Each new season of the year reminds us of change and adaption in our environment or circumstances. Along these lines, we are introducing a new column to Contact Lenses Today titled "Specialty Lens Space" and would like to welcome Karen DeLoss, OD, as our new columnist.
At the same time, we would like to thank Andrew Pucker, OD, PhD, for his previous contributions to our "Care Solution Corner" column in the newsletter. If you enjoyed Dr. Pucker’s approach, look for more from him in 2019 in Contact Lens Spectrum’s "Research Review" column.
As always, we want to acknowledge and thank all of our expert columnists who contribute to both Contact Lenses Today and Contact Lens Spectrum, as they are the key to our ability to bring cutting-edge clinical information to you and your practices.
Jason J. Nichols, OD, MPH, PhD
B+L Launches Expanded Parameters of Biotrue Oneday for Astigmatism Lenses
Bausch + Lomb expanded the parameters of its Biotrue Oneday for Astigmatism daily disposable contact lenses. The full power range now includes sphere powers of +4.00D to –9.00D in three cylinder powers of –0.75D, –1.25D, and –1.75D as well as additional parameters in a –2.25D cylinder.
BCLA to Collaborate on New Course in Ortho-k
Eyecare professionals with an interest in orthokeratology (ortho-k) can take advantage of a new course being launched as part of a collaboration between the British Contact Lens Association (BCLA) and The Hong Kong Academy of Orthokeratology.
The comprehensive Orthokeratology Continuing Education (OKCE) course is expected to feature a range of online and didactic lectures, lab sessions, seminars, and exams. It will share the same 12 learning goals as the exam route OKCE, which is for practitioners who have five or more years of ortho-k practice.
The first 12 delegates (experienced ortho-k practitioners in China) have already begun their studies toward the qualification, which include hands-on laboratory sessions and up to five days attending lab sessions, selected didactic lectures at BCLA conferences, case reports, and taking a written and practical exam.
The BCLA has backed the course and plans to launch an extended global rollout of the content via an online digital platform. The OKCE will count for 10 of the 50 points required for Fellowship status of the BCLA and, together with four case records of suitable standard on myopia control, would achieve the FBCLA [myopic control].
Blanchard Contact Lenses Announces New Account Manager on West Coast
Blanchard Contact Lenses announced that Rachel Behdadnia has joined the company as an account manager for the Western region of the United States. Ms. Behdadnia brings 23 years of experience in the eyecare industry, 13 of which were spent as a director of contact lens services and as a contact lens specialist, with her most recent tenure being at Eye Consultants of Atlanta, PC. There, she managed fitting of all contact lens types, including for keratoconus, corneal transplants, post-refractive surgeries, ocular surface disorders, trauma and eye injuries, orthokeratology, and pediatric patients.
American Academy of Optometry Foundation Announces Award Recipients
The American Academy of Optometry Foundation (AAOF) announced the recipients of several awards.
George Mertz Contact Lens Residency Award (supported by Johnson & Johnson) – Kelsy Steele, OD, MS, The Ohio State University College of Optometry; Erin Tomiyama, OD, University of Houston College of Optometry; Pratik Patel, OD, The Ohio State University College of Optometry; and Emily Wiecek, OD, PhD, New England College of Optometry.
Douglas W. Hopkins Primary Care Residency Award – Dorothy Chou, OD, family practice resident at the University of Houston College of Optometry.
Alfred A. Rosenbloom, Jr., Low Vision Residency Award – Rebecca A. Deffler, OD, clinical instructor at The Ohio State University College of Optometry.
Bert C. & Lydia M. Corwin Residency Award – Celia R. Gong, OD, MS, cornea and contact lens resident at the University of California, Berkeley School of Optometry.
Fredric Rosemore Low Vision Educational Grant – Gregory Hopkins, OD, MS, clinical assistant professor at The Ohio State University College of Optometry.
The Brien Holden Vision Institute Academy will launch a new myopia management course, "Complex Cases," in November 2018. It will follow the original "Managing Myopia" course, which will run again in October 2018.
The online courses are accredited for continuing education points by COPE, the General Optical Council (GOC), Optometry Australia (OA), the Optometrists and Dispensing Opticians Board (ODOB), and the Optometristen Vereniging Nederland (OVN) for practitioners across North America, Europe, and Asia Pacific.
The self-paced, independent learning courses utilize interactive case studies in which practitioners are guided through cases using polls, questions, and videos from global leaders. The Myopia Education Program is available in both English and Spanish (course one only). Early bird enrollment is open until Sept. 14, and attendance is limited. A discount is applied if both courses are purchased together.
Natural Ophthalmics, Inc. Announces New Distributor in Puerto Rico
Natural Ophthalmics, Inc. announced that Advanced Ophthalmic Solutions, a new distributing company started by David Brenes, will be distributing its products in Puerto Rico. Previously, from 1997 to 2018, Mr. Brenes was a Senior Sales Executive with Allergan.
Rahul Patani Promoted to Executive Vice President and Chief Commercial Officer at Euclid Systems
Rahul Patani has been promoted to Executive Vice President and Chief Commercial Officer at Euclid Systems Corporation. According to the company, Mr. Patani will utilize his extensive experience in general management and global marketing to help Euclid improve the lives of patients managing their nearsightedness without the use of glasses, contact lenses, or laser-assisted in situ keratomileusis (LASIK) surgery.
