One of the challenges I often hear in contact lens practice relates to keeping an inventory—and I mean this in two regards. First, keeping an inventory of trial lenses (for diagnostic fitting) can be a challenge. Second, keeping an inventory of contact lenses for purchase by patients (e.g., a year’s supply) can be a challenge. Both of these issues are often associated with available office space. We would like to hear your thoughts on creative ways you have solved these dilemmas in your office. Please email us at firstname.lastname@example.org.
Jason J. Nichols, OD, MPH, PhD
Alcon Spotlights Dailies Total1 in National Television Campaign
Alcon has launched a national television campaign in support of Dailies Total1 contact lenses. This national television spot is aimed at reaching contact lens wearers looking for a comfortable and highly breathable daily disposable contact lens, for white, healthy-looking eyes. Fifteen-second spots are now airing on several major network and cable channels, including USA, TNT, TBS, HGTV, Lifetime and more.
The ad features Jared Nelson, a Principal Scientist at Alcon who worked for more than a decade on the development of water gradient technology, as he explains the science and drive behind Dailies Total1 contact lenses. The campaign began airing nationally in August.
Novartis to Begin Testing of Smart Lens for Presbyopes in 2016
According to reports from Reuter’s and other news sources, Novartis plans the first human tests next year of the contact lens for correcting presbyopia that it is developing with Google. In July, 2015, Novartis announced that its eye care division, Alcon, has entered into an agreement with a division of Google Inc. to in-license its “smart lens” technology for all ocular medical uses. (See http://www.cltoday.com/new/issue_071814.asp.) The agreement was designed to marry Google’s expertise in miniaturized electronics, low power chip design and microfabrication with Alcon’s expertise in physiology and visual performance of the eye, clinical development and evaluation, as well as commercialization of contact and intraocular lenses.
In a recent interview Novartis Chief Executive Joe Jimenez told Swiss newspaper Le Temps that the project is progressing well. "I had said it would take about five years to see a product on the market," Jimenez told the paper. "The calendar is on track and we are already developing a technological lens prototype (that) should be tested on humans in 2016."
Blanchard Hosts Scleral Lens Fitting Workshops This Fall
Blanchard Contact Lenses will be hosting five 1-day intensive scleral lens fitting workshops, Beyond the Limbus, in various cities this fall. The popular workshop is designed to train eyecare professionals how to fit, apply and remove scleral lenses; build and enhance slit lamp evaluation skills; and also provide business management techniques for profitable incorporation of scleral lenses into their practice. Over 1,000 eye care professionals have already trained with Blanchard Contact Lenses.
These full immersion, hands-on, 1-day workshops are accomplished in small class environments with peers and offer one simplified fitting process with five different applications. Here is the information for the fall workshops:
Weehawken, NJ – Saturday, October 3rd or Sunday, October 4th
Pittsburgh, PA – Saturday, October 24th or Sunday, October 25th
Syracuse, NY – Saturday, November 7th or Sunday November 8th
Houston, TX – Saturday, November 14th or Sunday, November 15th
Don’t Miss the 10th Global Specialty Lens Symposium
The 10th Global Specialty Lens Symposium will be held January 21 – 24, 2016 at Caesars Palace 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.
The 2015 event was attended by almost 600 registrants from 36 countries, 42 states, Puerto Rico and Guam. It continues to be the largest conference of its kind in the U.S.
Join your peers in 2016 for the 10th anniversary in Las Vegas! Visit www.GSLSymposium.com for more information and to register.
New Data on Growing Product Options Driving U.S. Shift to Daily Contact Lenses
In the U.S. contact lens market, upgrade appears to be the word of the moment, according to a report from GfK, one of the world’s leading research companies. In the past six months, 36% of contact lens users who switched brands moved to higher-priced products, usually from Weekly/Monthly to Daily lenses, or from “traditional” models to those made of higher-quality materials.
GfK Fits data from independent optics shops and chains in the U.S. show that Daily disposable lenses continue to post double-digit annual growth after roughly 20 years on the market. In 2015, Daily lens sales have already risen 23%, while Monthly sales grew by 7% and Weekly dropped 6%.
