As you review our monthly poll results that relate to the impact of daily disposables in clinical practice, I think you will find an interesting result. The majority of respondents this month (51%) said that the area in which daily disposables have the greatest impact is improving patient compliance with lens replacement. This response surpassed improving contact lens discomfort and reducing complications such as infiltrative events and microbial keratitis.
I find this trend very intriguing in that the order of the responses is somewhat opposite to the responses of a similar Quick Poll we ran six years ago (http://www.cltoday.com/issues/CLToday_100911.htm). In the previous poll, ensuring compliance had the lowest response rate (only 6%!), and optimizing ocular health had the highest response rate.
I think we can all agree, however, that regardless of your reasons for prescribing daily disposable contact lenses, they can offer a wealth of benefits for your patients.
Jason J. Nichols, OD, MPH, PhD
B+L Offers Boston Materials Guarantee
Bausch + Lomb’s Specialty Vision Products (B+L SVP) Business now offers a Boston Materials Guarantee. If patients are not 100% satisfied with the wettability or breakability of any Boston lens material for six months, they may work through their eyecare professional to exchange it for an equivalent lens manufactured from Boston GP lens material. The guarantee is available through participating Authorized Boston Manufacturers, including Alden Optical and Unilens.
Paragon Vision Sciences and Essilor China Extend Partnership
Paragon Vision Sciences has extended its business partnership with Essilor China, who serves as the exclusive distributor of Paragon’s CRT Contact Lenses in China.
Essilor and Paragon began their China partnership in 2014. This collaboration resulted in the successful launch of CRT in China in March of this year. The new agreement will extend the working relationship through the next five years, continuing with Essilor being the master distributor for CRT lenses in China.
Scleral Lens Book Available for Pre-Order
Bentham Science Publishers is publishing Contemporary Scleral Lenses: Theory and Application, edited by Drs. Melissa Barnett and Lynette Johns. This in-depth book covers the history and evolution of scleral lenses, basic scleral lens structure, optics and customizable features of scleral lenses, analysis of ocular surface shape, ocular surface topography, and advances in technology. These topics provide an explanation of how to utilize diagnostic equipment and enable practitioners to employ a scientific and objective approach to scleral lens fitting. Geared for students and practitioners alike, there are clinical pearls throughout the text that can even enhance the practice style of seasoned scleral lens practitioners.
International Vision Expo and OptiCon have announced a partnership to bring OptiCon’s optician and contact lens technician education program to the largest gathering of eyewear and eyecare professionals in the Americas.
Beginning in 2018, the dedicated educational programing previously found at OptiCon, plus additional sourcing and networking opportunities for opticians and contact lens technicians, will be offered alongside the expansive International Vision Expo continuing education program. OptiCon @ Vision Expo is designed to provide opticians and contact lens technicians with the highest quality and most affordable opportunity to learn, source, and network with peers. In addition, attendees will find a new show floor destination designed specifically for opticians and contact lens technicians—the “OptiCon Hub”—hosting pop-up talks, networking, social events, and access to representatives and resources from ABO&NCLE, NAO, OAA, CLSA, and NFOS as well as vendor partners.
This partnership provides the same preferred pricing structures previously available at OptiCon shows. Now at Vision Expo, opticians and contact lens technicians have access to a comprehensive education package that includes:
• 15 hours of ABO&NCLE continuing education
• Exhibit hall access
• Lunch vouchers
• Tailored special events including a general session, welcome party, and peer networking
• Access to discounted rates at a dedicated OptiCon hotel
Educational programming will cover four key areas: spectacles, contact lenses, business, and exam review. In addition, opticians and contact lens technicians can now take ABO&NCLE review courses and sit for the exams at both Vision Expo East and West. Visit www.visionexpo.com.
