In many parts of the world, this is the season in which many kids go “back to school”—returning for a new or continued academic school year. We always like to suggest that eyecare providers be proactive with the patient populations they serve regarding the importance of eye examinations relative to successful school performance. It’s ideal to get kids scheduled for these visits prior to starting the school year, but it is never too late to attend to comprehensive eyecare.
Jason J. Nichols, OD, MPH, PhD
Xiidra Now Available in the U.S.
Shire plc announced that Xiidra (lifitegrast ophthalmic solution) 5%, a twice-daily prescription eye drop indicated for the treatment of both the signs and symptoms of dry eye disease, is now available by prescription in the United States. The U.S. Food and Drug Administration (FDA) approved Xiidra on July 11, 2016.
With the availability of Xiidra, Shire has patient-focused resources to share information about prescription coverage and savings (subject to eligibility):
ask iiris, a phone service offering live-person responses to questions regarding information about insurance coverage, benefits, co-pays and availability in pharmacies. To ask iiris, please call 1-844-my-iiris
Xiidra iinsider, an optional program that patients can sign up for to receive information and special offers, either via text or email.
Also, to get Americans to talk about their chronic dry eye symptoms Shire launched eyelove, an educational awareness campaign featuring actress Jennifer Aniston. On myeyelove.com, a story-driven site which harnesses the voices of leading eye doctors as well as women with dry eye, consumers can find information to help better recognize the symptoms of dry eye, learn about the causes, and can access a conversation guide to speak with their eye doctor.
Xiidra (lifitegrast ophthalmic solution) 5% is a prescription eye drop indicated for the treatment of signs and symptoms of dry eye disease. It is dosed twice per day, approximately 12 hours apart, in each eye. Xiidra is packaged in a foil pouch containing five low density polyethylene 0.2 mL single-use containers, and is supplied in a carton of 60 single use containers.
AOF Selects 2016 Bert C. & Lydia M. Corwin Contact Lens Residency Award Recipient
Caitlin J. Morrison, OD, cornea and contact lens resident at the State University of New York College of Optometry, was chosen by a committee of members in the Cornea, Contact Lenses and Refractive Technologies section of the American Academy of Optometry (AAO) as this year’s recipient for the Bert C. & Lydia M. Corwin Residency Award.
The award is intended to promote the practice and development of the field of contact lenses by providing incentive and support to talented optometric residents who demonstrate a passion and commitment to practice, research, and education. Of the thirteen applicants who applied to the program, Caitlin presented an impressive resume of experience in clinical, volunteer service, research, and lecture presentation. Caitlin will receive a $2,000 education award and a $750 travel fellowship to attend the Academy 2016 Anaheim annual meeting in November.
The 2017 Global Specialty Lens Symposium will be held January 26-29, 2017 at the Rio Hotel in Las Vegas, Nevada.
The GSLS is a must-attend meeting, brought to you by Contact Lens Spectrum, focusing on the successful management of ocular conditions using today's specialty contact lenses. This meeting will include insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.
International Forum for Scleral Lens Research Announced
The International Forum for Scleral Lens Research (IFSLR) is scheduled for Monday, December 5, 2016 by the Texas Eye Research and Technology Center, University of Houston College of Optometry. The IFSLR will be following the 33rd Annual Cornea, Contact Lens & Contemporary Vision Care Symposium on Saturday and Sunday, December 3-4, 2016 at The Westin Houston Hotel, Memorial City.
The IFSLR is an open meeting and practitioners and laboratories interested in the latest developments and research are invited to attend this first annual symposium dedicated exclusively to research supported presentations by some of the best known experts working in the scleral lens field today.
Like all contact lens modalities, scleral lenses come with their own set of unique challenges such as midday fogging, conjunctival prolapse, handling difficulties and potential corneal edema issues to name a few. Furthermore, there is no consensus on the ideal size or vault of a scleral lens or how the lens specification should be expressed, either in base curve or sagittal depth measurements or both. For this field to move forward, there is a tremendous need for evidence-based information. This is the purpose of IFSLR and this is what invited leading researchers will discuss – what has current research shown and what directions of research are needed for future progress.
The IFSLR is governed by a Scientific Executive Committee consisting of Jan Bergmanson, Chair, Melissa Barnett, Thomas Arnold, Ralph Stone, William Miller, Jan Svochak and John Hibbs. The IFSLR is supported by the experienced University of Houston College of Optometry educational meeting administration led by Marcus Piccolo, Jennifer Ebert and Amanda Johnson.