According to the report, a number of factors have contributed to these marketplace shifts:
new “family” assortments – mixing sphere, multifocal, and/or toric lenses – in the Daily category have made switching more convenient
the introduction of lower-priced Daily products has also made upgrading more attractive
a Unilateral Pricing Policy (UPP) introduced in June 2014 has helped to hold the line on prices for some lenses
Also, GfK’s data shows strong growth among several new Daily lens styles in 2015:
Daily Toric – unit volume up 37%
Daily Multifocal – 66% unit growth
Daily Cosmetic – 59% unit growth
Click here to download a summary of GfK’s findings.
RegeneRx Enrolls First Patients in Phase 2b/3 U.S. Dry Eye Clinical Trial
RegeneRx Biopharmaceuticals, Inc. announced that the first patients have been enrolled in a Phase 2b/3 clinical trial with RGN-259 (Thymosin beta 4), its sterile, preservative-free eye drop formulation developed for patients with dry eye syndrome, neurotrophic keratopathy (NK), and other corneal disorders. The clinical trial is being sponsored by ReGenTree LLC, a joint venture between RegeneRx and GtreeBNT Co. Ltd., a Korean biopharmaceutical company, and is being conducted by Ora Inc., an established contract research organization specializing in the field of ophthalmology.
The double-masked, placebo-controlled trial is being conducted at four sites, will enroll approximately 350 dry eye patients, and is expected to be completed by the end of the first quarter of 2016. The co-primary endpoints are assessments of total corneal staining and reduction of ocular discomfort in patients using RGN-259 compared to those using placebo. Patients will use the eye drops 4 times daily for 28 days and be assessed periodically throughout the trial and at completion of treatment. There will be numerous secondary endpoints that will also be evaluated pursuant to the trial protocol.
RGN-259 (GBT-201) for the Treatment of Dry Eye Syndrome RGN-259 (designated GBT-201 in Korea) is a sterile, preservative-free topical eye drop for ophthalmic indications whose active ingredient is Thymosin beta 4 (Tβ4). Based on U.S. Phase 2 clinical trials in moderate and severe dry eye syndrome, RGN-259 was found to show statistically significant improvements in several signs and symptoms of dry eye, as well as positive trends in other outcome measures. The data from these trials, as well as a recently completed clinical trial of RGN-259 in patients with NK, reflect RGN-259's mechanisms of action, support the "protective" effects of RGN-259, and provide RegeneRx with FDA-approvable clinical endpoints to be targeted in future clinical trials.
New AOA Resource Available to Help Optometrists Rehabilitate Patients with Brain Injury
The American Optometric Association (AOA) issued the next iteration of its Brain Injury Electronic Resource Manual, titled Volume 1B, Traumatic Brain Injury Visual Dysfunction: Optometric Management and Advanced Topics, to help optometrists evaluate patients with traumatic brain injury (TBI).
With nearly 50 percent of the brain devoted to vision, optometrists play a crucial part of a multidisciplinary approach to brain injury care. Volume 1B provides an overview of optometric management protocols that are important to incorporate into the care of patients with visual sequelae of closed head trauma. It includes:
Management of patients with visual sequelae of TBI
The prescribing of contact lenses for TBI patients, management of low vision in TBI patients and more
Sample case studies
Practice management considerations
The first volume of the Brain Injury Electronic Resource Manual, Volume 1A, Traumatic Brain Injury Visual Dysfunction Diagnosis, launched in January 2014, focuses on evaluation and assessment of common visual conditions associated with TBI.
NovaBay Pharmaceuticals, Inc. announced that the company’s prescription daily eyelid and lash hygiene product Avenova will be marketed through ALLDocs Optometry Group, making the product available to the group’s optometrists.
ALLDocs, also known as The Association of LensCrafters Leaseholding Doctors, is the second largest independent optometry group in the U.S. It works closely with its LensCrafters partners.
Combined with NovaBay’s previous distribution agreements with McKesson Corporation, Cardinal Health, AmerisourceBergen and Vision Source, the new agreement means that Avenova now will be available in thousands of optometrist and ophthalmologist offices across the country, in addition to the majority of the nation’s 67,000 pharmacies and many retail chains.