AAOF Announces 2017 Johnson & Johnson Vision Residency Awards
The American Academy of Optometry Foundation (AAOF) recently announced the recipients of the 2017 Johnson & Johnson Vision Residency Awards:
Terrance N. Ingraham Pediatric Residency Award: Amanda E. Beaudry, OD, MS, Southern California College of Optometry at Marshall B. Ketchum University, and Kristen L. Kerber, OD, MS, New England College of Optometry.
George Mertz Contact Lens Residency Award: Jamie Kuzniar, OD, Indiana University School of Optometry; Kelsy R. Steele, OD, MS, The Ohio State University College of Optometry; and Grace Liao, OD, Southern California College of Optometry at Marshall B. Ketchum University.
Sheldon Wechsler Contact Lens Residency Award: Trevor J. Fosso, OD, Illinois College of Optometry; Emily M. Korszen, OD, Pacific University College of Optometry; and Jessica Jose, OD, Illinois College of Optometry.
These residency awards are envisioned to support post-graduate, advanced training in optometric clinical care, education, and research methods specific to the fields of children’s vision and contact lenses. The 2017 residents, carefully chosen by peer review members from the American Academy of Optometry (AAO) Cornea, Contact Lenses, and Refractive Technologies Section and the Binocular Vision and Pediatric Optometry Section, each received $2,000 toward their graduate education and a $750 travel fellowship to attend Academy 2017 Chicago last month.
The AAOF recognized these exceptional residents at Academy 2017 Chicago during the AAOF Celebration Luncheon on Saturday, Oct. 14.
In which of the following areas do you feel that daily disposable contact lenses have the greatest impact?
Celia de Lourdes Feliciano, OD, Santa Isabel, Puerto Rico
This patient arrived at my office with severe ocular pain, swollen lids, and secretions. She thought that she had conjunctivitis. She reported that symptoms had begun two days prior. She was a contact lenses wearer who slept in her lenses. In addition, she routinely discarded her lenses every three months rather than the prescribed 30 days.
I diagnosed her as having a severe corneal ulcer with hypopyon. She was prescribed Vigamox (moxifloxacin 0.5%; Alcon) one drop q1h. Subsequently, the corneal specialist added Besivance (Besifloxacin 0.6%; Bausch + Lomb).
Now that the eye has healed and because she has a thin cornea, we may fit her with a scleral contact lens.
We thank Dr. Celia de Lourdes Feliciano 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
There Are Multiple Ways to Skin the Cat for Myopia Progression
Awareness in the ophthalmic community about the alarming increase in myopia prevalence and the implications of higher degrees of myopia is developing across all of the “O’s.” No longer are we debating the importance of addressing this issue, and no longer can we claim that there is insufficient evidence to support multiple modalities that can be used to control myopia progression in young individuals (corneal reshaping/orthokeratology, pharmacological/atropine therapy, and the use of multifocal daytime wear contact lenses). The greater challenge, however, is to have more clinicians incorporate myopia management into their practices or, minimally, actively refer appropriate patients to those who do.
A recent article provided further evidence that soft distance-center multifocal contact lenses can reduce the rate of myopia progression in documented progressive myopes.1 The objective of the study was to determine the rate of myopia progression in children fit with a commercially available extended depth of focus (EDOF; center-distance) multifocal soft contact lens that has attributes theoretically expected to slow the progression of myopia.
A retrospective case series analysis of 32 patients (ages 6 to 19 years, mean 10.98 years ± 2.95 years) from 10 practice locations was performed. At initial presentation, 44% wore spectacles, 37.5% wore spherical soft contact lenses, 15.6% wore a different soft multifocal contact lens, and 3% wore orthokeratology lenses. All participants showed progression of at least –0.50D with current corrections and were fit with an EDOF (center-distance) multifocal soft contact lens. Follow-up time was 6 to 25 months (mean: 10.94 months ± 4.76 months).
