It is that time of year when we start our planning for our much-anticipated annual report, which features trends in contact lens prescribing both in the United States and abroad. As part of this process, we ask our Contact Lens Spectrum readers to complete a quick survey to help inform and broaden our findings specific to what these eyecare practitioners are using in their practices. The survey is located here, and our publisher greatly appreciates a few moments of your time.
Jason J. Nichols, OD, MPH, PhD
In Memoriam: Frank “Uncle Frank” Fontana, OD
On Oct. 3, our profession—and the contact lens world—lost one of the most iconic and popular optometrists of all time with the passing of Dr. Frank Fontana, who had suffered a massive stroke a few days prior. Having never fully retired, it was only appropriate that he was, at age 96, very engaged at Vision Expo West in Las Vegas when his health issue occurred. Dr. Fontana, affectionately known as "Uncle Frank," possessed an ever-present smile that radiated and made everyone around him feel important and special; his "nieces" and "nephews" were too numerous to count.
Dr. Fontana served his country for three years during World War II, including 28 months of overseas duty in the European Theatre of Operation. By chance, he was selected into the Medical Corps, and that initiated his interest in optometry. Upon his discharge, he enrolled (via the G.I. Bill) into the (then) Northern Illinois College of Optometry. Upon graduation in 1950, he established his St. Louis-based private practice, Fontana Eyecare Associates; he only recently retired from patient care. As was true of so many of his optometric contemporaries, soon after he initiated practice, he was taught how to fit contact lenses by Drs. Newton Wesley and George Jessen. He went on to become one of the pioneers—and exceptional promoters—of contact lenses and their benefits.
He co-founded the American Optometric Association (AOA)’s Contact Lens & Cornea Section (CLCS) and has received several honors from the CLCS including its (lifetime) Achievement Award and the Legends Award. He also served on the original board of directors for the Heart of America Contact Lens Society and was a Diplomate in the Cornea, Contact Lenses and Refractive Technologies Section of the American Academy of Optometry. In 2014, he was honored as the first recipient of the Review of Optometry Visionary Award. He was recognized as one of the 50 most influential in optometry by Optometric Management. And, in 2012, he achieved one of the industry’s highest honor when he was inducted into the National Optometry Hall of Fame.
His legacy, however, goes well beyond being one of the most renowned and recognizable contact lens specialists in the world. He had an impact on everyone he met. Regardless of your status, race, or gender, you were treated as a cherished member of his immediate family. There is no greater tribute that we can give to another person than the love that we all felt for Uncle Frank. This is perhaps best summed up by his good friend and former associate, P. Douglas Becherer, OD: “Optometry was his world. He was a crusader for the profession and everyone who was involved with it. We will miss him but are grateful for the impact he had on our lives and our profession.”
—Contributed by Ed Bennett, OD, MSEd, clinical features editor for Contact Lens Spectrum.
Therapeutic Use of DigiForm Scleral in Optimum Extra and Optimum Extreme Materials
TruForm Optics announced the therapeutic use of its DigiForm Scleral contact lens through the company’s strategic partnership with Contamac, which received U.S. Food and Drug Administration (FDA) 510(k) clearance for Optimum Extra and Optimum Extreme contact lens materials to treat dry eye conditions.
Optimum Extra and Optimum Extreme lens materials are suitable for therapeutic use in eyes that have ocular surface disease (e.g., ocular graft-versus-host disease, Sjögren’s syndrome, dry eye syndrome, and filamentary keratitis), limbal stem cell deficiency (e.g., Stevens-Johnson syndrome, and chemical, radiation, and thermal burns), disorders of the skin (e.g., atopy, ectodermal dysplasia), neurotrophic keratitis (e.g., herpes simplex, herpes zoster, familial dysautonomia), and corneal exposure (e.g., anatomic, paralytic), in which the expanded tear reservoir and protection against an adverse environment afforded by a scleral lens might prove beneficial.
New Website Highlights CooperVision Sustainability Efforts
CooperVision has launched a new website that highlights its sustainability efforts around the globe. Available at coopervision.com/sustainability, the data and stories profile multiple environmental initiatives focused on saving water; conserving energy; reducing, reusing, and recycling resources; and empowering people within the company and the communities in which it operates. The company anticipates updating the site periodically as its sustainability efforts continue.
