Based on this month’s Quick Poll results, there is clearly a need for more research about the impact of scleral lens wear on intraocular pressure. If you have thoughts on the topic, we would love to hear from you. Share your views with our readership by emailing me directly at firstname.lastname@example.org.
Jason J. Nichols, OD, MPH, PhD
Optometry Giving Sight Establishes New Board
Optometry Giving Sight (OGS) has established a new board of directors to oversee the organization. Dr. Juan Carlos Aragón, president of CooperVision’s Specialty Eye Care Division, is the president of the new board. He previously served as Optometry Giving Sight’s chair of its Advisory Council U.S.A. and was on its Global Board for several years.
Joining Dr. Aragón on the board are Dr. Howard Purcell, president and CEO of New England College of Optometry; Yvette Waddell, CEO of Brien Holden Vision Institute Foundation; Dr. Susan Cooper, former president of the World Council of Optometry; and Dr. Earl Smith, former dean of the University of Houston College of Optometry.
Oculus Licenses Predictive Algorithm Technology for Refractive Error Management Developed by BHVI
Brien Holden Vision Institute (BHVI) and Oculus Optikgeräte GmbH announced an agreement in which Oculus will incorporate BHVI’s algorithms for tracking and estimating refractive error into its Myopia Master ophthalmic instruments. According to the company, the Oculus Myopia Master combines all of the important measurement methods of myopia management including axial length, refraction values, and the central corneal radii. Oculus, BHVI, and the Shanghai Eye Disease Prevention and Treatment Center (its collaboration partner) will continue to work together to develop further functionality of Oculus’ Myopia Master featuring myopia management software incorporating a unique refractive outcome algorithm.
In unrelated news, BHVI launched its Myopia Education Program at the 2019 American Academy of Optometry meeting. With the launch, all three courses are available in an anytime, anywhere format, which enables eyecare professionals to complete the program in their own time. According to the company, the use of interactive case studies, videos, polls, and discussions gives participants an interactive, engaging, and supported learning experience. Participants have a six-week time frame in which to complete the courses. The BHVI Myopia Education Program addresses managing myopia from both a clinical and a business practice perspective. The current program includes three modules: Managing Myopia – Changes the way you understand and treat myopia; Complex Cases – Strategies and tools to help confidently manage more complex myopia cases; and The Business of Myopia – Maximize business results and grow your practice through managing myopia.
B+L Introduces PreserVision AREDS 2 Formula Minigel Eye Vitamins
Bausch + Lomb (B+L) announced the U.S. launch of PreserVision AREDS 2 Formula minigel eye vitamins. The new minigels will replace the currently offered PreserVision AREDS 2 Formula soft gels, offering patients an easier-to-swallow option as compared to the original AREDS 2 soft gels, according to the company. B+L says that PreserVision AREDS 2 Formula minigel eye vitamins contain the exact nutrient formula recommended by the National Eye Institute (NEI) for people who have moderate-to-advanced age-related macular degeneration (AMD). PreserVision AREDS 2 minigel eye vitamins are available at major retailers nationwide in the vitamin aisle and have a suggested retail price of $32.99 for a 120-count bottle.
Tangible Hydra-PEG Available on Most GP Lenses
Tangible Science LLC announced that the following GP lens materials can now be coated with Tangible Hydra-PEG: Acuity Polymers – Acuity 200 (available in non-U.S. markets); Bausch + Lomb – Boston XO, Boston XO2, Boston ES, and Boston EO; Contamac – Optimum Classic, Optimum Comfort, Optimum Extra, Optimum Extreme, Optimum Infinite, and HEXA 100; Paragon – FluoroPerm and Paragon HDS; and SynergEyes – Duette and UltraHealth hybrid materials.
U.S. laboratories that offer Tangible Hydra-PEG coating on finished custom lenses include ABB Optical Group, AccuLens, Advanced Vision Technologies (AVT), Alden Optical, Art Optical, Blanchard Contact Lenses, BostonSight, Essilor Contact Lens Specialists, GP Specialists, Metro Optics, SynergEyes, TruForm Optics, Valley Contax, Visionary Optics, Visionary, and X-Cel Specialty Contacts. International laboratories include Corneal Lens Corporation, Falco, Galifa, Hetych Kontaktlinsen, LCS, Mediphacos, Medlac Iovino, Multi-Lens, NKL, Northern Lenses, and No.7.
Eyevance Pharmaceuticals Acquires TobraDex ST and Natacyn
Eyevance Pharmaceuticals announced the acquisition of TobraDex ST (tobramycin/dexamethasone ophthalmic suspension) 0.3%/0.05% and Natacyn (natamycin ophthalmic suspension) 5% from Novartis.
TobraDex ST, which is U.S. Food and Drug Administration (FDA)-approved in the United States, is a fixed-dose topical antibiotic and corticosteroid combination indicated for steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and in which superficial bacterial ocular infection or a risk of bacterial ocular infection exists.
Eyevance also acquired the global rights to Natacyn, an FDA-approved ocular antifungal, which is listed on the World Health Organization's (WHO) list of essential medicines. Natacyn is indicated for the treatment of fungal blepharitis, conjunctivitis, and keratitis caused by susceptible organisms including Fusarium solani keratitis.
Notal Vision Announces Appointment of Dr. Kester Nahen as CEO
Notal Vision Ltd. announced the appointment of Kester Nahen, PhD, as CEO. Dr. Nahen joined the company as COO in August 2019, bringing a wealth of global leadership experience in the medical device industry to his new position.
Prior to joining Notal Vision, Dr. Nahen was managing director of ophthalmic diagnostic device manufacturer Heidelberg Engineering GmbH and served on the board of the company’s U.S. subsidiary. From 2001 to 2006, Dr. Nahen worked at Laserscope Inc., a Silicon Valley-based medical laser company.
