As noted in the results from the October 2018 Quick Poll, more respondents believe that hydrogel materials have better on-eye tear film coverage compared to silicone hydrogel materials. However, there was also a good percentage of respondents who believed that there is no difference between the soft lens material classifications and tear film wetting of the pre-lens tear film.
These results point toward an area in which there is a lack of consensus—either knowledge gained from clinical research or clinical practice—in terms of soft lens material tear film wetting characteristics. It may also point toward individual variability in various tear film parameters that can impact wetting of the pre-lens tear film. Whatever the cause, more understanding is definitely needed to help guide the best material characteristics for each individual patient.
Jason J. Nichols, OD, MPH, PhD
DryEyeAccess.com, a subscription-based education website that helps ophthalmology and optometry practices understand how to identify, diagnose, and treat patients who have dry eye disease, is now available.
DryEyeAccess.com is built on content developed for Dry Eye University, a dry eye education program that was created by clinicians and staff at Bowden Eye & Associates in Jacksonville, FL. It is supported by four distinct advisory boards: an ophthalmology board, an optometry board, an administrator board, and a board composed of leaders from different eyecare companies.
The web site consists of more than 25 clinical learning modules, white papers, case studies, diagnostic and therapeutic product overviews, implementation protocols, and information that includes everything from staff training to financing. Future modules will extend beyond clinical information to present education, insights, and resources that address the business challenges and patient education needs that are unique to dry eye disease.
Johnson & Johnson Vision Launches MyAcuvue Subscription Program
Johnson & Johnson Vision launched its MyAcuvue Subscription Program that, according to the company, was developed to provide contact lens wearers with greater access and convenience when purchasing an annual supply of Acuvue Brand contact lenses through their eyecare professional.
Following a comprehensive eye exam and contact lens fitting with an eyecare professional, patients have the option to purchase an annual supply of lenses whereby they can either maximize savings by using MyAcuvue Rewards or spread out the cost into affordable payments with MyAcuvue Subscription.
Orders through the subscription program are placed through the eyecare professional’s practice and shipped directly from Johnson & Johnson Vision Care, Inc. to the contact lens wearer. There are no fees to the eyecare practice to participate. In addition, shipping is free, and the program will allow lens wearers to use their full insurance benefit. Eyecare practices set pricing for their patients. The MyAcuvue Subscription Program is offered through Johnson & Johnson Vision Care, Inc.
American Academy of Optometry Announces Executive Director Departure
The American Academy of Optometry has announced that its long-serving executive director, Lois Schoenbrun, will step down from her position in April 2019. Ms. Schoenbrun has been executive director of the American Academy of Optometry and the American Academy of Optometry Foundation since 1996.
The organization is initiating a search to identify a new leader. It has formed a search committee to oversee the process and has retained executive search firm Vetted Solutions to coordinate the search. The search will commence immediately, and the organization’s goal is to have a new executive director identified by Feb. 1, 2019.
Orasis Appoints Jeffry Weinhuff as Chairman of the Board of Directors
Orasis Pharmaceuticals Ltd., a clinical-stage pharmaceutical company developing a corrective eye drop for the treatment of presbyopia as an alternative to reading glasses, announced the appointment of Jeffry Weinhuff as chairman of the board of directors. As a managing partner of Visionary Ventures, Mr. Weinhuff joins the Orasis board of directors in conjunction with the recent Series B financing led by venture capital fund Visionary Ventures. Mr. Weinhuff has been active in the private equity realm for more than 30 years and is the managing partner of Visionary Venture Fund.
Just a Few More Days Left to Save
Register by Nov. 2 to take advantage of Early Bird pricing for the 2019 Global Specialty Lens Symposium. Being held Jan. 24 through Jan. 27, this must-attend 3.5-day conference focuses on the successful management of ocular conditions using today's specialty contact lenses through continuing education and networking. www.GSLSymposium.com
Which reusable soft lens material is associated with the longest pre-lens tear film breakup time?
Scleral lens edge alignment is imperative for comfort and to reduce fogging. The left image shows a scleral lens on a left eye, viewed under a microscope in straight-ahead gaze. The lens appears very well aligned. The right image is of the same lens on the same eye viewed from an off-axis angle with retro-illumination. Notice the shadowing behind the edge of the lens; this shows that the edge is not actually completely aligned with the eye. Proper adjustments can be made to improve comfort and fogging issues with this patient. Sometimes looks can be deceiving!
We thank Dr. Pillai 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
Another Level of Scleral Lens Analysis—Use of OCTA in Scleral Lens Diagnostics
The introduction of advanced diagnostic technologies is intended to improve practitioners’ diagnostic performance. As it relates to scleral contact lens fitting, appropriate corneal clearance and lens landing on the bulbar conjunctiva above the sclera is critical to lens performance and physiological response. More and more contact lens practitioners have added optical coherence tomography (OCT) technologies in their offices. The use of anterior segment OCT (AS-OCT) allows for a precise measurement of scleral lens corneal clearance or vaulting as well as assessment of the landing pattern peripherally. Both peripheral landing compression and edge lift can result in comfort issues as well as potential physiological compromise.
