Science is evolving as it relates to studies of “-omics”—genomics, proteomics, metabolomics—just to name a few. Take for instance the microbiome—which is the complete genetic material of all of the microorganisms within a biological system (e.g., the whole body or a part of the body). As noted in this week’s abstract, we are developing a deeper understanding of the ocular microbiome and how it differs regionally across the ocular surface.
Ultimately, unlocking this information will translate into etiological understandings of disease, such as the link between bacteria and dry eye disease. It will also lead to improved devices and therapeutics aimed at targeting these newly uncovered disease processes.
Jason J. Nichols, OD, MPH, PhD
Call for Papers for BCLA Clinical Conference and Exhibition
The British Contact Lens Association (BCLA) opened a call for papers on Sept. 1 for next year’s BCLA Clinical Conference and Exhibition. A pre-screening service will be available, with a deadline of Nov. 23, 2018. The final deadline for papers to be submitted via the BCLA website is Jan. 11, 2019. All abstracts will be published in Contact Lens and Anterior Eye (CLAE). Submissions should be in the form of abstracts and can be a paper or electronic poster (to be allocated by the Academic Committee), with case reports also encouraged.
The three-day Clinical Conference and Exhibition is scheduled for May 30 to Jun. 1, 2019. For more details about how to submit papers, visit www.bcla.org.uk.
EyePoint Secures Pass-Through Payment Status and Assignment of C-Code for Dexycu
EyePoint Pharmaceuticals announced that the Centers for Medicare and Medicaid Services (CMS) has approved transitional pass-through status and reimbursement through a C-code for Dexycu (dexamethasone intraocular suspension) 9%. Dexycu is the company’s U.S. Food and Drug Administration (FDA)-approved product for the treatment of postoperative inflammation that is administered as a single intraocular dose at the end of ocular surgery. The code, C9034, will become effective on Oct. 1, 2018.
Valley Contax Launches Optometry Podcast
“Try Not To Blink” is a newly launched podcast sponsored by Valley Contax. The show is hosted by James Deom, OD, MPH, and Roya Habibi, OD. Dr. Deom is in private practice in Hazleton, PA, and Dr. Habibi practices with Eye Associates Northwest in Seattle.
According to the company, the program focuses on providing news, tips, and tricks in a format that’s fun and easy to listen to. Episodes are published weekly and are typically about one hour in length. The hosts regularly include guests on the podcast to provide expert advice on a wide range of topics; recent guests have included dry eye expert Dr. Scott Schachter and digital marketing guru Dr. William To.
Listen to the “Try Not To Blink” podcast in iTunes, the Apple Podcast app, Google Play, or Spotify or by visiting trynot2blink.com.
Mark’ennovy has launched Versa One Day Toric, a made-to-order daily disposable contact lens that provides a wide range of spheres, cylinders, and axes. The hydrogel contact lens has a sphere range of ±10.00D and a –0.75D to –5.75D cylinder range with axes of 0° to 180° in 5° steps. Available to order in 30 and 90 packs, the company says that Versa is designed for patients who are outdoor enthusiasts or part-time wearers. The lenses include a handling tint, a water content of 55%, a diameter of 14.40mm, and a base curve of 8.70mm. Note: These lenses are not available in the United States.
Eyevance Pharmaceuticals Acquires Freshkote Products from Focus Laboratories
Eyevance Pharmaceuticals, LLC announced the acquisition of Freshkote, a family of lubricant eye drops from Focus Laboratories, Inc. Under the terms of the agreement, Eyevance acquired Freshkote and all of its formulations, including a preservative-free multidose bottle and single-unit vials, to market and commercialize worldwide.
According to the company, Freshkote PF is designed to support the integrity of all three layers of the eye’s tear film, offering dry eye patients relief from their symptoms. Freshkote PF is designed to combat evaporation on the ocular surface with a patented polymer blend formulated to mimic the lipid layer of the tear film. Eyevance says that Freshkote PF is safe for contact lens wearers and can be used on an as-needed basis. A non-prescription product, new Freshkote PF is available in 10mL multidose bottles or boxes of 30 single-unit vials.