The researchers found reductions in the annualized rate of myopia progression from –0.85D per year ± 0.43D to –0.04D per year ± 0.18D (P < 0.00000) OD, –0.90D per year ± 0.57D to –0.03D per year ± 0.17D (P < 0.00000) OS. These data represent a reduction of 95.4% OD and 96.25% OS. Approximately 98.4% of the children showed reduction of annualized myopia progression; 91% showed a decrease of 70% or greater. Overall, 81.25% showed complete halting of myopia progression, including 6.25% demonstrating myopia regression. The researchers concluded that this unique EDOF (center-distance) daily disposable multifocal contact lens was effective in slowing myopia progression in these children.
With the availability of multiple modalities of treatment for the control of myopia progression, clinicians have the ability to determine the most appropriate treatment approach for individual patients based upon clinical findings, lifestyle factors, and philosophic approach. Again, our challenge now is to simply get more practitioners on board to actively take on myopia. Where are you on this issue today in your practice?
1. Cooper J, OʼConnor B, Watanabe R, Fuerst R, Berger S, Eisenberg N, Dillehay SM. Case Series Analysis of Myopic Progression Control With a Unique Extended Depth of Focus Multifocal Contact Lens. Eye Contact Lens. 2017 Oct 19. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
The Smoke Is Lifting
Last week, in one of my favorite places for a Brooklyn bagel, I stood at the counter to enjoy a coffee and a quick nosh. As I glanced over to my neighbor at the counter, I spied his Daily News, which had a cover story on vaping. Vaping, or electronic nicotine and vapor delivery systems, includes e-cigarettes, vaping pens, e-hookah, and similar devices that typically contain nicotine.
For those of you who read my offerings to Contact Lenses Today, you know that vaping or electronic cigarettes is a top-of-mind topic for me.
According to a recent U.S. Surgeon General’s report,1 tobacco use among youth and young adults in any form, including e‐cigarettes, is not safe; nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain. In contrast to the effects of tobacco smoking, the impact of vaping on the ocular surface is not well understood.
The New York State Department of Health found that e-cigarette use by high school students nearly doubled from 10.5% in 2014 to 20.6% in 2016. Additionally, the U.S. Surgeon General’s report1 shows that the number of high school students using e-cigarettes soared 900% between 2011 and 2015, becoming the most commonly used form of nicotine among youths.
Recently, Gov. Andrew M. Cuomo signed legislation (S.750 / A.611) that will immediately ban the use of electronic cigarettes on all public and private school grounds in New York State. This adds e-cigarettes to New York’s Clean Indoor Air Act. I would like to think that this legislation is a step not only to protect our youth, but also to protect the exquisite balance of the ocular surface.
1. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General—Executive Summary. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.
Stromal Striae: A New Insight into Corneal Physiology and Mechanics
The authors of this study uncovered the significance of a previously unappreciated structural feature in the corneal stroma important to its biomechanics. Vogt’s striae are a known clinical indicator of keratoconus and consist of dark, vertical lines crossing the corneal depth. However, the authors detected stromal striae in most corneas, not only in keratoconus.
Striae were observed with multiple imaging modalities in 82% of 118 human corneas, with pathology-specific differences. Striae generally depart from anchor points at Descemet’s membrane in the posterior stroma obliquely in a V-shape; in keratoconus, striae depart vertically from posterior toward anterior stroma. Optical coherence tomography shear wave elastography showed discontinuity of rigidity. In addition, second harmonic generation and scanning electron microscopies showed undulation of lamellae at striae locations. Striae visibility decreased beyond physiological pressure and increased beyond physiological hydration. Immunohistology revealed striae to predominantly contain collagen VI, lumican, and keratocan. The role of these regions of collagen VI linking sets of lamellae may be to absorb increases in intraocular pressure and external shocks.
Grieve K, Ghoubay D, Georgeon C, Latour G, Nahas A, Plamann K, Crotti C, Bocheux R, Borderie M, Nguyen TM, Andreiuolo F, Schanne-Klein MC, Borderie V. Stromal striae: a new insight into corneal physiology and mechanics. Sci Rep. 2017 Oct 19;7:13584.