Given the magnitude and outcomes of contact lens discomfort, we are always looking for new insights into its causes as well as subsequent ways to manage and treat this condition. I think one of the most exciting concepts is understanding the ability of the pre-lens tear film to cover the lens surface—in addition to understanding how it plays a role as a boundary lubricant with the palpebral conjunctiva (in terms of prevention of lid wiper epitheliopathy). Further, it will be key to utilize new imaging technologies to understand how contact lens polymer surfaces aid in standing up the tear film. We hope to continue to see exciting developments in contact lens polymers and surfaces come to the market.
Jason J. Nichols, OD, MPH, PhD
IACLE Presents Lifetime Achievement Award at 2017 Congress on Contact Lens Education
The International Association of Contact Lens Educators (IACLE) has presented the IACLE Award for Lifetime Achievement in Contact Lens Education to Australian educator and researcher Professor Deborah Sweeney. She received the award at the IACLE Congress on Contact Lens Education held in Hyderabad, India on Sept. 9 to 10.
Her contributions to global contact lens education include serving as IACLE president from 2000-2011 and as its secretary and treasurer for 10 years, having first become a member in 1990. She has held executive roles at the Cornea & Contact Lens Research Unit, School of Optometry and Vision Science University of New South Wales, Cooperative Research Centre (CRC) for Eye Research & Technology, and Vision CRC. Her current role is pro vice chancellor Research and Innovation at the University of Western Sydney.
Optometry Giving Sight to Host a Twitterchat on World Sight Day
Children’s eye health is the focus of a Twitterchat to coincide with the 11th annual World Sight Day Challenge on World Sight Day on Oct. 12, 2017. The Twitterchat, aimed at parents and eyecare practitioners around the world, will take place from 12:00 p.m. to 1:00 p.m. ET and is hosted by Optometry Giving Sight.
Helping to moderate the discussion will be All About Vision, ABB Optical Group, Bausch + Lomb, CooperVision, Essilor of America, EyePromise, FYidoctors, Vision Source, VSP Vision Care, and Zeiss. Parents and eyecare and industry professionals are invited to participate in the chat by following and using the hashtags #shareforsight, #givingsight, and #ourchildrensvision.
This is Optometry Giving Sight’s second year hosting a Twitterchat as a part of its annual World Sight Day Challenge.
LensFerry Offers EHR Integration
EyeCare Prime announced that its LensFerry solution now integrates with electronic health record (EHR) systems utilized by eyecare practitioners. LensFerry allows wearers to order their prescribed contact lenses from anywhere at any time, including text-to-order, subscriptions, an online practice portal, and other selling tools. The EHR integration enables contact lens prescription and ordering information to automatically sync between systems, streamlining the ordering process for both patients and practices.
The integration between LensFerry and practice management systems enables patients’ prescription information to automatically pre-populate, making the checkout process simpler compared to many other retailers, according to the company. Patients can also receive intelligent reminders based on purchases at the time of their exam including a “Win Back” campaign targeting patients who leave the office without purchasing anything. Subscriptions are also available for patients who want to pay monthly for their lenses and receive automatic deliveries directly to their homes.
The Vision Source Foundation Raises Monies to Support Optometrists Affected by Hurricanes Harvey and Irma
Vision Source, an independent optometric alliance, has raised more than $310,000 in 15 days to help optometrists directly affected by the widespread damage and destruction caused by Hurricane Harvey and Hurricane Irma. More than 316 Vision Source member practices are located in the areas impacted by recent storms.
Established in 2007 as a resource to provide relief aid for optometrists impacted by catastrophic events, the Vision Source Foundation has provided aid for eyecare clinicians dealing with situations such as hurricanes, tornadoes, floods, death, cancer, and stroke.
Michael Port, PhD, MSc, a contact lens expert and academic, passed away on Aug. 24, 2017 after battling cancer.
