Of note in our Quick Poll of the month, most practitioners report that, most of the time, they are fitting lenses that they believe are best for their patients—regardless of the rebates available. However, in last month’s Quick Poll (https://www.clspectrum.com/newsletters/contact-lenses-today/august-26,-2018), about two-thirds of practitioners stated that rebates influence them "modestly" to "significantly" when prescribing contact lenses. It is unclear how to reconcile these data points. As always, comments on this are welcome at firstname.lastname@example.org.
Jason J. Nichols, OD, MPH, PhD
October Is Contact Lens Safety Awareness Month
Prevent Blindness has declared October as Contact Lens Safety Awareness Month to educate the public on the best ways to care for their eyes through safe use and care of contact lenses. Prevent Blindness notes that, as Halloween approaches, many people may not be aware that a prescription is required for legal purchase of contact lenses, even for those that are cosmetic (which are popular for Halloween costumes).
Prevent Blindness also notes that the use of contact lenses increases the risk of eye infection, which in some cases can lead to serious vision impairment or permanent vision loss. Therefore, contact lenses should only be used under the direction of an eyecare practitioner.
X-Cel Introduces New Custom Soft Lens Pricing Model and Warranty
X-Cel Specialty Contacts announced a simplified pricing and extended warranty structure for its line of custom soft lenses including all Flexlens and Westcon designs. The new pricing model goes into effect Nov. 1 and consists of two prices (Warranted and Non-warranted) in two categories (Standard and Specialized). Eyecare professionals will no longer be required to purchase an initial lens to purchase the multipack.
In addition, X-Cel’s custom soft lens warranty is being extended to unlimited exchanges within 120 days from the original date of invoice, which gives practitioners an additional 30 days to finalize the fit if needed.
Blanchard Provides Premium Packaging and Patient Care Kit for Onefit Scleral Lenses
Blanchard Contact Lenses has upgraded its packaging for all of the Onefit family of scleral lenses to now include a patient scleral lens care kit and carrying case. Within the silver carrying case, patients will find their lenses in an attractive paper wrap, care and handling information, Menicon’s Lacripure non-preserved saline, and a variety of application and removal devices. The enhanced packaging is automatically provided for Onefit, Onefit MED, and Onefit Asian new orders.
Paul Karpecki Named Lead Optometric Advisor for OcuMedic, Inc.
OcuMedic, Inc., a developer of drug-eluting soft contact lens and clear corneal bandage technology, appointed Paul Karpecki, OD, as the company’s lead optometric advisor and member of its Scientific Advisory Board. His role with the company is in the development of its activities, communications, meetings, and strategies relating to research and product development.
Dr. Karpecki is director of Cornea Services at the Kentucky Eye Institute and recently completed a preceptorship in retina at Retina Associates of Kentucky. He also serves as director for the advanced ocular surface disease clinic at Gaddie Eye Centers in Louisville, KY and is associate professor at the University of Pikeville Kentucky College of Optometry.
FMO Announces Optrafair Exchange
The Federation of Manufacturing Opticians (FMO) announced that Optrafair, the United Kingdom’s flagship optical exhibition, has been officially relaunched and that registration is open. The show is scheduled for Mar. 30 through April 1, 2019 in Birmingham NEC.
In addition to a new theme is a new name—Optrafair Exchange. The show will incorporate fashion, medical, and optics. Each segment will be covered throughout the show, including new exhibitors and dedicated CET streams. A completely restructured education program will be coordinated by the FMO with the support of its partners in the sector. This program covers eight distinct streams: dispensing, contact lenses, orthoptic, refractive, health and lifestyle, technician, clinical optometry, and business. The FMO is working closely with the Association of British Dispensing Opticians, the British Contact Lens Association, The College of Optometrists, and more.
Current support includes Optos and Topcon as platinum sponsors and Heidelberg Engineering as gold sponsor. For more information, visit www.optrafair.co.uk.