Alcon Introduces Air Optix plus HydraGlyde Multifocal Contact Lenses
Alcon launched Air Optix plus HydraGlyde Multifocal contact lenses. The lenses incorporate Alcon’s Precision Profile Design together with the HydraGlyde molecule. According to Alcon, the lenses will provide clear, seamless vision at all distances—near, intermediate, and far; lasting lens surface moisture through the HydraGlyde Moisture Matrix; and deposit protection and consistent comfort with Alcon’s SmartShield Technology.
These lenses are made in the lotrafilcon B material. They have a water content of 33%, a 14.2mm diameter, a 8.6mm base curve, and, at –3.00D, a Dk/t of 138 and a center thickness of 0.08mm. Lenses are available in powers from +6.00D to –10.00D (in 0.25D steps) and have Lo, Med, and Hi adds. They are recommended for daily wear and up to six nights of extended wear with a monthly replacement schedule.
The Air Optix plus HydraGlyde Multifocal contact lenses will be widely available beginning on Oct. 1, 2018.
Advanced Vision Technologies Launches Prime Series of GP Lenses
Advanced Vision Technologies (AVT) has developed a signature line of contact lenses called the Prime Designs, which include small- and large-diameter corneal designs as well as scleral designs. AVT says that the Prime series is the culmination of 30 years of designing and fitting GP lenses on irregular corneas including keratoconus, pellucid marginal degeneration, post-refractive surgery, post-penetrating keratoplasty, adult post-cataracts, and pediatric post-cataracts.
The Prime Kone design is a small GP design that AVT says is best used on steep, nipple keratoconus. Diameters range from 8.0mm to 9.9mm with a specialized peripheral system to mimic the contour of these corneas, according to AVT.
The Prime Scleral design is a mini-scleral lens that has diameters of 13.5mm, 14.0mm, and 14.5mm.
The Prime Limbal design has diameters ranging from 10.0mm to 12.0mm and is meant to fit within the limbus. AVT says that these help for better positioning, better vision, enhanced GP comfort, and it gives fitters the ability to vault the corneal ectasia. It’s available with reverse geometry as well.
The Prime Pediatric series is a Prime Limbal design variation in Menicon Z material for extended wear for kids who have congenital cataracts. The most common diameters for these conditions are 10.4 mm and 10.8mm, according to the company.
Elise Kramer, OD, Miami
Sometimes practitioners have to worry about oxygen transmission even in patients who do not have corneal transplants. This 77-year-old patient, who visited us from Mexico City, underwent radial keratotomy 40 years ago and now has severe ectasia. Due to a sectoral limbal stem cell deficiency as well as relative hypoxia caused by scleral lenses, his neovascularization grew substantially in the last year since he began wearing scleral lenses, and it is now threatening the visual axis. The patient saw a corneal specialist to get an intracorneal bevacizumab injection. He was then referred to me so that I could improve his scleral lens fit to maximize the amount of oxygen for this delicate cornea.
We thank Dr. Kramer 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
Try as Hard as You Do, All Often Rests on Compliance
Modern overnight corneal reshaping (CR) or orthokeratology (ortho-k) has been shown to be a highly effective method for the correction of low-to-moderate degrees of myopia, thus providing patients clear daytime vision without the need to wear vision correction. Additionally, there is significant evidence to suggest that this treatment also inhibits myopia progression and ocular axial elongation. As such, CR/ortho-k has gained popularity worldwide. Because this treatment involves wearing contact lenses overnight, there is always concern regarding complications such as microbial keratitis. There is evidence, however, that overnight CR/ortho-k is safe and effective when lenses are prescribed, worn, and cared for in an appropriate manner.
A recent study was published that looked at compliance to CR/ortho-k in China.1 A questionnaire was sent to ortho-k patients in the Eye Hospital of Wenzhou Medical University (EHWMU) in Mainland China who were prescribed ortho-k lenses after Jan. 2013 and who have worn ortho-k lenses for more than one year. The researchers sought to determine the compliance rate for eight wear-and-care behaviors. Follow-up visit compliance was then investigated among these patients using a retrospective survey.
A total of 1,500 questionnaires were distributed, and 405 patients responded. The mean age of the patients was 13.1 ± 3.9 years (range 9 to 22 years old); 60.5% of the patients were female, and 98.3% were younger than 18 years. The full compliance rate was 14.1%, the compliance rate for wear-and-care behaviors was 18.5%, and the compliance rate for follow-up visits was 63.3%. The three highest noncompliance categories for wear-and-care behaviors were exposure to nonsterile solution, not removing lens deposits according to the eyecare practitioners' (ECPs) recommendations, and inadequate hand washing. No correlation was observed between the compliance for wear-and-care behaviors and age, sex, and wearing experience. The follow-up visit compliance rate significantly decreased from the third month to the ninth month. The common reasons for discontinuing follow-up were lack of time, no symptoms, and inconvenience.