A recent study looked at a new element of OCT technology termed optical coherence tomography angiography (OCTA) that evaluates vascular flow patterns. In this case, researchers looked at conjunctival vascular flow in the areas near and around the lens landing areas.1 A pilot study was performed fitting three different scleral contact lenses (Irregular Corneal Design [ICD]) with different sagittal heights (4200µm, 4800µm, and 5600µm) in a healthy 27-year-old volunteer. Using OCT (DRI Triton), the researchers evaluated the apical clearance achieved with each of the three lenses fitted. The impact on scleral flow was assessed with the OCTA module of the same device.
The apical clearance was 310µm, 901µm, and 1680µm with the scleral lenses of sagittal heights 4200µm, 4800µm, and 5600µm, respectively. With OCTA, they evaluated the impact of the lens bearing on the conjunctival vascular flow, observing an area of vascular interruption of 0%, 25%, and 75% with the lenses of 4200µm, 4800µm, and 5600µm of sagittal heights, respectively. The vascular interruption was induced in the perilimbal area, suggesting the need of readjusting the limbal clearance zone of the lens.
The researchers concluded from this pilot study that scleral contact lens fitting may be optimized with the use of OCTA, allowing practitioners to perform the fitting with better control of the peripheral bearing of the lens on the conjunctival tissue, assessing the impact on vascular structures.
The impact of OCTA on scleral lens fitting assessment has great potential to further advance our ability to fit scleral lenses that provide optimized vision and improved ocular surface response, all while maximizing physiological outcomes. Further research is needed regarding OCTA applications in scleral lens fitting along with the development of software programs to make such analysis clinically efficient.
1. Gimenez-Sanchis I, Palacios-Carmen B, García-Garrigós A, Cantó-Vañó J, Pérez-Ortega AJ, Piñero DP. Anterior segment optical coherence tomography angiography to evaluate the peripheral fitting of scleral contact lenses. Clin Optom (Auckl). 2018 Sep 4;10:103-108.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
It Is Here At last!
I have been waiting for a specific smartphone feature, and it has finally arrived!
Digital eye strain, an emerging public health issue, is a condition characterized by visual disturbance and/or ocular discomfort related to the use of digital devices and resulting from a range of stresses on the ocular environment. As many as 90% of digital device users experience symptoms of digital eye strain.1 Studies suggest that multiple factors are associated with digital eye strain. Prevention is the main strategy for management of digital eye strain and includes ensuring an ergonomic work environment and visual hygiene practice through patient education.1
It is likely that the amount of time patients report using digital devices is well-underestimated. One popular smartphone is now equipped to monitor how much time the owner spends using the device. It also allows users to program downtime, set locked time limits for applications for the individual or shared family users, and set content blocking.
Be a dry eye hero and share this information with your patients so that they can be proactive participants in their ocular health.
1. Coles-Brennan C, Sulley A, Young G. Management of digital eye strain. Clin Exp Optom. 2018 May 23. [Epub ahead of print]
Maximum Blink Interval Is Associated with Tear Film Breakup Time: A New, Simple Screening Test for Dry Eye Disease
The prevalence of dry eye disease (DED) is increasing worldwide, and its diagnosis often needs dedicated reagents and machines. The purpose of this study was to investigate the usefulness of maximum blink interval (MBI; the length of time that participants could keep their eyes open) in screening for DED.
The cross-sectional study included 292 patients (194 who had DED and 98 who did not have DED) recruited between Sept. 2016 and Sept. 2017. The researchers compared the MBI between patients who did and did not have DED. They examined correlations between MBI and other clinical features of DED, including subjective symptoms (Dry Eye-Related Quality-of-Life Score), tear film breakup time (TFBUT), cornea fluorescence score (CFS), and Schirmer test I value. Additionally, the researchers determined the optimal cutoff value of MBI to suspect DED using a receiver operating characteristic (ROC) analysis.
The MBI was significantly shortened in the DED group compared to the non-DED group (10.0 ± 9.1 seconds versus 24.3 ± 38.2 seconds, p < 0.001). TFBUT was strongly positively correlated with MBI (r = 0.464), whereas CFS was negatively correlated with MBI (r = –0.273). The area under the ROC curve was 0.677, and the optimal MBI cutoff value was 12.4 seconds, providing a sensitivity of 82.5% and specificity of 51.0% to suspect DED.
In conclusion, the study results showed that MBI may be a simple, useful test for screening DED.
Inomata T, Iwagami M, Hiratsuka Y, et al. Maximum blink interval is associated with tear film breakup time: A new simple, screening test for dry eye disease. Sci Rep. 2018 Sep 7;8:13443.