Opternative Announces Ability to Route Online Vision Test Results
Opternative, Inc. announced the ability to route a patient’s online vision test results from its platform to a portal where designated eyecare practitioners can review and dispense prescriptions for their own patients.
Instead of Opternative’s network of doctors reviewing all patient results, eyecare providers and eyewear retailers who offer the online vision test can identify the practitioners to review the patients’ results. Designated practitioners are then able to determine the recommended next step for each patient based on the results, a renewed prescription, or a comprehensive eye exam.
Avedro Names Tim Homer Vice President of Health Policy & Market Access
Avedro, Inc. announced that Tim Homer joined the company as vice president of Health Policy & Market Access. Mr. Homer will lead Avedro’s health policy, reimbursement, and government relations activities.
According to the company, his first initiative has been to expand ARCH (Avedro’s Reimbursement Customer Hub) services, including establishing a new field-based team to educate physician offices and payers and to ultimately expand patient access to cross-linking. Mr. Homer has more than 20 years of medical device and health policy experience. Previously, he worked at IRhythm as vice president of Health Policy and Market Access. Prior to IRhythm, Mr. Homer led global reimbursement and market access activities at HeartWare and, additionally, worked in similar capacities at Boston Scientific and Johnson & Johnson.
In unrelated news, Avedro announced that 50 commercial insurance plans now cover Avedro’s FDA-approved corneal cross-linking procedure, following Cigna’s recent announcement that it is covering the Photrexa drug formulations and the KXL System used in the treatment of progressive keratoconus. Other health plans recently initiating coverage include Humana, Blue Cross Blue Shield of Florida, Capital Blue Cross of Central Pennsylvania, Health Alliance Plan of Michigan, Blue Cross Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota, and Priority Health of Michigan.
What unique situations arise in your clinical practice in which contact lens rebates play no significant role in your prescribing? (Please indicate all that would apply for you in this situation.)
This image shows a dendritic ulcer in a patient who has recurring herpes simplex keratitis. This patient was prescribed acyclovir ophthalmic ointment, which eventually resolved the event.
We thank Dr. Romualdez 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
Monitoring Keratoconus Progression and Treatment Outcomes Following Contact Lens or Corneal Ring Segment Treatment
Appropriate monitoring for progression of keratoconus has become of paramount importance since the introduction of treatments that can control or halt progression of the disease such as corneal cross-linking (CXL). Additionally, other treatment modalities implemented for keratoconus management should be evaluated for their potential ability to control disease progression.
A recent published study looked at the use of Scheimpflug-based corneal tomography to monitor disease progression.1 The aim of this study was to compare the pretreatment and post-treatment corneal densitometry and corneal thickness value of keratoconus (KCN) patients managed via contact lenses (CLs) or by both intrastromal corneal rings and CLs. Patients were recruited before treatment and followed for up for 12 months. Data of corneal densitometry and corneal thickness were collected using the Oculus Pentacam at the pretreatment visit and the post-treatment visit at 12 months.
Results indicated that corneal clarity significantly differs between both groups at pretreatment at the 0mm to 2mm zone for the anterior layer (P = 0.002). The same diversity is present at the 2mm to 6mm zone for the anterior layer (P = 0.003) and posterior layer (P = 0.008). The corneal clarity diversity was not statistically significant at 12 months post treatment (P > 0.05). Corneal thickness was statistically significantly different between pretreatment and post-treatment for the CL group for central corneal thickness (CCT) and thinnest area (P = 0.01 and P = 0.02, respectively).
The researchers concluded that KCN management with Intacs was effective in maintaining corneal clarity for a longer time compared to with CLs alone. On the other hand, corneal clarity reduces with disease progression in cases managed with CLs only. Analysis of Oculus Pentacam images provides an objective evaluation to monitor the corneal status after these different pathways of management.
The challenge of finding a consensus as to what measures accurately indicate disease progression or stability in keratoconus is one that continues to be debated. It is a critically important goal that needs to be achieved as soon as possible.