CLX and Crystal PM Announce Integration
CLX, a contact lens management and marketing system, has completed a system integration with practice management system Crystal PM. CLX says that with the integration, Crystal PM users can now effectively compete with online retailers by offering their patients a mobile-enhanced, secure option to reorder contact lenses directly from their practitioner. The CLX Capture Strategy includes functionality designed to identify patients due to reorder contact lenses, automatically send an email or text notification, and prompt patients to reorder by providing a personalized link. Another feature of the integration allows Crystal PM users to offer a contact lens subscription to their patients. Both reorders and subscriptions are managed by the CLX System.
Do you believe that scleral lens wear is associated with an increase in intraocular pressure?
This patient has a history of an alkaline burn with multiple penetrating keratoplasty (PK) and limbal stem cell grafts. The patient presented to our clinic with a non-healing epithelial defect on the eye.
We thank Dr. Bedi 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
It’s that time of year when patients come in requesting to be fit for cosmetic or decorative contact lenses for their Halloween costumes. This is exactly what practitioners hope for—patients who want a safe and healthy contact lens option. On the flip side, a quick search of the internet reveals a ton of sites selling cosmetic contact lenses for costume purposes, even scleral lenses! The websites claim that the contact lenses are safe and “approved” by all kinds of organizations, which may provide a false sense of security to buyers that those lenses are safe. One website even states that you can safely wear its scleral lenses for three hours! Hmmm.
This situation serves as an opportunity to educate patients about the importance of U.S. Food and Drug Administration (FDA) clearance, Federal Trade Commission (FTC) oversight, and prescription laws regulated by the states. But, what does that really mean? The FDA specifically regulates and monitors clearance, marketing, and labeling of contact lenses. Retailers are required to be presented with, and validate, contact lens prescriptions, but many slip through the cracks. Contacting the FDA via MedWatch is one way to alert the authorities about adverse events related to medical devices.2 Another option is utilizing the American Optometric Association website to help combat illegal sales.3 Regardless of what avenue we take, it is our duty to report contact lens sales problems if we witness them.
Margaret has been my patient for the last seven years. She is a lovely 72-year-young lady. Having lost her husband two years ago, she has decided to move on with her life by enjoying time with her friends and family and by meeting new people. She has a youthful spirit and, recently, a look that I have not seen in her before. She told me that her daughter wears multifocal contact lenses and that she would like to wear them as well. She recently had cataract surgery, so her distance vision is nearly plano with 0.50D of cylinder. Additionally, she requires a strong add power. She carries around reading glasses when she is not wearing full-time vision correction. I shared with Margaret the obstacles that switching to multifocals would pose for her, but she insisted that she was up for the challenge and had all the time in the world to work with me to adapt to them. Not being someone who says no to a young lady like Margaret, we got to work.
In my experience, the biggest challenge that someone like Margaret will face when transitioning to multifocal vision is cortical adaptation. We initially tried using some standard soft multifocals by following the fitting guides, but she complained about distance vision and shadows. We then attempted to shift one eye for distance and one for near, but she complained that her depth perception wasn’t the same, and she was unwilling to continue. At this point, I reminded Margaret about our prior discussions; she looked at me and said “try something else.”
So, I decided to work through the cortical adaptation at a slower pace. I fit her with very low-add lenses that only slightly changed her vision in the distance. I explained that she was not to go even a single day without wearing the lenses and that she should wear reading glasses over her lenses to improve her near vision. She came back to the office and shared that she was able to see the computer just fine and could even make out the menu during her lunch dates with slightly better clarity. Over the next couple of weeks, I slowly increased the add power in her lenses.
Through this process, we were able to help her adapt to lens wear, but not with a sudden change. Margaret was overjoyed with our final outcome and said that she could not wait to wear the lenses on her upcoming date.
Topical Review: Effects of Contact Lens Wear on Corneal, Conjunctival, and Lid Margin Sensitivity
The purpose of this review was to examine and summarize the current evidence for the impact of both historical and contemporary contact lens wear on ocular surface sensitivity, the etiology of changes in ocular surface sensitivity, contact lens wear-related factors associated with changes in ocular surface sensitivity, and the relationship between sensitivity and discomfort.
Contemporary soft contact lenses do not affect mechanical sensitivity of the cornea, whereas conjunctival sensitivity increases compared to non-wearers. Orthokeratology lens wear, however, reduces corneal sensitivity. The effects of contact lenses on lid margin sensitivity are unclear, and the link between ocular surface sensitivity and discomfort requires further exploration. Although up to 50% of contact lens wearers experience discomfort with varying severity, impact, and frequency, the relationship between ocular surface sensitivity and ocular surface discomfort experienced during contact lens wear is unclear.
Despite minimal effects on mechanical corneal sensitivity with contemporary soft contact lens wear, orthokeratology reduces corneal sensitivity through pressure-related effects. This review addressed the relevance of conjunctival and potentially lid margin sensitivity in tolerance and discomfort with contemporary lens wear and the impact of instrument and stimulus characteristics. Less invasive techniques particularly for lid margin sensitivity measurements are required. Given the potential interactions between a contact lens and the varied types of ocular surface nociceptors, instruments that allow for exploration of cold and chemical sensitivity particularly may better allow the effects of lens wear to be elucidated compared to those that explore high-threshold mechanical sensitivity alone.
The authors concluded that a better understanding of the relationships between lens wear and ocular surface sensitivity may result in improved management of contact lens discomfort.
Stapleton F, Chao C, Golebiowski B. Topical Review: Effects of Contact Lens Wear on Corneal, Conjunctival, and Lid Margin Sensitivity. Optom Vis Sci. 2019 Oct;96:790-801.