This meeting is sponsored by Art Optical Contact Lens, Bausch + Lomb, Contamac, Essilor, Metro Optics, and TruForm Optics.
IACLE Members Benefit from Access to New Teaching Resource
IACLE members now have access to a major new teaching resource with the addition of the Salazar Image Collection to their online resources. These images are the work of the late Ralph Salazar, a Venezuelan optometrist, and record almost 140 unusual anterior eye conditions.
IACLE’s Director of Educational Development, Dr. Lewis Williams, explained that Salazar had extensive interests in contact lenses, the anterior eye, and ocular pathology. Fortunately for IACLE, he also had access to hospital cases and an interest in recording, photographically, what he saw in practice. This collection is a selection of his work, a series he always intended to be used for educational purposes.
The acquisition of these images almost a decade ago was brokered by Dr. Percy Lazon, then IACLE’s Latin America Regional Coordinator. Currently, Dr. Lazon is Principal Clinical Scientist at CooperVision in Pleasanton, California, USA. The original Spanish titles were translated into English by Dr. Lazon and the PowerPoint presentation was finalized by IACLE staff.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Dysgeusia and Nasal Flow
Dysgeusia (taste sensation) is of broad interest to us as topical ophthalmic medication prescribers. It is important we understand the potential systemic side effects that ocular medications may precipitate, as well as the studies performed to ensure safety for our patients. This admonition is overarching to almost every class of eye drops that we employ from dilation drops to glaucoma medications (and others).
In most cases, due to the natural course of tear flow, applied medications will drain through the naso-lacrimal system of the nose and throat (hence, taste sensation may be affected, not uncommon with many ocular topical medications). Some of the molecules possibly reach the circulatory system. Recall that the nasal cavity is covered by a thin mucosa that is well vascularized: a drug molecule can be transferred quickly across the single epithelial cell layer directly to the systemic blood circulation without a first-pass hepatic and intestinal metabolism. The effect is often reached within five minutes for smaller drug molecules.1 Nasal drug delivery therefore, is considered an attractive route for systemic drug delivery, especially when rapid absorption and effect are desired and may address issues related to poor bioavailability, slow absorption, drug degradation, and adverse events in the gastrointestinal tract.2 In the case of most ocular topical preparations, the systemic concentrations, measured via bloodwork in studies associated with the regulatory process, is usually negligible.
With the above discussion in mind, it is prudent to review proper installation of ocular topical medications with our patients that includes punctal occlusion to limit naso-lacrimal drug flow. A good instruction sheet can be found here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072510/.
1. Chien YW,. SU KSE, Chang S.F. Nasal systemic drug delivery. Marcel Dekker, Inc., New York, 1989.
2. Djupesland PG. Nasal drug delivery devices: characteristics and performance in a clinical perspective—a review. Drug Deliv Transl Res. 2013 Feb; 3(1): 42–62. Published online 2012 Oct 18. doi: 10.1007/s13346-012-0108-9 PMCID: PMC3539067
Myopia Management with Contact Lenses – Just Do Something.
Epidemiological data demonstrates a significant rise in the prevalence of myopia worldwide. Implications of higher degrees of myopia are impactful both in terms of increased risk of ocular disease (glaucoma, cataract, peripheral retinal disease and myopic macular degeneration) and negative influences on quality of life and increased economic burden. The rate of myopic progression can be reduced by a number of methods of which contact lenses are at least two (corneal reshaping and use of multifocal contact lenses).
An article published recently conducted a systematic literature review of studies that evaluated methods to reduce myopic progression.1 They found the most efficacious was the use of atropine pharmacological therapy. This was followed by optical means aiming at the correction of peripheral hyperopic defocus. They also cited studies suggesting that increased daylight exposure could reduce the risk of incident myopia (i.e. could influence the onset of myopia, not its progression once established). They concluded that myopia progression can be effectively attenuated by the use of low-dose atropine and optical means utilizing contact lenses.
