymptomatic CL wearers (23.1 ± 2.6 mOsmol/L versus 11.3 ± 1.4 mOsmol/L, p = 0.001). People experiencing CL discomfort had higher tear IL-17A (122.6 ± 23.7 pg/mL versus 44.0 ± 10.0 pg/mL, p = 0.02) and reduced tear stability (6.3 ± 1.1 seconds versus 10.4 ± 1.6 seconds, p = 0.03) after several hours of CL wear. Tear IL-17A levels correlated with the I-SOD (r = 0.43, p = 0.01) and CLDEQ-8 score (r = 0.40, p = 0.01).
The study concluded that CL discomfort occurs in individuals having no clinical dry eye signs and is associated with higher tear levels of the pro-inflammatory cytokine IL-17A. These findings support an association between the discomfort response and low-grade ocular surface inflammation.
Gad A, Vingrys AJ, Wong CY, Jackson DC, Downie LE.Tear film inflammatory cytokine upregulation in contact lens discomfort. Ocul Surf. 2018 Oct 12. [Epub ahead of print]