Dr. Port completed his diploma in ophthalmic optics at Northampton College of Advanced Technology in 1963 (it later became City University). He then went into practice until the late 1970s. During this time, he was involved with the United Kingdom-based Association of Optometrists as well as his local optical committee. He also earned his MSc in Methods of Ophthalmic Investigation and his diploma in contact lens practice (DCLP) from Aston University.
In 1979, he became senior ophthalmic optician in the contact lens department at Moorfields Eye Hospital. Toward the end of his time at Moorfields, he received the British Contact Lens Association’s Dallos Award, a monetary award to fund a research project that is judged likely to further understanding of a topic related to contact lenses and/or anterior eye.
In 1983, he joined the academic staff in the optometry department at City University. In addition to teaching, his contact lens research led to his earning a PhD.
He was elected a College of Optometrists’ councillor in the 1980s and served a term as its president in the early 1990s. Even in retirement, Dr. Port still contributed to the development of British and international contact lens standards.
He is survived by his wife Yvonne, daughter Eleanor, and three grandchildren.
If you haven’t voted yet in this month’s poll…
Do you concurrently prescribe a saline solution with a hydrogen peroxide-based care system to your contact lens wearers?
This image shows a scleral contact lens fitted with a scleral multiple elevation edge (SMEE) on a keratoconic eye that has an intracorneal ring inserted into it; SMEE is a new geometry/philosophy to design asymmetric lenses in scleral lens fitting that is currently being employed in Italy. Note the tear layer thickness in the area where the ring pushes out the corneal profile; the epithelium there is dry and fragile, and it is necessary to use the lacrimal vault to protect the tissue.
We thank Davide Brambilla 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
Looking for Evidence-Based Data on the Importance of Disposal Frequency of Soft Contact Lenses
Intuitive benefits of wearing daily disposable (DD) soft contact lenses (CLs) have been mentioned over the years; however, it is always important to have well-established evidence-based data to support any suggested medical treatment strategy. A recent study1 looked at the relationship of ocular inflammatory responses to lens replacement frequency, specifically comparing DD lenses to reusable contact lenses.
The researchers stated that DD lenses are often used to improve CL discomfort, but the effect on ocular inflammatory responses has not been fully investigated. This study aimed to compare the concentrations of tear cytokines and conjunctival cell morphology in healthy habitual DD and reusable soft CL wearers. Thirty-six established daily CL wearers, including 14 DD and 24 reusable lens wearers, were enrolled in the study. Symptoms and ocular surface integrity were evaluated.
The concentration of tear cytokines (interleukin 1β [IL-1β], IL-6, IL-10, IL-12 (p70), IL-17A, and tumor necrosis factor α) were determined using multiplex assays. The ratios of pro-inflammatory and anti-inflammatory cytokines were calculated. Impression cytology was performed on the conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified. Differences in variables by CL replacement schedules and the associations between variables were analyzed.
Results indicated that reusable CL wearers had higher concentrations (in pg/mL) of IL-1β (26 ± 7 versus 16 ± 11), IL-6 (42 ± 14 versus 25 ± 20), IL-10 (83 ± 23 versus 49 ± 36), IL-12 (p70) (145 ± 44 versus 91 ± 68), IL-17A (93 ± 26 versus 54 ± 44), and tumor necrosis factor α (312 [171 to 468] versus 189 [6 to 447]) (all P < 0.01) and greater conjunctival metaplasia in the region covered by CLs (0.7 [0.2 to 1.6] versus 0.4 [0.04 to 1.2], P = 0.01) compared with DD wearers. There was a positive association between CL discomfort and ratios of IL-1β to IL-10 and IL-12 (p70) to IL-10 (ρ = 0.42 and ρ = 0.33, P < 0.05).
The researchers concluded that higher ocular inflammatory responses, as indicated by higher tear cytokine concentrations and higher conjunctival epithelial metaplasia, were found more in reusable CL wearers than in DD CL wearers. The balance of pro-inflammatory and anti-inflammatory cytokines may be helpful to assess the inflammatory status of the eye.