A second study2 was published that compared the relative efficacy of myopia progression control of corneal reshaping contact lenses (orthokeratology) and dual focus soft contact lenses (multifocal contact lenses). Of the 110 patients reviewed in this study, 56 were prescribed corneal reshaping contact lenses and 32 dual focus contact lenses, and 22 received advice only. Results found that initial myopia, vitreous and axial eye length, previous myopia progression, age, number of myopic parents, and gender were not significantly different between orthokeratology and dual focus soft contact lens groups. Mean follow-up time for the orthokeratology and dual focus lens groups was the same (orthokeratology: 1.30 ± 0.88 years; dual focus lens: 1.33 ± 0.80 years (p = 0.989)). There was a significant reduction in the annualized myopia progression in both groups (orthokeratology: -1.17 ± 0.55 to -0.09 ± 017 D/yr, p < 0.001; dual focus soft contact lens: -1.15 ± 0.46 to -0.10 ± 0.23 D/yr, p < 0.001). There was no difference between orthokeratology and dual focus lens treatment efficacy (p = 0.763), nor in axial or vitreous chamber length changes after treatment (p = 0.184). One adverse event was reported over the 4-year period. The authors concluded that both orthokeratology and dual focus soft contact lenses are effective strategies for targeting myopia progression. They found no significant difference in the efficacy of the two methods in this regard, and stated that there are very few barriers for any contact lens practitioner to be actively promoting myopia control treatment to at-risk patients.
We are becoming more aware of the importance of preventing myopic progression for our young patients, though the use of contact lenses and pharmaceutical agents for myopia progression management is an off label use of these products. We have a number of methods to potentially achieve this goal, however currently the majority of eye care practitioners have not incorporated myopia management into their practices. It may be time for myopia management to become a part of primary eye care practice or at least a part of pediatric eye care practice. Where are you on this topic in your practice?
1. Lagreze WA, Loachimsen L, Schaeffel F. Current recommendations for deceleration of myopia progression. Ophthalmologe. 2016 Aug 26 (Epub ahead of print).
2. Turnbull PR, Munro OJ, Phillips JR. Contact Lens Methods for Clinical Myopia Control. Optom Vis Sci. 2016 Sep; 93(9): 1120-6.
Lid Wiper Microvascular Responses As an Indicator of Contact Lens Discomfort
The purpose of this prospective, cross-over clinical study was to analyze quantitatively the alterations in the microvascular network of the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva relative to ocular discomfort after contact lens wear.
Functional slit-lamp biomicroscopy (FSLB) was used to image the microvascular network of the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva. The microvascular network was automatically segmented, and fractal analyses were performed to yield the fractal dimension (Dbox) that represented vessel density. Sixteen healthy subjects (nine female and seven male) with an average age of 35.5 ± 6.7 years old (mean ± standard deviation) were recruited. The right eye was imaged at 9 AM and 3 PM at the first visit (Day 1) when the subject was not wearing contact lenses. During the second visit (Day 2), the right eye was fit with a contact lens for 6 hours. Microvascular imaging was performed before (at 9 AM) and after lens wear (at 3 PM). Ocular comfort was rated using a 50-point visual analogue scale before and after 6 hours of lens wear, and its relationships with microvascular parameters were analyzed.
There were no significant differences in Dbox among the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva among the measurements at 9 AM (Day 1 and Day 2) and 3 PM (Day 1) when the subjects were not wearing the lenses (P > 0.05), whereas after 6 hours of lens wear, the microvascular network densities were increased in all three of these locations. Dbox of the lid wiper increased from 1.411 ± 0.116 to 1.548 ± 0.079 after 6 hours of contact lens wear (P < 0.01). Dbox of the tarsal conjunctiva was 1.731 ± 0.026 at baseline and increased to 1.740 ± 0.030 (P < 0.05). Dbox of the bulbar conjunctiva increased from 1.587 ± 0.059 to 1.632 ± 0.060 (P < 0.001). The decrease in ocular discomfort was strongly related to the Dbox change in the lid wiper (r = 0.61, P < 0.05). There were no correlations between the changes of ocular comfort and the microvascular network densities of either the tarsal or bulbar conjunctivas (P > 0.05).
This study is the first to show that the microvascular network of the lid wiper can be quantitatively analyzed in contact lens wearers. The microvascular responses of the lid wiper were significantly correlated with contact lens discomfort.
Deng Z, Wang J, Jiang H, Fadli Z, Liu C, Tan J, Zhou J. Lid wiper microvascular responses as an indicator of contact lens discomfort. Am J Ophthalmol. 2016 Aug 16. pii: S0002-9394(16)30392-0. doi: Lid wiper microvascular responses as an indicator of contact lens discomfort. 10.1016/j.ajo.2016.08.009. [Epub ahead of print]