Educators Call for Professional Involvement in CL Fitting and Supply Worldwide
The International Association of Contact Lens Educators (IACLE) has released its first-ever position statement, calling for trained professionals to be involved in the fitting and supply of contact lenses in all countries to help ensure their proper use worldwide.
IACLE points out that contact lenses are enjoyed by over 180 million people worldwide and provide many potential benefits to users. However, regulations on contact lens fitting and supply vary widely around the world. In some countries, legislation requires that contact lenses only be fitted by a suitably trained and/or qualified eye care or health professional, while in other countries fitting remains unregulated. Supply of contact lenses may be restricted to specified personnel, or be available via routes such as pharmacies, supermarkets and online suppliers, or from unregulated optical shops.
IACLE’s position is that whenever contact lenses are fitted and supplied, safeguards must be in place to help protect the health and comfort of wearers’ eyes.
The involvement of a trained professional in contact lens fitting and supply is important to the proper use of contact lenses worldwide. Instruction and advice on contact lens wear and care is an essential step in promoting safe use and helping wearers enjoy the many benefits of contact lenses.
The importance of regular check-ups to monitor eye health and compliance cannot be overemphasized. Our view is that this is best achieved when a trained professional is involved in both fitting and supply of lenses, and is able to intervene when necessary.
This image, captured with a specular reflection lipidoscope, shows an ocular tear film lipid pattern. Discrete brown and blue, well spread lipid layer interference fringes superimposed on a whitish background. This pattern belongs to the first-order color fringes and it is observed in 10% of the population. Clinical consequences: Lipid formations on lenses are sometimes encountered and lenses should be cleaned by rubbing after removal from the eye. Deposits are rarely a serious problem since lenses are replaced on a regular basis.
We thank Anastasia Rotondi for this image and we 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 an explanation of the photo and your full name, degree or title and city/state/country.
We Don’t Know What We Don’t Know… Contact Lens Wearer Risk Behaviors for Contact Lens Related Eye Infections in the United States
The Center for Disease Control (CDC) recently reported on the outcomes of a survey of contact lens wearers age 18 or older to evaluate the prevalence of risk behaviors for contact lens related infections. Approximately 1,000 contact lens wearers responded to a previously validated contact lens risk survey. Using the population-based survey, an estimated 40.9 million persons in the United States aged ≥18 years wear contact lenses (16.7% of U.S. adults); 93.0% of contact lens wearers reported wearing soft contact lenses. Risk behaviors included: sleeping and napping in contact lenses, topping off solutions, replacing contact lenses and CL cases at intervals longer than prescribed, rinsing or storing CLs in tap water, swimming and showering with CLs, and lack of hand washing prior to inserting or removing CLs.
Approximately 99% of wearers reported at least one contact lens hygiene risk behavior. Half or more of wearers reported ever sleeping overnight in contact lenses (50.2%), ever napping in contact lenses (87.1%), ever topping off disinfecting solution (adding new solution to existing solution in the contact lens case instead of emptying and cleaning the case before adding new solution, 55.1%), extending the recommended replacement frequency of lenses (49.9%) or cases (82.3%), and ever showering (84.9%) or swimming (61.0%) in contact lenses. Approximately one third (35.5%) of contact lens wearers reported ever rinsing their lenses in tap water and 16.8% reported ever storing their lenses in tap water. Almost all rigid wearers (91.3%) reported ever rinsing their lenses in water, and 33.3% of them reported ever storing their lenses in tap water. Nearly one third of contact lens wearers reported having experienced a previous contact lens-related red or painful eye requiring a doctor's visit.
The survey also investigated where respondents purchased their contact lenses. All soft lens categories (daily disposable, planned replacement soft and other) had similar responses (approximately 2/3 purchased from their ECP’s office, the remaining 1/3 either purchased from the internet or a retail store without exam). However, approximately 85% of rigid CL wearers purchased their lenses from their ECP’s office.
In my next column we will review the CDC’s recommendations to reduce the risk for contact lens-associated complications.