Although there is a strong move in the United States and other parts of the world to fit more patients in a daily disposable modality, it is very important that clinicians make their fitting decisions based on well-established evidence-based data such as is presented in the study reviewed here.
1. Chao C, Stapleton F, Willcox MDP, Golebiowski B, Richdale K. Preinflammatory Signs in Established Reusable and Disposable Contact Lens Wearers. Optom Vis Sci. 2017 Aug 29. [Epub ahead of print]
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Something to Think About
There is acute awareness of the iatrogenic effects of glaucoma medications on the ocular surface, but have you considered the effect of intravitreal injections on dry eye?
This past August, a monograph reviewed the reasons why dry eye may develop during the course of repeated ocular anti-VEGF therapy.1 The authors highlighted the key concerns about current practices and proposed possible solutions to improve the outcome for the patients. To summarize, they suggested that closer attention be paid to the precondition of the patients’ overall health and the ocular health status before any surgical (injection) intervention. They also proposed that doctors evaluate this using a combination of the Ocular Surface Disease Index (OSDI) test and eye examination to identify the current condition, predisposition to dry eye, normal eyelid microflora, possible resistance to prolonged use of postoperative antibiotics, and other possible risks that may affect the outcome of the treatment.
And, while current research does not recommend eliminating the iodine treatment as an antiseptic agent before intravitreal injection, they have highlighted the concern with using 5% and higher concentration of povidone-iodine and endorse a more thorough clinical study into the effects and efficacy of a lower dose (< 5%) and/or reduced treatment time (< 2 minutes) of povidone-iodine treatment to reduce the side effects of postoperative dry eye.
If preoperative antibiotics are used, the authors stated that a shorter course using preservative-free preparations is preferred to reduce cytotoxic effects on the ocular surface. However, antibiotic resistance should also be considered when using topical antibiotics.
I laud these observations and recommendations and suggest that you factor in possible challenges to the ocular surface related to repetitive intravitreal injection-related preparations and procedures.
1. Laude A, Lim JW, Srinagesh V, Tong L. The effect of intravitreal injections on dry eye, and proposed management strategies. Clin Ophthalmol. 2017 Aug 16;11:1491-1497.
Non-Invasive Pre-Lens Tear Film Assessment with High-Speed Videokeratoscopy
The purpose of this study was to evaluate the effect of two types of daily disposable contact lenses (delefilcon A and omafilcon A) on the tear film, to establish whether this effect is dependent on pre-corneal tear film characteristics using a new method to analyze high-speed videokeratoscopy recordings, and to determine the sensitivity of this method in differentiating between contact lens materials on eye.
High-speed videokeratoscopy recordings were analyzed using a custom-made automated algorithm based on a fractal dimension approach that provides a set of parameters directly related to tear film stability. Fifty-four subjects participated in the study. Baseline measurements, in suppressed and natural blinking conditions, were taken before subjects were fitted with two different daily disposable contact lenses and after four hours of contact lens wear.
The method for analyzing the stability of the tear film provides alternative parameters to the noninvasive tear break-up time to assess the quality of the pre-corneal and pre-lens tear film. Both contact lenses significantly decreased the quality of the tear film in suppressed and natural blinking conditions (p < 0.001). The utilized method was able to distinguish between contact lens materials on eye in suppressed blinking conditions. The pre-corneal tear film characteristics were not correlated with the decrease in pre-lens tear film quality.
The authors determined that high-speed videokeratoscopy equipped with an automated method to analyze the dynamics of the tear film is able to distinguish between contact lens materials in vivo. Incorporating the assessment of pre-lens tear film to the clinical practice could aid with improving contact lens fitting and understand contact lens comfort.
Llorens-Quintana C, Mousavi M, Szczesna-Iskander D, Iskander DR. Non-invasive pre-lens tear film assessment with high-speed videokeratoscopy. Cont Lens Anterior Eye. 2017 Aug 29. [Epub ahead of print]