Competition to Encourage Students Launched by BUCCLE
British and Irish University and College Contact Lens Educators (BUCCLE) has announced a competition to encourage students to embrace challenging patients. The competition involves submitting a case report on a patient seen by a student. It is divided into two categories: a patient who presented a challenge to successfully fit contact lenses, and a patient who has an anterior eye disorder requiring management. It will run for the first time this academic year and is open to undergraduate optometry or contact lens optician students.
Two winners will be selected and will each receive £250 and travel and accommodation to the British Contact Lens Association conference the following year. They will then present their case reports at the conference.
VTI Signs Agreement with Corneal Lens Corporation NZ and Contact Lens Centre Australia
Visioneering Technologies, Inc. (VTI) announced that it has signed an agreement with Corneal Lens Corporation (CLC), NZ Ltd and with its associated company Contact Lens Centre Australia (CLCA), making them authorized distributors of VTI’s NaturalVue (etafilcon A) Brand 1 Day Contact Lenses in New Zealand and Australia. Headquartered in Christchurch, New Zealand, CLC is a manufacturer and distributor of contact lens and vision care products in the Australasia region, South Africa, and Hong Kong. CLCA is a distributor of eyecare products and contact lenses throughout Australia and has a distribution facility in Melbourne.
University of Waterloo to Open VR Optometry Lab
The University of Waterloo’s School of Optometry and Vision Science announced the creation of a new virtual reality (VR) training lab that is being funded through an $800,000 investment by national eyecare provider FYidoctors. According to the university, the authentic experience simulates a patient’s eye and provides students with an opportunity to use virtual reality to practice on many cases that range from wellness through to diseases such as macular degeneration and diabetes. At a total cost of $1.5 million, the FYidoctors Simulation Lab is the first of its kind in Canada.
The simulation equipment will supplement real-life training, which is limited. The lab will initially include five Eyesi Binocular Indirect Ophthalmoscopes (BIO), which are augmented reality simulators for training of retinal examinations and provide a highly realistic and dynamic 3D simulation of the anatomical structures of the eye and ophthalmoscope optics.
Phase two of the lab, to be unveiled at a later date, will include the addition of the Eyesi Slit Lamp simulators. This technology will allow students to practice basic handling of the device and skills required to conduct a corneal exam, retinal exam, and gonioscopy and tonometry.
Uprise Integrates with Glimpse to Provide ECPs with Data Insights
Uprise by VisionWeb, a cloud-based practice management and electronic health records (EHR) system designed for optometrists, is integrating with Glimpse, a healthcare analytics provider, to offer eyecare professionals (ECPs) performance dashboards that measure business success and help improve profitability. For more information about using Uprise with Glimpse, call (866) 630-2036.
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.
Fitting the cornea after radial keratotomy can be a challenge, as seen in this eye that has 16 cuts. Practitioners normally assume that these corneas exhibit an oblate profile with a flattened apex. However, high spots are common and must be vaulted in the same manner as for a prolate cornea.
We thank Dr. Arnold 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
Sclerals Instead of Surgery?
Corneal ectasia—including keratoconus, pellucid marginal degeneration, and corneal ectasia following refractive surgery—is predominantly managed with spectacles or contact lenses. Historically, corneal GP lenses were the gold standard. The primary indications for specialty contact lenses and GP lenses are high astigmatism and corneal scarring.1-4 In the past, roughly 12% to 20% of this patient population would go on to need a corneal transplant due to inadequate vision or to contact lens intolerance.5,6 However, because of the growth of scleral lenses, the rate of corneal transplant surgeries may be changing.
Worldwide, the rate of scleral lens fittings has consistently increased over the past few years.7 Recently, studies compared outcomes of scleral lens fitting for keratoconus to penetrating keratoplasty. Koppen and coworkers concluded that scleral lenses for severe keratoconus patients were effective in long-term treatment, and many patients were able to avoid corneal transplant as a result of scleral lens use. The rate of keratoplasty was reduced by nearly 50%.8 Another study had similar findings; patients fitted with scleral lenses were able to avoid or delay corneal transplantation.9 Both studies highlight the integral role that contact lens practitioners have in the care and management of this patient population long term.
It will be interesting to see how scleral lenses impact other ocular conditions moving forward and how they might potentially shift the paradigm of management.
1. Krachmer JH, Feder RS, Belin MW. Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol. 1984 Jan-Feb;28:293-322.
2. Pallikaris IG, Kymionis GD, Astyrakakis NI. Corneal ectasia induced by laser in situ keratomileusis. J Cataract Refract Surg. 2001 Nov;27:1796-1802.