The authors concluded that the level of compliance with ortho-k lens wear in Mainland China is not high, necessitating ECPs to stress to patients the details of wear-and-care behaviors, especially avoiding exposing lenses to nonsterile solution. Improving monitoring of follow-up visits, particularly within the first nine months of wearing ortho-k lenses, is needed.
So, the take home here is that we have developed absolutely wonderful lens designs, utilize high-oxygen-transmissible materials, and have achieved great success in the temporary treatment of myopia and likely in the control of myopia progression with contemporary CR/ortho-k lenses. However, we are highly dependent on patient compliance to lens wear, care, and replacement according to the prescribed methods. Compliance is highly connected to patient education. Take the time to not only instruct patients and their family members, but also to educate them as to why all elements of compliance are critical to success in the utilization of CR/ortho-k.
1. Jun J, Zhiwen B, Feifu W, Lili L, Fan L. Level of Compliance in Orthokeratology. Eye Contact Lens. 2018 Sep;44:330-334.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
MBI = DED?
Can the maximum blink interval (MBI; the length of time that patients can keep their eyes open between blinks) be diagnostic for dry eye disease? Yup, and 12.4 seconds is the magic number.
In a cross-sectional study of 292 patients (194 who had dry eye disease [DED] and 98 who did not have DED), researchers measured the MBI between patients who did and did not have DED.1 Room temperature and humidity in the testing room was controlled. Correlations between MBI and other clinical features of DED, including subjective symptoms (Dry Eye-Related Quality-of-Life Score [DEQS]), tear film breakup time (TFBUT), cornea fluorescence score (CFS), and Schirmer test I value were processed, and the optimal cutoff value of MBI to suspect DED was determined.
Not surprisingly, 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, whereas CFS was negatively correlated with MBI.
The optimal MBI cutoff value was 12.4 seconds, providing a sensitivity of 82.5% and specificity of 51.0% to suspect DED. This quick, simple, instrument-free diagnostic may prove to be a useful test to screen for DED.
1. 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.
Identification and Visualization of a Distinct Microbiome in Ocular Surface Conjunctival Tissue
Knowledge of whether microorganisms reside in protected niches of the conjunctiva is potentially significant in terms of minimizing risks of contact lens inflammation/infection and endophthalmitis. In this study, the researchers aimed to define whether and how microbial communities from limbal and forniceal conjunctival tissue differ from those on the conjunctival surface.
Human limbal and forniceal conjunctival tissue was obtained from 23 patients undergoing pterygium surgery. It was analyzed with data from a recent study of conjunctival surface swabs (n = 45). Microbial communities were analyzed by extracting total DNA from tissue samples and surface swabs and sequencing the 16S rRNA gene using the Illumina MiSeq platform. Sequences were quality filtered and clustered into operational taxonomic units (OTUs) at 97% similarity. OTUs associated with blank extraction and sampling negative controls were removed before analysis. Fluorescent in situ hybridization (FISH) was performed on cyrosections of limbal and forniceal conjunctival tissue.
There was a significant difference in bacterial community structure between the conjunctival surface and fornix (P = 0.001) and limbus (P = 0.001) tissue. No difference was found in bacterial communities between the limbus and fornix (P = 0.764). Fornix and limbal samples were dominated by OTUs classified to the genus Pseudomonas (relative abundance 79.9%), which were found only in low relative abundances on conjunctival surfaces (6.3%). Application of FISH showed the presence of Pseudomonas in the forniceal tissue sample.
The authors concluded that there is a discrete tissue-associated microbiome in freshly-collected human limbal and fornix tissue that is different from the microbial community structure and composition of the ocular surface microbiome.
Ozkan J, Coroneo M, Willcox M, Wemheuer B, Thomas T. Identification and Visualization of a Distinct Microbiome in Ocular Surface Conjunctival Tissue. Invest Ophthalmol Vis Sci. 2018 Aug 1;59:4268-4276.