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 20-year-old female in orthokeratology lenses that was taken with a Burton lamp while she was in the supine position. This tool/position combination allows practitioners to further evaluate orthokeratology lens fit and centration.
We thank Dr. Lee 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.
SPECIALTY LENS SPACE
Karen DeLoss, OD
Be in Control
Specialty soft contact lenses have increased in popularity over the last few years as a viable option for hard-to-fit patients. Soft lenses for keratoconus are an option for patients that can provide the comfort of a soft lens with the ability to correct vision on an irregular cornea. In addition, specialty soft lenses for keratoconus can further improve quality of vision with aberration control.
Custom-made soft contact lenses afford advantages to patients in that they are easy to prescribe, offer improved comfort, and can be reasonably priced.1 Custom-made soft lenses are based on wavefront aberrometry that reduces vertical coma, which commonly impacts vision in keratoconus patients.2 Studies have shown that correction of this higher-order aberration can significantly improve visual performance in this patient population.3
The diameter of these lenses can vary from 14.0mm to 15.0mm (and beyond), with base curves from 5.6mm to 8.6mm. Spherical powers are well within commonly prescribed parameters, ranging from –30.00D to +30.00D, and cylinder options are available up to –10.00D in a wide range of steps. Modulus can be varied in thickness to further aid patient comfort. With several designs available, eyecare providers have a wide array of options for these patients.
In addition, the increasing popularity of corneal cross-linking allows for early intervention, which may lead to a larger population of mild-to-moderate keratoconus patients for whom soft lenses for keratoconus may be an option for a longer period of time.4
While GPs remain the gold standard for keratoconus and scleral lenses have increased in popularity, it is important to remember that the custom soft modality is also a viable option for patients and has many attributes that may allow a successful fit by practitioners and a successful outcome from the patients’ perspective.
1. Suzaki A, Maeda N, Fuchihata M, Koh S, Nishida K, Fujikado T. Visual Performance and Optical Quality of Standardized Asymmetric Soft Contact Lenses in Patients with Keratoconus. Invest Ophthal Vis Sci. 2017 Jun 1;58:2899-2905.
2. Kosaki R., Maeda N, Bessho K, et al. Magnitude and orientation of Zernike terms in patients with keratoconus. Invest Ophthal Vis Science. 2007 Jul;48:3062-3068.
3. Marsack JD, Parker KE, Applegate RA. Performance of wave-front guided soft lenses in three keratoconus subjects. Optom Vis Sci. 2008 Dec;85:E1172-E1178.
4. Hernriquez MF, Villegas S, Rincon M et al. Long-term efficacy and safety after corneal collagen crosslinking in pediatric patients: Three-year follow-up. Eur J Ophthal. 2018 Jul;28:415-418.
MATERIALS & DESIGNS
David L. Kading, OD
Go Away Computer—You Are Burning My Eyes
The battle against digital devices continues. They just don’t seem to give up. Right now, most of you are reading this on smartphones. Correspondingly, you are blinking far less than if you were doing another non-digital activity. Along with less blinking comes partial blinking. Contact lens materials require a smooth surface to maintain quality vision and comfortable wear, but when soft lenses dry, it is far less likely that ideal lens wear can be achieved.
When approaching the topic of contact lens comfort with patients, it is always important to analyze the lens material being used. Keeping patients in the best lens material will always aid the wettability, vision, and comfort. However, if practitioners are making continual changes and the lens surface remains dried from exposure throughout the day, they are fighting an uphill battle.
The dry eye literature talks about the blink and the effect of digital devices. If practitioners want to change a blink, they need to educate their patients. Have conversations about visual hygiene. Although they may not be met with 100% compliance, talking to patients about taking visual breaks every 20 minutes may help move them in the right direction. Additionally, tell patients that it is a good idea to blink purposefully several times an hour—not a hard-squeezed blink, but a normal, thought-out blink. This simple solution has helped several of my contact lens patients regain comfortable lens wear.
Recommending a new lens and/or modality is always in the best interest of lens wearers, but keep in mind that a little exercise can go a long way toward helping keep the lens moist and wettable throughout the day.
Level of Compliance in Orthokeratology
The purpose of this study was to investigate the level of compliance with orthokeratology (ortho-k) guidelines and the main behaviors of poor compliance to guide clinical care.
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 January 2013 and have worn ortho-k lenses for more than one year 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); 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.
Oxygen/metabolite transport calculations for open-eye scleral lens wear show that typical PoLTF thicknesses fitted by clinicians (i.e., PoLTF thicknesses < 400 µm) with modern scleral lenses (i.e., oxygen Dk/L > 25 hBarrer/cm) produce corneal swelling of less than 2% in agreement with the experiment. Therefore, the researchers determined that scleral lenses prescribed today evoke less than physiological hypoxic swelling (i.e., less than 4%) for healthy corneas during open-eye wear. Closed-eye wear, however, appears clinically unsafe.
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.
Jun J, Zhiwen B, Feifu W, Lili L, Fan L. Level of Compliance in Orthokeratology. Eye Contact Lens. 2018 Sep;44(5):330-334.