3. Negishi K, Kumanomido T, Utsumi Y, Tsubota K. Effect of higher-order aberrations on visual function in keratoconic eyes with a rigid gas permeable contact lens. Am J Ophthalmol. 2007 Dec;144:924-929.
4. Jhanji V, Sharma N, Vajpayee RB. Management of keratoconus: current scenario. Br J Ophthalmol. 2011 Aug;95:1044-1050.
5. Lass JH, Lembach RG, Park SB, et al. Clinical management of keratoconus. A multicenter analysis. Ophthalmology. 1990 Apr;97:433-445.
6. Wagner H, Barr JT, Zadnik K. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: methods and findings to date. Cont Lens Anterior Eye. 2007 Sep;30:223-232.
7. Harthan J, Nau CB, Barr J, et al. Scleral Lens Prescription and Management Practices: The SCOPE Study. Eye Contact Lens. 2018 Sep;44:S228-S232.
8. Koppen C, Kreps EO, Anthonissen L, Van Hoey M, Dhubhghaill SN, Vermeulen L. Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus. Am J Ophthalmol. 2018 Jan;185:43-47.
9. Deloss K, Fatteh NH, Hood CT. Prosthetic replacement of the ocular surface ecosystem (PROSE) scleral device comparted to keratoplasty for the treatment of corneal ectasia. Am J Ophthalmol. 2014 Nov;158:974-982.
MATERIALS & DESIGNS
David L. Kading, OD
Success in Multifocals
Successful multifocal contact lens fitting is a dream for eyecare practitioners. Most pass off their failures as unfortunate examples of how the lenses are imperfect when compared to the accommodative system of a 20- or 30-year-old. Like all lenses, the two major things that keep them from success with multifocal lenses are comfort and vision.
Start by completing an ocular surface screening to make sure that patients do not have any signs of dry eye. Ensure that they are in the most ideal lens. In my office, we only utilize daily disposable lenses for our spherical patients. For many patients who have an altered ocular surface and a less-than-ideal material, the surface of the lens will not wet properly, which decreases clarity of vision. To maximize success, combine the best lens material with an optimized ocular surface.
Most practitioners select one or two lenses that they use for most of their patients. Spend some extra time reviewing the fitting guides of the lenses. At a recent optometry conference, I was reminded again of how important this is. Many times, when practitioners use the fitting guide, they can achieve around 70% or higher success. The success of most lenses goes well into a high-90% with a second set of lenses. By listening to their patients’ complaints, paying attention to their vision, and consulting the fitting guide, practitioners will be able to achieve that sought-after success.
Patterns of Altered Corneal Sensation in Patients with Chronic Migraine
Migraines are a central sensitization disease characterized by recurrent unilateral headaches. The aim of this study was to evaluate corneal sensitivity and associated findings in patients who experience migraines.
In this study, the researchers included 58 patients who suffer from migraines (52 females and six males, mean age: 32.98 ± 8.51 years) and 30 healthy control subjects (27 females and three males, mean age: 35.29 ± 8.00 years). Only patients who did not have any eye disease were included in this study. Corneal sensation was evaluated with a Cochet-Bonnet esthesiometer in five different regions of the cornea.
There was no significant difference between the groups for age, sex, and visual acuity. Increased mean sensitivity of the nasal cornea in the patients who experience migraines was found (55.0mm versus 53.75mm, P = 0.020). There was no significant difference in mean sensitivity for central (57.5mm versus 55mm, P = 0.163), temporal (57.5mm versus 55mm, P = 0.066), superior (52.5mm versus 52.5mm, P = 0.551), and inferior (48.75mm versus 47.5mm, P = 0.818) cornea or in mean overall sensation (54.0mm versus 52.75mm, P = 0.14), although there was a trend toward increased sensitivity in the patients who suffer from migraines. Among the subgroup of patients who experience unilateral migraines, mean overall sensation (54.0mm versus 53.0mm, P = 0.049) and temporal sensation (57.5mm versus 55.0mm, P = 0.043) were increased on the affected side.
In this study, the researchers demonstrated that patients who experience migraines have increased corneal sensation, especially in the cornea of the affected side. This finding supports the idea that corneal sensation is altered in patients who suffer from migraines.
Aykut V, Elbay A, Esen F, Kocaman G, Savran Elibol E, Oguz H. Patterns of Altered Corneal Sensation in Patients With Chronic Migraine. Eye Contact Lens. 2018 Sep 27. [Epub ahead of print]