Cope JR, Collier SA, Rao MM, Chalmers R, Mitchell GL, Richdale K, Wagner H, Kinoshita BT, Lam DY, Sorbara L, Zimmerman A, Yoder JS, Beach MJ. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections - United States, 2014. MMWR Morb Mortal Wkly Rep. 2015 Aug 21;64(32):865-70.
OCULAR SURFACE UPDATE Katherine M. Mastrota, MS, OD, FAAO
Something to Think About
A couple of years back at an AOA panel lecture on Demodex, time ran short and our panel was unable to include some information on delusional parasitosis (now referred to as delusional infestation). Delusional infestation is a rare and fascinating disorder where affected patients have a fixed, false belief that they have a parasitic infestation.1 These patients sometimes present with scratches or other self-inflicted trauma as they respond to sensations of burrowing or crawling in/under their skin, confounding the psychiatric disorder diagnosis.
Recently, some attention has been given to Demodex and its association with ocular surface disease, blepharitis and skin disorders. Clinicians have been made aware of clinical clues suggesting Demodex mite overpopulation, and treatments and products have been developed to address the clinical concern. Similarly, patients have a wealth of information at their fingertips regarding “mite infestation” that may guide their perceptions and self-diagnosis.
In our dedicated efforts to ease the misery of patients suffering from dry eye/ocular surface disease, we tease away every contributor to the process, including Demodex overpopulation. I urge practitioners to be alerted to the patient who may suffer from delusional infestation and avoid becoming an inadvertent contributor to its pathological process. In upcoming columns I will comment more on the clinical symptoms of the delusional infestation patient.
1. Thakkar A, Ooi KG, Assaad N, Coroneo M. Delusional infestation: Are you being bugged? Clin Ophthalmol. 2015 Jun 2;9:967-70. doi: 10.2147/OPTH.S76420. eCollection 2015.
The purpose of this study was to describe the outcomes of limbal stem cell transplantation in eyes with limbal stem cell deficiency related to soft contact lens wear.
This was a retrospective interventional case series. An institutional database search at the Cincinnati Eye Institute revealed 9 patients (14 eyes) who underwent limbal stem cell transplantation with systemic immunosuppression for soft contact lens wear-related limbal stem cell deficiency. Outcome measures included patient demographics, symptoms, best corrected visual acuity, ocular surface stability, adverse events, and additional surgeries required.
Average patient age at time of surgery was 46.6 ± 11.1 years (range 20 to 60 years). Average duration of follow-up was 28 ± 19.1 months (range 12 to 70 months). Preoperative best corrected visual acuity (BCVA) was 20/40 or worse in all eyes (average 20/70, range 20/40 to 20/250) and patient symptoms included foreign body sensation, tearing, redness and/or pain. Four eyes (29%) underwent living-related conjunctival limbal allograft and 10 eyes (71%) underwent cadaver-donor keratolimbal allograft surgery. Topical and systemic immunosuppression was used in all patients. At final follow-up after limbal stem cell transplantation, there was a stable ocular surface in 12/14 (86%) eyes, and improvement in BCVA to 20/30 or better and complete resolution of patient symptoms in all except one patient who had significant rosacea blepharokerato-conjunctivitis whose BCVA remained at 20/150 and 20/60, in right and left eyes, respectively. The most common adverse event was an increase in intraocular pressure in 8 of 14 (57%) eyes, requiring topical anti-glaucoma treatment. Ten of 14 (71%) eyes underwent cataract extraction related to topical steroid use. No eyes required subsequent penetrating keratoplasty.
The authors concluded that limbal stem cell transplantation is a viable option for the management of soft contact lens wear-related limbal stem cell deficiency in young healthy patients. Early intervention prior to subepithelial fibrosis can lead to good visual outcomes with no need for subsequent cornea transplant. Co-management with a solid organ transplant specialist is helpful for the monitoring and management of systemic adverse events related to patient systemic immunosuppression.
Shen C, Chan CC, Holland EJ. Limbal stem cell transplantation for soft contact lens wear-related limbal stem cell deficiency. Am J Ophthalmol. 2015 Aug 20. pii: S0002-9394(15)00510-3. doi: 10.1016/j.ajo.2015.07.038. [Epub ahead of print]