1. Alzahrani K, Cristian C, Harper S, et al. Corneal imaging and densitometry measurements in keratoconus patients to monitor disease progression and treatment outcomes after contact lens or Intacs treatment. Clin Ophthalmol. 2018 Sep 4;12:1653-1658.
OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD
Recently, I examined a 41-year-old male who reported that his eyes were red with a mild discharge, especially the left eye. It was worse in the morning upon awakening and had been occurring for two weeks. His young daughter had been treated with gentamicin solution for “conjunctivitis” approximately one month prior.
Upon examination, the patient’s left eye was mildly, diffusely injected in the cornea without stain and with quiet anterior chambers. Of note, there was nasal conjunctival staining of both eyes. The lower eyelids were lax, with slow snap-back. Nasally, the apposition of the lower eyelids to the globe was poor in both eyes. There was a hint of lagophthalmos in the left eye. A scant discharge was present in the left eye, with a mild papillary reaction and a number of concretions in both eyes. No pre-auricular node (PAN) was palpable. No history of contact lens wear was elicited in this mildly amblyopic anisometropic hyperope.
The patient’s medical history was notable for Alagille syndrome. Alagille syndrome is a genetic disorder that affects males and females in equal numbers. The incidence of Alagille syndrome has been estimated to be approximately 1 in 30,000 to 45,000 individuals in the general population.1 Individuals who have Alagille syndrome usually have distinctive facial features including deeply set and widely spaced eyes, a pointed chin, broad forehead, and low-set eyes. In older individuals and adults, the chin may appear prominent.
Was I looking at an exposure-based dry eye secondary to syndrome-related deep-set eyes in this patient? If so, what was the tipping point for the red eye manifestation?
This was a curious case for me, with a syndrome of which I was not aware. Look to a future issue of Contact Lens Spectrum for a review of the other ocular and systemic manifestations of Alagille syndrome.
Acanthamoeba Keratitis: Confirmation of the UK Outbreak and A Prospective Case-Control Study Identifying Contributing Risk Factors
Acanthamoeba keratitis (AK) is a chronic debilitating corneal infection principally affecting contact lens (CL) users. Studies were designed to test claims that the U.K. incidence may have increased during the 2012 to 2014 time frame and to evaluate potential causes.
For this research, annualized incidence data were collected from Jan. 1984 to Dec. 2016. Case-control study subjects were recruited between Apr. 14, 2011 and Jun. 5, 2017. Reusable CL users who have AK were recruited retrospectively and prospectively. Controls were reusable CL users, recruited prospectively, who have any disorder other than AK. Multivariable analysis of questionnaire data measured independent risk factors for AK.
The results showed that the current outbreak of AK in the United Kingdom started in 2010 to 2011, with an incidence threefold higher than in 2004 to 2009. Risk factors for AK were Oxipol disinfection (note: this product has been phased out by its manufacturer), CLs made of group IV CL materials, poor CL hygiene, deficient hand hygiene, use of CLs while swimming or bathing, being white British, and being in social classes four through eight.
The researchers concluded that AK is a largely preventable disease. The current outbreak is unlikely to be due to any one of the identified risk factors in isolation. Improving CL and hand hygiene, avoiding CL contamination with water, and use of effective CL disinfection solutions or daily disposable CLs will reduce the incidence of AK. In the longer-term, water avoidance publicity for CL users can be expected to reduce the incidence further. Ongoing surveillance of AK numbers will identify changes in incidence earlier. They also noted that evaluation of Acanthamoeba contamination in end-user drinking water would contribute to their understanding of regional variations in the risk of exposure.
Carnt N, Hoffman JJ, Verma S, et al. Acanthamoeba Keratitis: Confirmation of the UK Outbreak And A Prospective Case-Control Study Identifying Contributing Risk Factors. Br J Ophthalmol. 2018 Sep 19. [Epub ahead of print]